Status of Thiamin deficiency in boarding school children from seven districts in Bhutan with previous history of peripheral neuropathy outbreaks: a cohort study

Abstract

Introduction: Peripheral neuropathy outbreaks have been a common occurrence amongst boarding schoolchildren from seven districts in Bhutan. Thiamin deficiency has always been suspected to be the cause but the status of the vitamin has never been established. This study aims to find the status of thiamin and dietary intake of micronutrients in boarding schoolchildren from seven districts with previous history of peripheral neuropathy outbreaks.
 Methods: Whole blood thiamin and dietary intake of micronutrients were assessed in 448 school children for four study periods (SP). Baseline data (SP1) was collected when the school children just joined the school at the start of the school academic year. SP2 was the first half of the school year and the data was collected just before the midterm break. SP3 was the short summer break and SP4 the second half of the school academic year.
 Results: 50.58% of the school children were found to be thiamin deficient at baseline which increased to 90.1% in SP2. The percentage of thiamin deficient school children increased to 91.8% in SP3 and then decreased to 79.82% in SP4. The requirements for vitamin B1, B12, vitamin A and iron were never met by dietary intakes in all the study periods.
 Conclusions: In conclusion, this study found a high prevalence of Thiamin deficiency in schoolchildren at baseline and the number of school children with Thiamin deficiency increased when in schools. The school children also had inadequate dietary intake of many micronutrients.

Outbreak of oral ulcers (glossitis) among the students of three central schools under Tsirang district Bhutan, 2018

“…This is further supported by the nutritional analysis which shows low intakes of all vitamin containing foods in the schools. Previous studies conducted among the boarding schools in Bhutan reported the lack of thiamine and cobalamin among the students [ 17 , 18 ]. The findings from this study suggests similar underlying nutritional deficiency in affected schools.…”

Infantile thiamine deficiency in South and Southeast Asia: An age‐old problem needing new solutions

“…Cases of infantile beriberi occurred in exclusively breastfed infants of mothers who consumed thoroughly washed white rice and followed post‐partum dietary restrictions. A number of outbreaks of thiamine deficiency have been documented among boarding schoolchildren in Bhutan in recent years (Dzed et al 20152018).…”

Vitamin B12 Deficiency among Boarding School Children from Seven Districts of Bhutan

“…A recent study from India reported that 32% of the healthy school children are deficient in vitamin B12 which was even more pronounced in the rural areas and in school children who had poor dietary intakes [10] . Bhutanese school children are also vulnerable to the deficiency of this vitamin as outbreaks of micronutrient deficiency diseases have been a common occurrence [11,12] . The causes of these outbreaks in the Bhutanese school children have been attributed to poor dietary intakes of micronutrient rich foods, including animal source foods [11] .…”

“…Bhutanese school children are also vulnerable to the deficiency of this vitamin as outbreaks of micronutrient deficiency diseases have been a common occurrence [11,12] . The causes of these outbreaks in the Bhutanese school children have been attributed to poor dietary intakes of micronutrient rich foods, including animal source foods [11] . Therefore, it is very plausible that vitamin B12 could be very much deficient among the school children of Bhutan.…”

“…In 2014, a study to assess the status of thiamin deficiency among boarding school children was conducted in seven districts of Bhutan that had previous history of micronutrient deficiency disease outbreaks [11] . During the study, serum vitamin B12 was also measured, and therefore this study presents the status of vitamin B12 deficiency among boarding school children from those seven districts.…”