They believe eight to 10 deaths were associated with measles, roughly another 10 with malaria, with several children suffering more than one infection. The precise cause of every death is less certain.Total 32 children have so far been died
Vaccination became an emergency response. Although official records suggested 90-95% coverage in some areas, health workers found children without records and families reluctant to vaccinate.
Authorities therefore offered the measles-rubella (MR) vaccine to all children under 15, regardless of recorded status. Of about 40,000 children identified in Birsa, roughly 27,000 had been vaccinated, Gautam said. Of the area's 180 villages, some 67 are predominantly Baiga and among the most vulnerable.
But vaccination is only one part of the protection children need. There are wider questions about whether basic nutrition and other health services are reaching those most at risk.
A 2024 audit by India's Comptroller and Auditor General found "serious irregularities" in Madhya Pradesh's distribution of take-home rations meant to supplement the diets of children aged six months to three years, pregnant women and lactating mothers, including problems with beneficiary identification, production, transport and distribution.
The outbreak has now subsided. Officials say the last child death was more than two weeks before their late-September assessment, while teams continue visiting villages. In Kundekasa, a medical camp that once saw about 120 children a day was seeing fewer than 10.
Back in Matla, Bamita's mother speaks about the child who would ask for money for snacks, play with her sister and run inside whenever cars approached because vehicles frightened her."I had hope she'd study and make something of herself. I never regretted I didn't have a boy," Koushila says.Then she looks at Ankita, the surviving sister.
"I want more kids," she says. "I feel alone. Ankita is alone. She keeps crying for her sister."
Parte is a landless farm labourer who earns about 200 rupees ($2; £1.58) on a good day, he said. Work is scarce in the monsoon, and although a small primary health centre is just 5km away, he had never been there. Poverty and remoteness had stacked the odds against his children.
The question of what was making children sick became harder to answer as the deaths mounted.
An investigation by the ICMR-National Institute for Tribal Health Research (NIRTH) tested 10 samples collected from the affected villages on 7 August. Six tested positive for measles; four were negative.
Measles is highly contagious, causing high fever, cough, runny nose and red, watery eyes, followed by a rash. Most children recover, but malnutrition can make measles far more dangerous, increasing the risk of pneumonia, severe diarrhoea and dehydration, and inflammation of the brain. The infection also weakens the immune system, leaving children vulnerable to other infections. Malaria can compound that risk.
But doctors cautioned that malaria did not necessarily follow measles, and not every fever and rash was measles. Instead, several infections and vulnerabilities collided.
Anahita Sachdev/BBC Two women and two children sitting on the floor of a medical camp in a village in India's Madhya Pradesh. The children have bandages on their hands where they were given a dripAnahita Sachdev/BBC
Sick children were brought to a health camp in Kundekasa village during the outbreak
"Sometimes there is no single factor behind the deaths," Gautam said. "There are malnourished children and there's zero health education and hygiene at home."
The Baiga villages are not entirely disconnected from modern India. Seasonal migration takes families to other states for chilli picking and other work. Children watch reels on smartphones, while many families have minimum single-bulb solar-powered electricity, bank accounts and, in some homes, piped water.
Yet malnutrition remains widespread, with children often poorly fed. A five-year-old who died recently of measles weighed around 5kg.
Gautam believes malnutrition is driven by early marriage and motherhood, with some girls becoming mothers at 16 or 17, when their bodies are still developing.
Closely spaced pregnancies, premature births and low birth weight can follow, while young mothers struggle to breastfeed and care for their children. Diet is another problem: many families rely heavily on rice and lentil soup, with too little protein and dietary variety. Studies on Baiga households have found widespread nutritional deficiencies, compounded by poor uptake of public services.
The gap between services on paper and on the ground was stark: the state response came weeks after deaths began, while health teams struggled to reach and persuade families.
Anahita Sachdev/BBC A woman and two children standing near the doorway of a dilapidated hut in a village in India's Madhya PradeshAnahita Sachdev/BBC
Malnutrition remains widespread among children in Balaghat's Baiga community
Once the outbreak was recognised, health workers began door-to-door screening in affected villages. Mobile medical units carrying oxygen, nebulisers, suction equipment, malaria tests and medicines visited more than 20 affected villages.
One mobile doctor, Neeraj Sharma, says teams routinely saw more than 50 patients a day, about half of them children. They conducted 10 or more malaria tests daily, sometimes finding two positive cases a day.