Bhutan Health Journal
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Knowledge, attitude and practice on advanced cardiac life support (ACLS) among the general duty medical officers in Bhutan
Get PDFAdvanced cardiac life support (ACLS) is one of the important lifesaving procedures administered by emergency medical professionals. International guidelines and literature recommends periodic training of health personnel on ACLS. In Bhutan, the General Duty Medical Officers (GDMO) is often the first line doctors to attend to the critically sick including cardiac arrest patients
Effect of use of direct observation of procedural skills for assessment for learning in Obstetrics and Gynaecology postgraduate students at Medical University, Bhutan: a prospective study
Get PDFIntroduction: Direct Observation of Procedural Skills (DOPS) is a valuable method to evaluate procedural skills. The aim of this study was to explore the effect of DOPS as an assessment method and its effect on their learning in Obstetrics and Gynecology Postgraduate students.
Methods: Five residents and four faculty members from the department of Obstetrics and Gynecology, Khesar Gyalpo University of Medical Sciences of Bhutan participated in this study. A validated checklist was adopted, from which five core areas of DOPS were utilized for this study. The two skills selected for this study were Pap smear and Intra Uterine Contraceptive Device (IUCD) insertion. The acquired data were analyzed by descriptive statistics (frequency, percent and mean).
Results: The results showed that student’s initial mean score was 4/9, which increased to nearly 8/9 in third attempt. Practically, all faculty members and students believed that DOPS was effective in facilitating students’ learning. Some of the students thought that repeated exposure to DOPS reduced their level of stress.
Conclusions: It may be stated that DOPS is effective in facilitating students’ learning and clinical skills.
Keywords: Assessment; DOPS; learning; Obstetrics and Gynecology; WPBA
Age of menarche and menstrual hygiene of pubertal female students in Bhutan: a cross-sectional survey, 2017
Get PDF Introduction: In Bhutan, pubertal and adolescent female students (10-19 years) make up 8.5% of the population. The need for menstrual hygiene management (MHM) is more urgent in post-menarcheal female students and in resource-poor settings. However, until recent time, there were strong socio-cultural barriers to discourses on menarche and MHM. This study was conducted to determine the age of menarche among Bhutanese female students to identify when to offer MHM support, their knowledge on menstruation and practices related to menstrual hygiene.
Methods: This was a cross-sectional survey of female students studying in Grade 10 in Thimphu, Bhutan. A multistage clustered sampling was used. Data was collected using a self-administered questionnaire developed for the purpose of this study.
Results: A total of 439 post-menarcheal female students were interviewed. The mean age of menarche was 12.8±1.1 years, and fear (38.3%) and confusion (25.1%) were the commonest responses. The mean score on knowledge on menstruation and MHM was 5.9±1.5 out of 9. The proportion of students with good knowledge was 36.7%. The common sources of information were the mother, teacher, and sister. The majority used commercial pads (92.5%) while some used clean cloths (5.7%) and tampons (1.6%). The proportion who stayed absent from school during menstruation in the month prior to data collection was 9.8%. Visiting religious places (67.6%) and participating in sports (4.3%) were common restrictions during menstruation.
Conclusions: Female students experience difficulties in menstrual hygiene management in schools. Menstruation could lead to missing schools and other activities.
Keywords: Developing country; Health behaviour; Menstrual hygiene product; Standard of living
Relying on Widal test alone could lead to over diagnosis of typhoid fever: Findings from a records review of febrile patients at Damphu Hospital, Bhutan, 2011-2012
Get PDFIntroduction: The Widal test is widely used in hospitals in Bhutan for diagnosis of typhoid fever. The right test with high sensitivity and specificity supplements clinical judgement and contributes to correct diagnosis of disease. This study focuses on the contribution of the Widal test in the diagnosis of typhoid fever.
Methods: Data was collected from records of patients who presented to Damphu hospital from March 2011 to June 2012 with clinical suspicion of typhoid fever. Blood samples were collected from patients and tested at Damphu Hospital, Tsirang and the Royal Centre for Disease Control, Thimphu. Seventy records were used for the study.
