Bhutan Health Journal
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Positioning Nurses in Primary Health Care in Bhutan
Get PDFIntroduction: Nursing in Bhutan had its beginning in the early 1960s, approximately 20 years prior to the Alma Ata Conference. From basic nursing care and housekeeping roles, Bhutanese nurses have now occupied central place in nursing service, administration and management and education. Nursing education has progressed from certificate level in the 1960s to bachelor, master and PhD levels in 2014. Although nurses have been closely associated with Primary Health Care development in Bhutan, apart from the role of the Auxiliary Nurse Midwives, nurses have rarely been explicitly associated with this area of practice. Therefore, the objective of this study was to find out the role of Bhutanese Nurses in PHC.
Methods: qualitative case study method was used to carry out focus group and in-depth interviews with 66 respondents that included policy makers, planners, educators, regulators and implementers. Data were analyzed through manifest and latent content analysis.
Results: The centrality of the nursing role in the area of PHC has not been realized. Discharge of the PHC role was identified more in terms of the place of work and by title or designation of the nurses. Primary Health Care momentum appeared to have slowed down and nurses differed in their understanding of PHC concept.
Conclusion: Although Nursing in Bhutan has made much progress, the uneven development of the nurses’ role in PHC in Bhutan and globally suggests a need to identify and implement strategies such as standardizing, role profiling, curricula review and leadership improvement to ensure progress in this area
To study the effect of Triamcinolone injection for low back pain due to lumbar disc herniation
Get PDFIntroduction: Low back pain is one of the most common complaints in the general population which represents a significant public health problem. Epidural Steroid Injection is being considered as a simple, effective and minimally invasive treatment modality for lumbar disc herniation. However, most studies only find a short-term benefit. In Bhutan, till date, no study has been done in Bhutan on this subject. The objective of our study was to find the effect of epidural steroid injection for low back pain due to lumbar disc herniation.
Methods: An observational one-year-period study completed in Jigme Dorji Wangchuck National Referral Hospital. Symptomatic and positive Magnetic Resonance Imaging patients with lumbar disc herniation were included in our study. Pain scores were collected using Numeric Rating Scale at three different points of study. We also included patients’ age, weight and trauma history as some of the independent variables to study their associations with pain scores. The data obtained were analyzed using the Stata software program. One way repeated measures ANOVA was used to assess the significant difference in pain score.
Results: Out of 100 participants recruited for the study, 91 of them completed demographic data and only 81 patients completed follow-up till 4 weeks post-treatment for demographic analysis and analytical analysis, respectively. There was a significant difference in pain scores in all three different points of study (p <0.01). No significant difference was observed in the pain scores amongst different age groups, gender, occupation and trauma history (p >0.05) at all three points of study.
Conclusion: Our study observed a significant short-term benefit from epidural Triamcinolone injection for symptomatic lumbar disc herniation
Situation of maternal health in Bhutan 2018
Get PDFBhutan has opened up to modernization in 1961s and since then good progress has been made in social sectors. Providing free health service and education has the top priority from the beginning to this day. With humble starting from almost bare grounds, the situation of maternal health has improved. Until the start of the Safe Motherhood program in 1994, health programs were not streamlined. The maternal mortality ratio (MMR) was 380 per 100000 livebirths in 1994. A lot of efforts with different programs have been implemented by the reproductive health program of Ministry of Health to improve maternal health. Main challenge has been with health human resource from the very beginning and it still stands to this day as number one challenge. With the inputs of various programs to improve maternal health and development in non-health sectors, the MMR has come down to 89 per 100000 livebirths in 2017
Assess Knowledge, Attitude and Practices of Respectful Maternity Care among nurse midwives in Referral Hospitals of Bhutan
Get PDFIntroduction: Respectful Maternity Care (RMC) acknowledges that respects for woman’s rights, choices and dignity during labor and childbirth is vital component of health care quality. This cross-sectional descriptive study intended to gain in-depth understanding on knowledge, attitude and practices of nurse midwives working in referral hospitals of Bhutan on RMC. The study also looked into determinants of RMC.
Methods: The sample consisted of 83 nurse midwives who were working in birthing and maternity unit of three regional referral hospitals of Bhutan. The sites were chosen purposefully due to their high delivery volume. A survey instrument was piloted in Paro hospital prior to study. Data was collected from July to October 2017. Analysis was mainly descriptive, simple percentages were used to calculate frequency distribution of aspects and determinants of respectful maternity care.
