Bhutan Health Journal
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Unusual presentation of a burst appendix
Get PDFA 56 year old woman referred from a district hospital for a liver mass on initial evaluation was found to have perforation of gas-containing hollow viscus. Emergency exploratory laparotomy revealed a burst appendix. She did well post op and was discharged in a healthy state. This case report was done to highlight the importance of proper history taking and clinical examination in order to prevent delay in implementing appropriate treatment
Status of Thiamin deficiency in boarding school children from seven districts in Bhutan with previous history of peripheral neuropathy outbreaks: a cohort study
Get PDFIntroduction: Peripheral neuropathy outbreaks have been a common occurrence amongst boarding schoolchildren from seven districts in Bhutan. Thiamin deficiency has always been suspected to be the cause but the status of the vitamin has never been established. This study aims to find the status of thiamin and dietary intake of micronutrients in boarding schoolchildren from seven districts with previous history of peripheral neuropathy outbreaks.
Methods: Whole blood thiamin and dietary intake of micronutrients were assessed in 448 school children for four study periods (SP). Baseline data (SP1) was collected when the school children just joined the school at the start of the school academic year. SP2 was the first half of the school year and the data was collected just before the midterm break. SP3 was the short summer break and SP4 the second half of the school academic year.
Results: 50.58% of the school children were found to be thiamin deficient at baseline which increased to 90.1% in SP2. The percentage of thiamin deficient school children increased to 91.8% in SP3 and then decreased to 79.82% in SP4. The requirements for vitamin B1, B12, vitamin A and iron were never met by dietary intakes in all the study periods.
Conclusions: In conclusion, this study found a high prevalence of Thiamin deficiency in schoolchildren at baseline and the number of school children with Thiamin deficiency increased when in schools. The school children also had inadequate dietary intake of many micronutrients
The effects of a behavioral change program in reducing the house index of mosquito larvae in households in Phetcabun province, Thailand
Get PDFIntroduction: The purpose of this quasi-experimental research was to study the effectiveness of a behavioral change program in reducing house index of mosquito in Village Baan-Wangpong, Lomsak district in Phetcabun province, Thailand.
Methods: The sample size of experimental and control group was 42 representatives of household in each group. Representatives of each sampled household were tested for knowledge, perception and behavioral practice in prevention of dengue fever before and after the program intervention. The program included training on dengue fever prevention by health personnel, demonstration of making mosquito repellents from local product, organising an awareness contest, broadcasting health messages through media and surveying households for mosquitoes’ larvae.
Results: The study found that most households in village Baan-Wangpong had low knowledge (60.4%), perceived risk (60.4%), perceived severity (64.6%) and behavioral practice (77.1%) in the prevention of dengue fever prior to the program, with comparability in intervention versus control. The results showed that after the program intervention, the experimental group had a significantly higher level of knowledge (p=0.001), perceived risk (p=0.042), perceived severity (p=0.002) and behavior (p=0.028) in preventing dengue fever than before the program intervention and higher than the control group post-intervention. The experimental group’s house index was also significantly (p=0.001) lower than before the program and lower than the control group post-intervention.
Conclusions: This study suggests that a proactive program about knowledge, perceptions and behaviors on prevention of dengue fever with support from public health personnel and community participation, can positively change health behavior, resulting in reducing the house index of mosquito larva
Prevalence, determinants and outcomes of unplanned pregnancy and perspectives on termination of pregnancy among women in Nganglam, Bhutan
Get PDFIntroduction: The objectives of this cross sectional study were to determine prevalence, determinants, and outcomes of unplanned pregnancy among women in Nganglam, a town in southeastern Bhutan. It also gauged opinions of women and healthcare providers towards abortion.
Methods: A total of 683 women attending health clinics were consecutively interviewed using a semi-structured questionnaire. The core group for analysis was 490 women who indicated their recent pregnancy as planned or unplanned. Percentages, x2 tests, and multivariate logistic regression analyses were used to determine prevalence and differences in unintended pregnancy by demographic characteristics.
Results: The prevalence of unplanned pregnancy was 20.2%. Higher education, employed status of partner, higher parity, and non-use of contraceptives significantly increased the odds of unplanned pregnancy. Over half (58.4%) of the women said they knew someone to have crossed Indian borders to avail abortion services. Overall, 23% women supported legal abortion but majority (64%) were ambivalent. Given specific circumstances, both participants and health care providers supported some scenarios (life of mother, severe anomaly in fetus, rape and incest, maternal mental health) and opposed some circumstances as reasons for abortion (desired number of children met, contraception failure, not wanting to marry,poverty).