Results: There was no growth of Salmonella typhi on blood cultures from patients who had tested positive in the Widal test. There were 20 (28.57%) samples which tested positive for scrub typhus; among these Widal test was positive in 10 (50%) samples. Thirty four out of 36 (94.44%) patients had duration of illness less than seven days and among them 26 (74.47%) had positive Widal test results.
Conclusion: None of the samples that tested positive by Widal test gave a definite diagnosis of typhoid fever with blood culture. Clinical judgement may be more challenging because patients with other febrile illnesses like Scrub typhus also have positive Widal test result. We conclude that it is best not to rely on the Widal test alone for the diagnosis of typhoid fever and this test should be replaced by more accurate ones
Stillbirth rate in Bhutan: a retrospective facility-based study
Get PDFIntroduction: Stillbirth is an important public health concern; yet there is no reliable stillbirth rate for Bhutan. Hence the aim of this study was to estimate the stillbirth rate for Bhutan.
Methods: A retrospective study was carried out for live and stillbirths recorded in delivery registers of all 253 health facilities across the country for a period of one year commencing 1st January till 31st December 2015.
Results: There were a total of 11,126 live births and 108 stillbirths documented in delivery registers. The stillbirth rate from this data set was 10 per 1000 live births.
Conclusions: The stillbirth rate for Bhutan from this study is 10 per 1000 live births lower than 16 per 1000 live births estimated in Lancet Series 2015. In order to find the true burden of stillbirths in the country, a surveillance may be instituted which can facilitate the prevention efforts while at the same time enable to strengthen information system
Hypotension, bradycardia and reversible conduction defect induced by prescription of Bhutanese traditional medicines
Get PDFAconite is widely used in both Chinese and Ayurvedic medications and therefore often used within the Himalayan Kingdom of Bhutan. Despite its use in traditional medicine, because of its narrow therapeutic index, significant cardiotoxic and neurotoxic events are documented due to both intentional and unintentional ingestion. In this case series we present 2 cases of bradycardia, hypotension and reversible conduction defects caused by prescribed aconite-based Bhutanese traditional medicines, for different therapeutic goals, who suffered cardiac dysrhythmias
Prevalence of intestinal parasitic infection in patients attending National Referral Hospital, Thimphu, from 2013 to 2015: A retrospective study
Get PDFIntroduction: Infection with intestinal parasites continues to be a significant public health problem worldwide. There is no information on the prevalence of these intestinal parasites in patients visiting the National Referral Hospital, Thimphu, Bhutan.
Methods: The study utilized information of stool data from 2013 to 2015 and was analyzed using SPSS 16.0. Wet and Iodine mount technique were used for identification.
Results: The overall intestinal prevalence rate was 2.1%. Out of 5919 stool samples, Giardia lamblia has the highest rate of 0.93%, followed by Entamoeba coli 0.15%, Trichomonahomonis 0.19% and Taeniaspp. 0.17%.Giardia lamblia infection was 1.03% in males and 0.85% in females. The overall prevalence rate of parasitic infections was highest in >56 years age group with 2.83% in females and 2.0% in males.
Conclusion: The overall prevalence of intestinal parasites is a concern in the country. Furthermore, this study provides insights to develop effective public health intervention for reducing parasitic infections in the country
Estimation of serum creatinine in biochemistry department, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
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Prevalence of ear cleaning and its characteristic physical findings in patients visiting tertiary care center in Bhutan
Get PDFIntroduction: Many studies have been done on prevalence and complications of ear bud across the globe but very few talk about the characteristics physical findings associated with ear cleaning. We aim to find the prevalence and characteristic physical findings of cotton bud usage in patients visiting a tertiary care center in Bhutan.
Methods: A cross sectional study in a tertiary care center in Bhutan over a period of one month.
Results: The prevalence of ear cleaning was 92.15%. The most common physical finding was shiny external auditory canal (66%), excoriations in the external auditory canal (longitudinal furrowing along the floor or Circular scratch marks)(52%), erythema and edema of ear canal (46.6%), wax in the bony canal near tympanic membrane(9.3%), stenosed external auditory canal (3.8%), cotton wool remnants in ear canal(2.8%).
Conclusions: It is important to recognize these characteristic clinical findings of cleaning the ear so that proper counseling can be given against its usage and prevent undue complications associated with it