Children In Bhutan Research Articles

Knowledge, attitude and practice of caries prevention in children among Bhutanese oral health professionals.

Dental caries remains prevalent among children in Bhutan, despite an increasing number of oral health professionals (OHPs). Insights into caries preventive practices among OHPs can identify areas for capacity building. This cross-sectional descriptive study assessed the knowledge, attitude and practice of caries prevention in children among OHPs in Bhutan. A self-administered online questionnaire was sent to all active registered OHPs. The respondents included 73 dentists and 61 dental hygienists (88% response rate) with a mean experience of 8.4 ± 7.1 years. Many practitioners rarely saw children; most of them, however, exhibited a positive attitude towards caries prevention in children, yet lacked knowledge and practice, especially in younger children. Caries risk factors were not all recognized, and assessment was not practised. Many forms of fluoride were available, but their efficacy was underestimated. Fluoridated toothpaste was underutilized in younger children. Preventive practice relied mainly on giving advice. The most common limitations on preventive practice were the unavailability of materials and treatment prioritized over prevention. Caries prevention in Bhutanese children requires a systematic approach in the oral healthcare system and further education of OHPs. Proactive strategies, time management and efficient distribution of preventive materials could promote better practice.

Review on Effect of Nutrition during Flood on Children

Purpose: Nepal is a highly disaster-prone country, experiencing earthquakes, floods, landslides, drought, hot and cold waves, and vector-borne diseases on a regular basis. Monsoonal floods and landslides affect the most vulnerable communities in the hills and plains every year. The paper is aimed to review the effects of nutrition during floods on children. Design/Methodology/Approach: It is a review-based study. In this review, the researcher attempts to recommend a pragmatic solution for the time being through the systematic literature. The researcher uses deductive logic reasoning at large during the review. In-depth archival analysis followed by an intensive review would be strategies adopted during the scientific review. Findings/Result: The floods affected children, mothers’ and elders in Nepal. June to September is the main monsoon month in Nepal. Floods damage houses, foods, agricultural crops, livestock, poultry, and cloth. Floods affect the Terai area of Nepal. There is found floods affected 3-5 years children in Bhutan, Bangladesh, Bhutan, India, and Nepal. At the flooding time floods damage houses, food, crops, livestock, and cloths. In Nepal all the family members’ victimised time more vulnerable found mothers, children and elders. June to July summer time floods affect more in the Terai districts children nutrition. It is needed to do research study in seven provinces of Nepal. Central, Province, and Local government allocate special funds for flooding victim children, mother, and elders. Originality/Value: The paper provides pragmatic solutions to the effect of the disaster on Children's nutrition status which might be the foundation for a healthy society overcoming the issue of flood in Nepal. Paper Type: Review paper

Oral Health Status of 3- to 5 -Year-old Children Attending Early Childhood Care and Development Centers in Bhutan: A Pilot Study

Introduction: Early Childhood Caries (ECC) is a common childhood dental disease worldwide. To date, dental disease prevalence in children in Bhutan is unknown. Objectives: This study was conducted to estimate the prevalence of early childhood caries and its modifiable risk factors. Methods: We conducted a cross-sectional survey in 3-5-years old children attending Early Childhood Care and Development Centers in Bhutan. Mouth examination recorded teeth with decay (d), missing due to decay (m) and filled (f), to calculate caries experience (mean dmft and standard deviation=SD). Parents and caregivers were interviewed about their children’s oral health status, oral hygiene practices and diets among others. The prevalence of modifiable risk factors for disease was described based on parental responses. The association between decay and selected sociodemographic characteristics and oral health variables were investigated with bivariate analyses (X2). Results: Overall, 80.5% children had caries experience with mean dmft + or - SD (4.9 + 4.2). In fact, 79.9% had untreated decay. Only few had fillings as an evidence for availing dental care with mean filled 0.2 (SD=0.7). The percentage of decay increased significantly as maternal education increased and with low socioeconomic status (p=0.02). Conclusions: Early Childhood Caries are highly prevalent in Bhutan. Very few young children sought dental care. We recommend engaging relevant stakeholders in efforts to promote dental care and educate parents to use fluoridated toothpastes.

Knowledge and Perception of Rabies among School Children in Rabies Endemic Areas of South Bhutan.