Results: Four in five of the respondents knew and practiced woman’s right to information and communication during childbirth process. However, providers were found lacking on some aspects of the knowledge and practices related to respecting choices and rights of the women during childbirth and recounted their experiences of observing events which are described as abusive in maternal health literatures. Inadequate facilities, overworked staffs and limited trainings were found as detrimental factors.
Conclusion: Aspects of RMC were not duly practiced. Providers must be made aware of the woman’s right to respectful care which is crucial to improve maternal health services. Individual Health Facility must provide conducive environment to practice RMC. Future studies on RMC from receiver end are recommended
Breastfeeding problems: an analysis of secondary data from Lactation Management Unit at the national referral hospital in Bhutan from 2014 to 2016
Get PDFIntroduction: Breastfeeding is one of the most natural and best forms of preventive medicine for the newborns. Lack of optimal breastfeeding contributes to about over million preventable child deaths every year. Despite numerous benefits of breastfeeding and continuous efforts to improve breastfeeding practices, breastfeeding rates are far from optimal. Problems faced by lactating mothers while breastfeeding are main reason leading to non-exclusive breastfeeding or early termination of breastfeeding. This descriptive study is aimed at examining breastfeeding problems among women visiting Lactation Management Unit [LMU] at Bhutan’s national referral hospital in Thimphu.
Methods: Data of all 2751 women-infant pair visiting Lactation management unit of Jigme Dorji Wangchuck National Referral Hospital with breastfeeding problems were double entered into Epi Data (version 3.1). Using STATA, descriptive statistical analyses were carried to examine common breastfeeding problems among the lactating mothers. Exclusive breastfeeding rates were also examined among the group.
Results: The commonest types of breastfeeding problem were nipple sore (60.8%), incorrect breastfeeding techniques (12.9%), and nipple problems (8.2%). Teenage, first timers, caesarean delivery, preterm infants, underweight infants, and mothers with full time paid job were more likely to suffer from breastfeeding problems.
Conclusion: Breastfeeding interventions for timely correction of breastfeeding techniques early in postnatal units could warrant prevention of up to 73.7% breastfeeding problems and thus, promoting exclusive breastfeeding and preventing early termination of breastfeeding
An unusual pseudoneoplasm: mass-forming tuberculosis infection mimicking rectal carcinoma
Get PDFA rare case of primary rectal tuberculosis presented as a rectal mass, indistinguishable clinically and radiologically from advanced rectal carcinoma . Histology failed at first to identify granulomas, acid fast bacilli, or malignancy, but subsequent biopsies showed multiple epithelioid granulomas with caseating necrosis and Langhans giant cells. Given these findings and the high regional incidence of tuberculosis, presumptive diagnosis was given and anti-tubercular drugs were initiated followed by resolution of the mass and symptoms
Penile implantation and risky sexual behaviour among male clients of female sex workers, Myanmar
Get PDFIntroduction: Male clients of female sex workers are at risk for sexually transmitted infections worldwide, yet their behaviours are seldom described in community-based samples. In addition, physical modifications to the penis, such as injections and implantations of objects to enhance sensation, have been noted in diverse cultures. The objective of the present study was to examine risk behaviours of male clients of female sex workers in Myanmar and assess associations between penile modifications and risk for sexually transmitted infections.
Methods: A cross-sectional survey was conducted in 2010 in seven cities of Myanmar. The design used probability proportionate to size sampling of male clients at sex work venues (e.g., brothels, entertainment centres, streets) to approximate a representative sample.
Results: Of 2,945 male clients at sex work venues, 2,740 (93.0%) enrolled. Overall, 9.9% reported penile injections and 10.7% reported implantations. Compared to male clients without penile modifications, those with penile injection or implantation had higher numbers of partners and more episodes of unprotected sex with casual and commercialpartners. Condom breakage and history of sexually transmitted disease symptoms were also higher among male clients with penile modifications.
Conclusions: Modifications of the penis mark a constellation of risky behaviours among male clients of female sex workers in Myanmar and may also be causally related to sexually transmitted infections through condom breakage or physical effects on the penis. Health education and counselling on the potential increased risk should be considered for men with penile modifications
