Early November, saw many students suffering from oral sores affecting mostly the tongue were reported in four Central Schools (CS) in Minjiwoong Central School under Samdrup Jongkhar, Dorokha Central School in Samtse and two central schools in Tsirang.
After sending the samples to Royal Center for Disease Control (RCDC), it was confirmed that students were affected from Glossitis, an inflammation of tongue which is mainly due to nutritional deficiencies, protein-calorie malnutrition, and pernicious anemia.Any form of glossitismay appearas a result of early signs of nutritional deficiency.
Minjiwoong Basic Health Unit (BHU) has received 121 such cases so far with at least 10to 20 students in a day. The BHU health assistant, Tshering Jamtsho said that although the number has decreased now, the cases received were highest compared to previous cases.
The hospital team along with the officials from dzongkhag visited the school to raise awareness about the disease. “Though the disease is not contagious, we had ten to twenty cases a day” he said and all were students.
“The outbreak occurring in such a clustered environment where large groups of students areliving together indicates common underlying causes,” he said. He said the cases are believed to be due to lack of vitamin B12 and nutrition deficiencies. The hospital provided vitamin supplements to students.
The school principal said the school has sent the report to Nutrition Division of Ministry of Education. “We are finding out the cause though the condition is much better now,” said the principal.
The same week, Dorokha BHU has also seen about 40 cases of glossitis, which were confirmed by RCDC.
The first case of glossitis among students in Tsirang emerged in the early weeks of September around two months ago with about 200 cases being reported from two central schools in Tsirang dzongkhag. One of them is Damphu CS and the other is Tsirangtoed CS. The investigative report compiled collectively by the concerned agencies from Dzongkhag, Ministry of Education,Ministry of Health and RCDC found out that almost all the affected were due to lack of vitamin rich dietary intakes and it also associated with low levels of iron folate in their diet as per the dietary analysis.
The team comprised of a Senior Program Officer from School Health and Nutritional Division, MoE, Senior ProgramOfficer from Nutrition Program from MoH and Field epidemiologist from RCDC and District Health Rapid Response Team (DHRRT).
The investigation of the two school in Tsirang showed that symptoms in almost all the students were a painful tongue with burning sensation, impaired taste and intolerance to spicy food which was diagnosed as glossitis.
“From the typical day 24-hour recall from the cases as analyzed by the dieticians it was found that the diet on that particular day did not meet the recommended daily allowance for vitamin B1, B2, B3, B5, B6, B9, B12 and iron which were deficient among students,” said the report.
From the foodfrequency questionnaire,it was found thatno varieties of vegetables were provided to students with only the same types of vegetables being repeated in every meal and that most of the female students were found to have unhealthy habit of skipping meals. “From the questionnaire, it was noticed that no other vitamin B12 containing food were given to vegetarian groups,” states the investigation report.
The study highlighted the need for monitoring and following up, inclusive balanced diets with green and leafy vegetables and advice to the school authorities to encourage students to minimize the unhealthy habit of consuming junk food and carbonated drinks.