Rabies is endemic in southern Bhutan and children are the frequent victims of dog bites. We surveyed the knowledge, attitude, and practices on rabies among school children in three schools located in southern Bhutan. A total of 701 students (57.9% female, 42.1% male) with an age range of 12–21 years (mean: 15 years) participated in the survey, of which 98.2% had heard about rabies. Most of the students demonstrated a good level of knowledge (59.7%) and a favorable perception towards rabies (57.7%). Multivariable logistic analysis revealed the relation between knowledge and the awareness campaign (OR:1.5, 95% CI: 1.1–2.1). Similarly, higher grades of students (OR:1.9, 95%CI: 1.3–2.9) and employed mothers of the students (OR: 1.6, 95% CI: 1.0–2.7) were associated with more favorable perceptions. However, some knowledge gaps were identified in this study, such as students not being able to clearly mention the susceptible hosts of rabies, transmission routes, clinical signs, and prevention and control options. Therefore, regular awareness programs on rabies are necessary among school children in Bhutan.

SASP: A School-Based Structured After School Program to Reduce Childhood Obesity of Primary School Children inBhutan

Childhood obesity has become a growing issue in Bhutan and it poses impending challenges. There are lots of preventable diseases and negative social impacts associated with obesity. Bhutan has no structured intervention in place and the increase in sedentary behavior is escalating the global epidemic. Incorporating physical activities in the school routine can bring positive outcomes since there is strong relationship amongst obesity, sedentariness and physical activity. This paper discovers that children are motivated to be obese because schools and communities do not provide platforms for children to be active. Schools need to provide a platform for children to be active and after school hours can be the best period. Hence, the paper argues and concludes that a School-based Structured Active After School Program (SASP) can reduce obesity and regulate sedentary behavior of Bhutanese children. Since programs like SASP are new to Bhutan, the paper reviews various literature from leading journals and other relevant sources that report on childhood obesity, sedentary behavior, after school programs et al. Nonetheless, Childhood obesity cannot be solved overnight. So future research is required to study the impact and advance accordingly. Nutrition related program should be included in future to improve the outcome.

Visual impairment andrefractive error in school children in Bhutan: The findings from the Bhutan School Sight Survey (BSSS 2019).

To estimate the nationwide prevalence of visual impairment and associated refractive error in school children in Bhutan. The sample of this prospective cross-sectional national survey comprised of randomly selected classes in levels IV-IX (age 10 to 15 years) from schools throughout Bhutan. The examination included measurement of visual acuity (VA), evaluation of ocular motility, refraction under cycloplegia, examination of the external eye, media and fundus. The principal cause of impairment was determined for eyes with uncorrected VA ≤6/12. The main outcome measures were distance VA and cycloplegic refractive error. With a sampling frame of 1967 class-based clusters from 190 schools, 160 classes in 103 schools were randomly selected; 4985 (98.5%) of 5060 enumerated children were examined. The prevalence of uncorrected, presenting, and best-corrected visual impairment (VA≤6/12) in the better eye was 14.5%, 12.8%, and 0.34%, respectively. Refractive error was the principal cause (94.2%) of impaired vision and 88% of children who could achieve VA ≥6/9 with best correction were without necessary spectacles. The prevalence of myopia (≤ -0.5 D) was 6.64% and was associated with female gender (P = 0.004), urban schooling (P = 0.002), and greater parental education (P<0.001). The prevalence of hyperopia (≥ +2.0 D) was 2.17% and was significantly associated with lower class-level (P = 0.033), and female gender (P = 0.025). The overall prevalence of astigmatism (≥ 0.75 D) was 9.75%. Reduced vision because of uncorrected refractive error is a public health problem among school-age children in Bhutan. Effective school eye health strategies are needed to eliminate this easily treatable cause of visual impairment.

Assessment of a neuro-developmental screening tool in children in Bhutan.

