WHO Bhutan

Health Information

National Nutrition Program

National Nutrition Programme was launched in 1985

Source: National Nutritional Program, Haemoglobin study in the school children aged 5-15 years

Anaemia in School Children aged 5-15 years, 2001

Hb = Haemoglobin

Remarks:

In 1985 a sample of 561 pregnant women, 550 pre-school children, 266 school children and 40 men found a 60% prevalence of anaemia in pregnant women (Hb>11gms/dl), 58% in pre-school children, 36% in school children and 35 in men.

Source: Sood, SK and Sharma, S, Occurrence and Causes of Nutritional Anaemia in Bhutan.

Protein Energy Malnutrition (PEM)

The immediate cause of PEM is a combination of low dietary intake, inadequate childcare and a high incidence of infections. Non-exclusive breast-feeding and inadequate complementary feeding contribute to faltering growth in young children. Anaemic and undernourished women on becoming pregnant has an increased risk of delivering low birth weight babies and dying during delivery.

Region-wise percentage Malnourishment by indicators, 1989

Source: Report on the National Nutrition Survey, Bhutan, 1989

Percentage Malnourshment by Indicators, 1988 and 1999

Source: 1999 Nutrition Survey

Namgyal, P and Yoezer, N, Nutritional status of Bhutanese Children, result of an Anthropometric Survey, 1999

Namgyal, Pem, Low Birth - Is it a problem in Bhutan ? 1998

Low Birth Weight

A child is defined as having low birth weight if it weighs less than 2,500 grams. With the weight being taken within 24 hours of delivery. LBW is a good indicator of the nutritional status of the mother as well as the likely future nutritional status of the child.

In 1998 a study based on a sample of 5,936 deliveries at the National Referral Hospital, Thimphu indicated that 13.5% of babies were categorized as having LBW with individual weights of less than 2,500 grams. WHO recommends 15% as the prevalence rate at which LBW would be viewed as public health concern. Bhutan is just inside that threshold. As the study was done at the National Referral Hospital, Thimphu, the results are not representative of the country as a whole.

Source: Namgyal, Pem, Low Birth weight - Is it a problem in Bhutan? 1998

Iodine Deficiency (ID)

Iodine deficiency occurs when iodine intakes are less than physiological requirement (about 150 micrograms daily per person) over a long period.

The prevalence of Iodine deficiency disorders (IDD) has been significantly reduced through the commercial distribution of iodized salt. The first nation wide IDD assessment in 1983 found the total goiter rate (TGR) to be 64.5% and salt iodization almost nonexistent. In 1984 the Iodine Deficiency Disorder Control Program (IDDCP) was established with five major components including salt iodization and distribution, administration of iodized oil injections, monitoring of iodine content in salt, internal evaluation of the program and community level education.

A salt iodization plant (SIP) was set up in 1985 in Phuentsholing as one of the key measure to combat IDD. As a result of these interventions, the second nation-wide study undertaken in 1991-92 found that the TGR had fallen to an average of 25.5% and iodized salt coverage averaged 95.8%.

A 1996 report found the total goiter rate among school children aged 6 to 11 years to be 14%, salt iodization close to 100% and iodized coverage at 82%.

Summary of milestones in the campaign against IDD

Source: Tracking Progress Towards Sustainable Elimination of IDD in Bhutan, 1996, RGoB, ICCIDD, AIIMS, UNICEF Bhutan, WHO SEARO and the Micro-Nutrient initiative, Canada

Vitamin A Deficiency (VAD)

VAD occurs when the body stores of vitamin A are depleted to the extend that physiological functions are impaired. Depletion occurs when the diet contains, over a long time, too little vitamin A to replace the amount used by tissues koir for breast feeding.

Sub-clinical vitamin A deficiency in children has been reported by various surveys in Bhutan. A 1985 study covering 134 pre-school children estimated that 14% were deficient in vitamin A. In 1989 a clinical examination of 3,273 children aged 0-60 months found that 99.3% showed no clinical evidence of xerophthalmia although no serum retinal estimated were made at the time.

A 1999 study involving 975 children aged 12-60 months and 173 pregnant women concluded that clinical vitamin A deficiency was not seen in Bhutan either in children or pregnant women and that while sub-clinical vitamin A deficiency still existed (2.6%) but was not considered to be a public health problem.

Source:

     Sood, SK and Sharma, S, Occurrence and Causes of Nutritional Anaemia in Bhutan.

     National Health survey, 1989; Namgyal, P, Gyeltshen, K and Tenzin, N, Survey for Vitamin A deficiency in Children under Five.

Comparative summary of selected indicators of nutritional status