Bhutan Health Journal
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South-East Asian Children’s Environmental Health: networking to improve health outcomes
Get PDFMajor progress has been made in improving the health of vulnerable populations, especially children and pregnant women in low and middle income countries after the launch of the Millennium Development Goals in 2000. While fewer children die, many now face the prospect of years lived with disability (YLD) from chronic non-communicable diseases (NCDs). The estimate for the total YLD for children under-5 years of age for South-East Asia was 2,780,104 in 2015. To improve the health outcomes for children globally, the World Health Organization’s Department of Public Health, Environment and Social Determinants of Health has designated a number of collaborating centres, each with differing areas of expertise. The collaborating centres have formed a network to address children’s environmental health (CEH) issues at the local, national, regional and international levels. However, many gaps in knowledge exist. To further this aim, the 1st Regional Workshop of South-East Asian Children’s Environmental Health was held at the Chulabhorn Research Institute, Bangkok, on 18th November 2016. The workshop was attended by three of WHO Collaborating Centres with representatives of five regional countries of Bhutan, India, Myanmar, Thailand and Vietnam. Workshops such as this one are designed to bring together researchers and policy makers from regionals areas to identify and close gaps in knowledge
Cessation of Betel Quid Chewing: Lessons from the ex-chewers
Get PDFIntroduction: The practice of chewing of betel quid is deep-rooted age-old traditions of most Asian countries including Bhutan. Health is an integral part of happy living and healthcare providers are generally looked up to as role models for healthier living. This paper focuses on the prevalence of ex-betel quid chewers and correlates of successful cessation of betel quid chewing among healthcare professionals in Thimphu, Bhutan.
Methods: Data for this study was collected from six healthcare centres within Thimphu, during June – July 2016, using self-administered questionnaire. 478 questionnaires were handed over to the healthcare professionals, and 391 (82%) were returned. Statistical analysis was performed using statistical package for social science version 21.0.
Results: The prevalence of ex-betel quid chewers was 16.9%. More than half (51.5%) of the ex-chewers discontinuedchewing betel quid because of fear of the ill effects of chewing it. About 29% gave up chewing betel quid because of healthrelated problems. Betel quid chewing was first sourced either with a friend or a parent (59.1%, 24.2% respectively). Number of family members chewing betel quid, smoking and drinking status were significantly associated with quitting of betel quid chewing.
Conclusions: Findings suggest that family and health risk behaviours such as drinking and smoking were significant correlates of quitting betel quid chewing. Hence, effective public health awareness could be targeted to both individual and their family members to enable them to quit betel quid chewing
Serotypes and antibiotic susceptibility of Streptococcus pneumoniae in the Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan: a preliminary finding
Get PDFIntroduction: Streptococcus pneumoniae cause life-threatening infections, mostly affecting children under five years in developing countries. Several countries in South Asia have incorporated a pneumococcal vaccine in their immunization schedule. Bhutan is currently considering the introduction of a vaccine, although no studies in the country to date have characterized the serotypes of S.pneumoniae to gauge the potential vaccine coverage. We, therefore, characterized pneumococcal serotypes isolated from patients in the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Thimphu.
Methods: Four hospitals attempted to study S.pneumoniae from various clinical specimens from January 2014 to December 2015, although only the JDWNRH was able to isolate pneumococci. Isolates were tested for antibiotic susceptibility and serotyped at a reference laboratory in India.
Results: Thirtyseven isolates were preliminarily identified as S. pneumoniae at the JDWNRH. At the reference laboratory, two isolates could not be revived and 14 were identified as non-pneumococcal streptococci. From the remaining 21 isolates, 15 different serotypes were identified. The Bhutanese serotypes were more comparable to those of India than Bangladesh or Nepal. Current vaccines would cover 26.7% (Prevnar, 7-valent), 40.0% (Synflorix, 10-valent), and 53.3% (Prevnar, 13-valent and Pneumovax23, 23-valent) of these serotypes. All isolates were sensitive to penicillin, chloramphenicol, and ceftriaxone; 9.5% were resistant to erythromycin and 38.1% to cotrimoxazole.