Background: Developmental screening tools are designed to fit the cultural context in which they are utilized, yet often find a wider international audience. This study evaluates the efficacy of one such tool, the Parental Evaluation of Developmental Status: Developmental Milestones (PEDS:DM), developed in the United States and tested in the lower income Asian country of Bhutan. We aimed to test the PEDS:DM instrument to measure neurodevelopmental delay in children in Bhutan. Methods: In total, 96 community-dwelling Bhutanese children (3-7 years old) without diagnosed neurocognitive conditions were recruited from ambulatory clinics in urban Bhutan in 2016 as part of a larger study on retinal imaging and cognitive and growth parameters. Scoring was based on neurocognitive domains (gross and fine motor, receptive and expressive speech, self-help, social-emotional). Rates of failure (meant to indicate delay) within domains were calculated. Results: Modifications of some standard questions were deemed necessary by the study staff to suit the cultural context, such as replacing kickball with football in a question regarding games played with rules to maintain local relevance. In a modified PEDS:DM test with these improvised modifications, the mean percentage of age-appropriate domains failed was 58.8% and the mean percent delay was 12.3% (range 0-41.4%, available in n=83). The highest prevalence of failures was 59.4% for receptive language and 76.3% for expressive language, much higher than the lowest rate of failure seen in self-help (5.4%). Conclusions: The PEDS:DM requires further modifications and validation studies before it can be reliably implemented to assess developmental delay in children in Bhutan. In this pilot study, the rate of delay as reported by the PEDS:DM would be scored as markedly elevated, especially when compared to available epidemiologic studies in the region.

Assessment of a neuro-developmental screening tool in children in Bhutan

Background: Developmental screening tools are designed to fit the cultural context in which they are utilized, yet often find a wider international audience. This study evaluates the efficacy of one such tool, the Parental Evaluation of Developmental Status: Developmental Milestones (PEDS:DM), developed in the United States and tested in the lower income Asian country of Bhutan. We aimed to test the PEDS:DM instrument to measure neurodevelopmental delay in children in Bhutan. Methods: In total, 96 community-dwelling Bhutanese children (3-7 years old) without diagnosed neurocognitive conditions were recruited from ambulatory clinics in urban Bhutan in 2016 as part of a larger study on retinal imaging and cognitive and growth parameters. Scoring was based on neurocognitive domains (gross and fine motor, receptive and expressive speech, self-help, social-emotional). Rates of failure (meant to indicate delay) within domains were calculated. Results: Modifications of some standard questions were deemed necessary by the study staff to suit the cultural context, such as replacing kickball with football in a question regarding games played with rules to maintain local relevance. In a modified PEDS:DM test with these improvised modifications, the mean percentage of age-appropriate domains failed was 58.8% and the mean percent delay was 12.3% (range 0-41.4%, available in n=83). The highest prevalence of failures was 59.4% for receptive language and 76.3% for expressive language, much higher than the lowest rate of failure seen in self-help (5.4%). Conclusions: The PEDS:DM requires further modifications and validation studies before it can be reliably implemented to assess developmental delay in children in Bhutan. In this pilot study, the rate of delay as reported by the PEDS:DM would be scored as markedly elevated, especially when compared to available epidemiologic studies in the region.

Assessment of a neuro-developmental screening tool in children in Bhutan

Background: Developmental screening tools are designed to fit the cultural context in which they are utilized, yet often find a wider international audience. This study evaluates the efficacy of one such tool, the Parental Evaluation of Developmental Status: Developmental Milestones (PEDS:DM), developed in the United States and tested in the lower income Asian country of Bhutan. We aimed to test the PEDS:DM instrument to measure neurodevelopmental delay in children in Bhutan. Methods: In total, 96 community-dwelling Bhutanese children (3-7 years old) without diagnosed neurocognitive conditions were recruited from ambulatory clinics in urban Bhutan in 2016 as part of a larger study on retinal imaging and cognitive and growth parameters. Scoring was based on neurocognitive domains (gross and fine motor, receptive and expressive speech, self-help, social-emotional). Rates of failure (meant to indicate delay) within domains were calculated. Results: Modifications of some standard questions was deemed necessary by the study staff to suit the cultural context, such as replacing kickball with football in a question regarding games played with rules to maintain local relevance. In a modified PEDS:DM test with these improvised modifications, the mean percentage of age-appropriate domains failed was 58.8% and the mean percent delay was 12.3% (range 0-41.4%, available in n=83). The highest prevalence of failures was 59.4% for receptive language and 76.3% for expressive language, much higher than the lowest rate of failure seen in self-help (5.4%). Conclusions: The PEDS:DM requires further modifications and validation studies before it can be reliably implemented to assess developmental delay in children in Bhutan. In this pilot study, the rate of delay as reported by the PEDS:DM would be scored as markedly elevated, especially when compared to available epidemiologic studies in the region.

