Mass screening in all schools started after the recent outbreak of Glossitis

Affected students have recovered

After the outbreak of Glossitis in some schools in the country, the Ministry of Education (MoE) has started a mass screening of glossitis in all the schools, irrespective of feeding and non-feeding schools.

Bhutan has been experiencing sporadic outbreaks of micronutrient deficiency over the years, the most prominent being the thiamine deficiency, beriberi. These outbreaks were mostly observed in schools and monastic institutes.

After the discussion with a wide array of professionals including experts in medicine, nutritionist, public health, education officials and development partners, MoE developed a protocol for management of oral lesions and peripheral neuropathy.

Currently, the rice provided in schools is fortified with Vitamin A, B1, B3, B9, B12, iron, and zinc. MoE indicates that outbreaks of peripheral neuropathy in the past have greatly reduced since the introduction of fortified rice.

However, since the beginning of 2018, MoH and MoE observed outbreaks of oral lesions from boarding schools across Bhutan.  Although the subsequent investigations could not establish the cause of the outbreak, the symptoms improved with Vitamin B-Complex supplementation.  Vitamin B2 (riboflavin) is a major component of the B-Complex tablet is missing in the fortified rice provided in schools. Thus B2 deficiency is widely suspected to be the likely cause of the recent outbreak.

Chief Program Officer of School Health and Nutrition Division (SHND) of MoE, Karma Wangchuk, said the government provides fortified rice and fortified oil in all the government-feeding schools. The recent outbreak of glossitis in some schools might be due to the missing of Vitamin B2 and B-Complex.  Currently, the team is investigating the glossitis outbreak and for time being children is given Vitamin B2 supplement and they are recovering from glossitis.

Earlier, MoE suspected that the outbreak must have been due to climatic conditions, but this was proven wrong when the children reported glossitis in Trashiyangtse. He said even the relocated students from Phuentsholing in Wangdue has reported cases of glossitis.

The ministry is seeking help from medical experts. Most probably from next year, the ministry hopes that there will not be more glossitis cases unlike this year, said Chief Program Officer.

The chief said the ministry has requested BAFRA to visit the ration stocks and checked the quality of rations in the schools where the outbreak of glossitis reported.

A nutritionist, Kunzang Deki, said the affected students who are taking Vitamin B2 supplement have already recovered from glossitis.

As per the record maintained by SHND, Senior Program Officer, Choening Sherub, said roughly around 544 students were reported with glossitis in 2021, mostly from the feeding schools. Around 9 schools, Tsenkharla Central School (CS), Rangjung CS, Yebilaptsa CS, Buli CS, Baylling CS, Tashitse CS, Zemgang CS, Kuenzangling CS and Tsirangtoe CS have reported cases of glossitis. Rangjung CS has reported the highest number of glossitis cases with 113 students being affected.

Meanwhile, MoE has already sensitized in all the schools on glossitis. All schools and institutions have to screening for oral lesions and symptoms of peripheral neuropathy twice a year.  During the screening, the concerned school authorities should inform the nearest health facilities, DEO, TEO, and any other concerned authorities for outbreak verification. The affected students are to be sent to their nearest health facility for individual treatment. The school authorities are to remain vigilant and screen for cases constantly, and report to the nearest health facility for intervention. Mass screening is recommended at any point in time if the school experiences an outbreak.

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