Conclusions: For the first time, we characterized serotypes of S. pneumoniae in Bhutan. However, the findings need to be interpreted cautiously due to small numbers of isolates from one referral hospital. A larger study is needed to validate the findings and guide selection of an appropriate vaccine
Maternal Hypovitaminosis D as a Cause of neonatal seizure
Get PDFMaternal hypovitaminosis D has many implications for both mother and newborn. The prevalence of vitamin D deficiency in Bhutan is not yet known. The case presented below represents a severe symptomatic presentation of vitamin D deficiency in a neonate due to maternal vitamin D deficiency. It highlights the need for raised suspicion of vitamin D deficiency as a cause of late-onset neonatal seizures, epidemiologic studies, and potential vitamin supplementation for pregnant women, as well as the need for vitamin D-only liquid supplements in pharmacies in Bhutan
Stillbirths at the National Referral Hospital in Bhutan: a historical description of the rate and related factors, 2006-2008
Get PDFIntroduction: A fetal death or stillbirth is a baby born weighing >500 grams and with no signs of life at or after 28 weeks of gestation.
Methods: This was a cross-sectional survey to estimate the rate of stillbirths and a case series study to describe all stillbirths occurring at Bhutan’s national referral centre, Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), from June 2006 to July 2008. Ethical approval was granted by the Ministry of Health. All pregnant women who had stillbirths with fetuses weighing >500 grams were included. Antenatal and socio-demographic details and examination of the newborn were abstracted from records.
Results: There were 96 stillbirths among 5,417 births at JDWNRH, for a rate of 17.72 per 1,000 births. The mean age of women with stillbirths was 26.5 years (range 15 to 44 years). The majority of stillbirths occurred in women aged between 20 to 34 years and in primipara. The majority (87.5%) of the women had at least one antenatal visit, 69.8% had at least two visits while 12.5% had zero antenatal visits. At birth, there were 39 fresh stillbirths and 57 macerated. Seventy-six stillborn babies (79.2%) had weight lesser than 2500 grams. The most common cause was congenital infections, severe pregnancy induced hypertension, prelabour premature rupture of membranes, chorioamnionitis, and prolonged rupture of membranes. Congenital anomalies causing death was relatively lower in rank. The proportion of unexplained stillbirths was 15.6%.
Conclusions: The rate of stillbirth was substantially high in our population. Many of the causes of stillbirth were preventable and measures can be reinforced to improve birth outcomes
Massive hemoperitoneum due to rupture of an unscarred uterus diagnosed postpartum: a near-miss maternal death
Get PDFSpontaneous rupture of an unscarred uterus during pregnancy and labor leading to massive hemoperitoneum is a rare occurrence but with significant morbidity to the mother and fetus. Oxytocin use in labour is a known risk factor for rupture of unscarred uterus. A 21-year-old primigravid woman at 39 weeks of gestation with no known risk factors had labor augmented with an oxytocin infusion; she developed tachysystole and delivered vaginally. Two hours postpartum, pallor, abdominal distension, and a dramatic fall in hemoglobin were noted. An abdominal ultrasound revealed a massive amount of free fluid. At emergency laparotomy the hemoperitoneum was confirmed, and rupture of the posterior wall of the uterus was discovered. Repair of the site of rupture, blood transfusion, and intensive care resulted in a satisfactory recovery. When hemoperitoneum develops in the postpartum period, uterine rupture should be strongly suspected, particularly when oxytocin has been utilized during labor. Judicious use of oxytocin, careful monitoring of labour, and high suspicion of uterine rupture when oxytocin is used play vital roles in preventing the disastrous outcome of maternal death
Anemia and risk factors among children 6 months to 59 months old: a hospital-based prospective study
Get PDFBackground: Anemia is a major public health problem and the most common nutritional issue in many parts of the world, especially in developing countries. The objective of the study was to determine the prevalence of anemia and factors associated with anemia among children 6 to 59 months old admitted in Pediatric ward of National Referral Hospital, Thimphu.