Nutritional status and risk factors for stunting in preschool children in Bhutan.

Childhood malnutrition remains endemic in South Asia, although the burden varies by country. We examined the anthropometric status and risk factors for malnutrition among children aged 0–59 months through the 2015 National Nutrition Survey in Bhutan. We assessed in 1,506 children nutritional status (by z‐scores of height‐for‐age [HAZ], weight‐for‐height [WHZ], and weight‐for‐age [WAZ]), estimating prevalence, adjusted for survey design, of stunting, wasting, underweight, and overweight (<−2 for HAZ, WHZ, and WAZ and >2 for WHZ). Children were also assessed for pedal oedema. We conducted multivariable linear/logistic regression analysis to identify child, maternal, and household risk factors for childhood undernutrition and overweight, excluding children with oedema (1.7%). Mean (SE) HAZ, WHZ, and WAZ were −0.82 (0.13), 0.10 (0.04), and −0.42 (0.05), respectively. Prevalence of stunting, wasting, underweight, and overweight were 21.2%, 2.6%, 7.4%, and 2.6%, respectively. In multivariable regressions, risk of stunting significantly increased by age: 5.3% at <6 months (reference), 16.8% at 6–23 months (OR = 3.06, 95% CI [0.63, 14.8]), and 25.0% at 24–59 months (OR = 5.07, [1.16, 22.2]). Risk of stunting also decreased in a dose–response manner with improved maternal education. None of the examined variables were significantly associated with wasting or overweight. Despite a WHZ distribution comparable with the World Health Organization reference (with ~2.6% vs. an expected 2.5% of children beyond 2 z in each tail), stunting persists in one fifth of preschool Bhutanese children, suggesting that other nutrient deficits or nonnutritional factors may be constraining linear growth for a substantial proportion of children.

Epidemiology of Helicobacter pylori infection in asymptomatic schoolchildren in Bhutan.

Bhutan is a small mountainous country between Tibet and India with relatively homogenous population. According to the World Health Organization, gastric cancer is the most frequent cause of cancer death in Bhutan. This study examined the prevalence of Helicobacter pylori among children in Bhutan with emphasis on water source and living conditions. A cross-sectional sero-epidemiologic study was conducted among schoolchildren who attended public schools in Thimphu, Bhutan. Between 2015 and 2016, blood samples from schoolchildren were collected after obtaining an informed consent from the school management and the children's parents. Demographic information, parents' education, family size living in the same household, and aspects of household environment including type of latrines, boiling drinking water were collected. All serum samples were tested for H.pylori immunoglobulin G (IgG) by commercial ELISA kits. There were 327 children between 4 and 19years of age participated, 44% boys, mean age=13.6±3years. The overall prevalence of H. pylori was 66% with no difference between boys and girls (66 vs 64%, respectively), P=.42. H. pylori prevalence was 75% among both 4-7 and 15-19years and not statically different from that of the 8-10 or 11-14 age groups (59% and 63%, respectively), P=.1. H. pylori prevalence was inversely correlated with the level of mother's education (70% vs 55%) for those without and with a college education, respectively (OR=2.3; 95%CI=0.9-1.7), P=.08. The total number of people living in the same household did not correlate with H. pylori sero-prevalence, but households had less than 3 children had lower prevalence than those with 3 or more children (62% vs 71%, respectively OR=1.7, 95% CI=[1.0-2.6], P=.05). H. pylori infection is prevalent among all age group children in Bhutan. The results suggest that transmission of H. pylori is related to personal care practices that directly correlate with the mothers' education and crowded living condition with children. Our results are important to developing prevention strategies for gastric cancer in Bhutan.

Acquisition of computer literacy skills through self-organizing systems of learning among children in Bhutan and India

This article describes a study under the Reaching the Unreached component of the Chiphen Rigpel project between the governments of Bhutan and India. This initiative is an attempt to provide computer literacy to children of Bhutan through setting up “hole in the wall” (HiWEL) Playground Learning Station(s) (PLSs). The study described here involves 14 sites (the experimental group), where PLSs are installed, and another 8 sites (the control group) without PLSs, but having similar demographic and socioeconomic profiling as the experimental group. This article compares the acquisition of computer literacy of school-going children in India with those in Bhutan. Results indicate that Bhutanese children have acquired computer literacy on their own and that their level of computer skills acquisition is similar to that of Indian children when the scores are normalized. This study was done over a one-year period, with results reported for eight months. In addition to verifying the earlier Indian results, this article hints at the fact that, irrespective of ethnicity, culture, and country, an identical—and possibly universal—self-organized learning mechanism seems to work with children vis-à-vis the Internet.

Nutritional status and stunting among pre‐school children in Bhutan: Findings of the 2015 National Nutrition Survey

The high prevalence of stunting along with the region's large population make South Asia home to about 40% of the world's stunted children. The prevalence, severity, and distribution of undernutrition or risk factors for stunting are relatively little known in Bhutan. A second Bhutan National Nutrition Survey (BNNS) was conducted in 2015 among children aged 0–59 months (n=1,506) and their households. Adjusting for survey design, we estimated nutritional status by Z‐scores of height‐for‐age (HAZ), weight‐for‐height (WHZ) and weight‐for‐age (WAZ) and prevalences of stunting, wasting, underweight, and overweight (WHZ&gt;2) carried out linear and logistic regression analyses to identify child, caregiver and household characteristics associated linear growth and relative odds ratios (OR) of stunting. Mean (SE) HAZ, WHZ and WAZ was −0.81 (0.13), 0.10 (0.04) and −0.41 (0.05), and the prevalence of stunting, wasting, underweight and overweight was 21.2%, 2.5%, 7.3% and 2.6%, respectively. In univariate logistic regressions, risk of stunting was higher in rural than urban areas (26.1% vs. 16.0%; OR=1.86, 95% CI: 0.87, 4.00; p=0.07), in the East than West or Central regions (29.1% vs. 17.0%, OR=1.41, 95% CI: 0.82, 2.42; p=0.11) and varied in a dose‐response manner by SES, from 33.7% in the lowest fifth to 16.6% in the highest fifth (reference group) of a wealth index (OR range from 3.75 to 8.95). These associations were not significant on multivariable adjustment (p&gt;0.10 for all). The risk of stunting significantly increased by age: 5% at &lt;6 mo (OR=1), 17.1% at 6–23 mo (OR=3.59; 95% CI: 0.74, 17.4; p=0.07) and 24.9% at 24–59 mo (OR=6.12; 1.40, 26.9; p=0.03) and was far lower among children of university‐educated (6.6%; OR=0.05; 95% CI: 0.00, 0.89; p=0.05) than uneducated mothers (35.4%; OR=1). Despite a lower national risk of pre‐school stunting compared to other South Asian countries, strong age‐ and household wealth‐associated gradients in risk exist. Programs to prevent stunting may achieve the greatest impact among children in lowest household wealth and educated strata within the East region.Support or Funding InformationUNICEF Regional Office for South Asia (ROSA), Kathmandu, Nepal

Addressing childhood dental health in Bhutan

Dental health is a critical component to a society’s overall health. The national oral health article highlighted the high levels of dental caries in six-year-old children in Bhutan. Poor dental health in childhood has long reaching negative effects through adulthood. This is an important pediatric health problem which needs to be addressed to help eliminate and prevent a host of health-related complications and expenses.

National oral health survey in 6- and 12-year-old Bhutanese school children

Introduction: Dental caries is a highly prevalent and a significant public health problem affecting 70% to 95% of children, including adults in member states of the South East Asia region. Epidemiological data on the prevalence of dental caries amongst Bhutanese children at the national level is non-existent. The objective of this study was to determine the prevalence of dental caries, periodontal status, traumatic dental injuries and fluorosis in 6-and 12-year-old school children.&#x0D; Methods: A descriptive cross-sectional survey in two age groups of school children in Bhutan was conducted in 2014. A total of 2904 students participated in the survey. A multistage cluster random sampling method was adopted that included samples from both urban and rural schools. The assessments for dental caries and periodontal conditions were done as per modified WHO methodology and criteria. Dental trauma and fluorosis were identified as present or absent irrespective of severity levels.&#x0D; Results: Dental caries prevalence was 41.90% and 83.80% with mean DMFT/ dmft 0.80 and 5.54 for 12-and 6-year-olds respectively. Urban students had more caries than their rural counterparts. Overall, 13.00% of 12-year-olds had healthy gingiva but more calculus was detected in rural children. Dental trauma and fluorosis were very low (0.01% to 5.00%) in both the age groups.&#x0D; Conclusions: Caries prevalence was very high in 6-year-olds while periodontal status in 12-year-olds was poor. Rural school children had lower caries levels compared to their urban counterparts. Imparting oral health awareness among parents can lower caries severity in younger children.