Methods: A hospital-based descriptive cross-sectional study. All children 6 months to 59 months old admitted in Pediatric ward of National Referral Hospital, Thimphu were included in the study. A total of 353 children were included in the study. Data was analyzed using STATA 12.
Results: The prevalence of anemia was 58.4%. Mild, moderate and severe anemia was 65%, 22.8% and 12.2% respectively. Anemia was more common in children less than 2 years old. The majority of the children had microcytic hypochromic anemia with low serum iron. The risk factors associated with moderate to severe anemia were malnutrition [p-value 0.001, OR 32.1, 95% CI (9.10-118.8)], low education level of caregiver [p value 0.0019, OR 5.10, 95% CI (1.66-15.68), monthly family income less than 5000/month [p-value 0.0004, OR 4.6 , 95% CI (1.89-11.54)] and chronic illness [p value 0.030, OR 2.43, 95% CI (1.08-5.47)].
Conclusion: This study found a high prevalence of anemia in under-5 children, with iron deficiency accounting for the majority of the cases. Children under 2 years were affected more
An approach to Illnessess by Traditional Medicine of Bhutan: An Introduction
Get PDFDepending on the different ailments, various diagnostic tools like laboratory tests, X-ray, ultrasound, magnetic resonance imagery, and computerized topography scan are used in modern medicine. However, in Bhutanese traditional medicine the method of diagnosis is based on the medical text of Sowa-Rigpa, the ancient practices involving physical examination, questioning, pulsation, palpation and analysis of excretion. These enduring techniques of diagnosis use no modern technologies. The system has been practised in Bhutan for hundreds of years and has been officially establishment in 1967. Insights of this article are compiled from the Buddhist medical text and oral transmission of senior physicians. We discuss diagnosis in three categories namely, visual (Ta-Wa), touch (Reg-Pa) and questioning (Dri-Wa). Visual diagnosis mainly investigates the urine, physical appearance and the tongue. Touch, reading the pulse through which the physician diagnose illnesses. Questioning about the signs and symptoms of the illnesses and past medical history
Prevalence of Gestational Diabetes Mellitus and its association with pregnancy outcomes in three referral hospitals in Bhutan
Get PDFIntroduction: Gestational Diabetes Mellitus (GDM) has been defined as any degree of glucose intolerance with onset or first recognition during pregnancy. There is no national data on the prevalence of gestational diabetes mellitus, and there is no routine screening system for diabetes in pregnancy in Bhutan. This study was carried out to determine the prevalence of GDM and its association with pregnancy outcomes in three referral hospitals in Bhutan.
Methods: This was a prospective study done between March and December 2016 in three referral hospitals in Bhutan, with 726 participants recruited between 24 to 28 weeks of pregnancy. Two blood samples were taken, one in a fasting state to test fasting blood sugar and another to test blood sugar level 2 hours after drinking 75g glucose in 300ml water. They were analyzed in the Clinical Biochemistry laboratories in the respective hospitals. Cut-off levels of 5.6mmol/ L (101mg/ dL) for fasting blood sugar and 8.5-mmol/L (153-mg/dL) for 2 hours blood sugar report were used. Women diagnosed with GDM were closely followed up throughout the pregnancy up till delivery. At delivery, information on mother and the baby were collected.
Results: The prevalence of GDM in the three referral hospitals in Bhutan was 15%. The prevalence of GDM cases in the three hospitals was similar and statistically was not significant. Conclusions: Universal screening of pregnant women is recommended to detect hyperglycemia and to achieve euglycemia in order to prevent complications in both mothers and babies