Novel human bufavirus genotype 3 in children with severe diarrhea, Bhutan.

We identified a new genotype of bufavirus, BuV3, in fecal samples (0.8%) collected to determine the etiology of diarrhea in children in Bhutan. Norovirus GII.6 was detected in 1 sample; no other viral diarrheal pathogens were detected, suggesting BuV3 as a cause of diarrhea. This study investigates genetic diversity of circulating BuVs.

The nutritional status of children in Bhutan: results from the 2008 National nutrition survey and trends over time

BackgroundThere are few reports on the nutritional status of Bhutanese children. The objective of this paper is to summarize results from the 2008 National Nutrition Survey and to describe progress achieved during the last two decades.MethodsA cross-sectional survey of 2376 children aged 6 to 59 months was conducted during November-December 2008 to provide national and regional estimates. A multi-stage cluster sampling method was applied and 40 gewogs/thromdes were selected from each region (Western, Central, Eastern). Guidelines on how to measure length/height and weight followed WHO standardized procedures. Data were analysed for consistency and validation using the software WHO Anthro and the WHO SPSS macro. Underweight, stunting, overweight, wasting and thinness were defined based on the WHO Child Growth Standards. Data from 1986-88 and 1999 national surveys were reanalysed using the WHO standards to describe trends in nutritional status.ResultsNationally, 34.9% Bhutanese preschool children are stunted and 10.4% are underweight. Wasting is 4.7%, with severe wasting close to 2% in rural areas, while overweight affects 4.4% of preschool children. While underweight rates are similar across regions, wasting is substantially more prevalent in the Western region and stunting in the Eastern region. Stunting shows a steep rise during the first two years of life, as high as 40%, and levels off thereafter, while wasting is greatest among children aged 6-24 months and subsequently decreases. The prevalence of stunting fell from 60.9% in 1986-88 to 34.9% in 2008, and underweight declined from 34.0% to 10.4% during same period. The percentage of wasted children dropped from 5.2% in 1986-88 to 2.5% in 1999 but then increased to 4.7% in 2008.ConclusionsThere have been major improvements in the nutritional status of Bhutanese children over the past two decades, however, linear growth retardation remains a significant concern. Early identification of growth faltering is essential for improving the effectiveness of public health programs to prevent stunting. Similarly, wasting rates indicate the need for a system to identify children with severe malnutrition in the isolated communities so that they can receive appropriate care.

Changes in the daily life and play of children in Bhutan

The purpose of this paper is to clarify the present condition of daily life for children in Bhutan, comparing the differences between districts, especially between a capital city and neighboring village or eastern Bhutan, and examining the influence of societal changes. The paper will report and consider, in detail, home education, children's play and work and how these facets of life are affected by the progress and change of the social economy and sense of values. Date for this paper was collated by conducting surveys and interviews.Results : Education is still fundamentally acquired through home education in Bhutan. On the other hand, it includes curriculum on environmental education, which reflects the communities, classes on religion and tradition. However these are simply set as policy to re-establish cultural identity, in the anticipation that young people 's mindset will change in the modernization. Children's play is almost always the basis of their work, where a part of work is changed into games or sports. The modern sports are in these years. Play, from an educational point of view is necessary for children's growth and advancement, and develop through the influence of the surroundings and human relations. Particularly, in local place, the belongings of children increased than before owing to the establishment of money economy, and have an effect on the way time is spent after school. According to work, children spending more time at school and in their house, in stead of in the fields and mountains, child labour in the 3rd world is still prevalent, and the in stances of which occur in greater numbers the further out of the city they live. Children provide an indirect means of studying an ethnic group, as their activities and daily life reflect the adult culture they live in. It is important to keep on an eyes on the influence of cultural and moral values on the changes in daily life, exposed in television programs. In doing so, one can compare such foreign cultures with those much closer to home.