Conclusions: One in five women in our setting in Bhutan experienced unplanned pregnancy. Programs to romote family planning are required among populations most at risk for unplanned pregnancy. Awareness programs are required to encourage use of effective contraceptive methods among Bhutanese women
Assessment of HIV risk behaviors, practices and knowledge among people living with HIV in Bhutan, 2011
Get PDFIntroduction: A total of 217 HIV positive cases have been reported in Bhutan as of 2010. A descriptive study toassess the knowledge and behavioral practices among 116 of those persons living with HIV (PLHIV) was conducted in 2011.
Methods: Data on demographic characteristics, sexual behavior, alcohol consumption: mobility and HIVknowledge both before and after testing positive for HIV were collected. Responses regarding behavior before and after HIV diagnosis were compared.
Results: Of 116 participants, 52.6% were males; a majority of male PLHIV (72.1%) belonged to salaried group of people while housewife represented 47.3% among female respondents. Fortythree percent of male and 5.5% of female participants reported having exchange sex and 52.5% of male and 41.8% of female participants reported having non-exchange sex partners before HIV diagnosis. The consistent condom use had significantly increased after HIV diagnosis among males with exchange (12% vs. 60%, p=.04) and non-exchange (13% vs. 100%, p<.001) partners. Eighty-four percent of male and 61.8% of female participants reported consuming alcohol before HIV diagnosis. Only one male respondent reported injection drug use before HIV. There was a decrease in incidence of sexually transmitted infection (56.9% vs. 31.9%) after HIV diagnosis. Forty-three percent of males had traveled abroad before HIV diagnosis; among those, 30.8% reported having exchange sex while abroad.
Conclusions: Our findings indicated that high-risk sexual behavior was common before HIV diagnosis and that sexual practices changed after diagnosis. Educational campaigns aimed at increasing HIV knowledge and safe sex, are critical to reduce HIV infections in Bhutan
Balancing traditional beliefs and medical science: mental health care in Bhutan
Get PDFIn the Kingdom where Gross National Happiness is the most precious commodity, there is a growing awareness ofthe individual and communal toll that unmet mental health needs bring to bear on Bhutanese society. Even thoughmental illnesses are becoming public health issue, there is a tendency to neglect the care of mentally ill person in thegeneral setting. The reason for the neglect is due to lack of understanding and poor management of mental illness bythe health professionals and community at large. This article emphasizes the need to balance the traditional beliefsand medical science in order to provide a comprehensive mental health care in Bhutan
Pediatric tele-echocardiography in the diagnosis of congenital heart diseases in a regional referral hospital in eastern Bhutan
Get PDFIntroduction: Congenital Heart Diseases are the commonest birth defects and the most common reason for out-country referral of pediatric patients in Bhutan.Without any qualified pediatric cardiologists in the country, early diagnosis and appropriate care of pediatric cardiac patients is often delayed or inappropriate. Collaboration through telemedicine between general pediatrician and pediatric cardiologist can improve the diagnosis of congenital heart diseases in Bhutan.
Methods: Pediatric patients clinically suspected to have congenital heart diseases underwent Echocardiography at Mongar regional referral hospital. The Echocardiograms, performed by general pediatrician, were e-mailed to Pediatric Cardiologist working in UK, who gave the diagnosis after viewing the Echo-loops. This was compared with the final diagnosis made at tertiary cardiac centre in India.
Results: 30 echocardiograms performed by general pediatrician at Mongar Hospital in eastern Bhutan were mailed to Pediatric Cardiologist working in UK. Of the thirty cases, 20 required no immediate referral and were put on medications and follow up plans. 10 of the 30 cases requiredearly referral to tertiary care hospital in India. There was excellent concordance between the diagnosis made through tele-echocardiology and the final diagnosis made at tertiary cardiac centre.
Conclusions: Tele-echocardiography between a general Pediatrician and a Pediatric Cardiologist can greatly enhance the diagnosis of congenital heart diseases in children
Primary Tuberculosis of pharynx-diagnostic difficulties, complications and treatment
Get PDFPrimary tuberculosis of the upper respiratory tract is extremely rare and poses a diagnostic challenge. Due to delay in diagnosis the disease may progress to life threatening airway compromise. Here we report a case of chronic granulomatous infection of the upper respiratory tract involving the oropharynx. Initial biopsy revealed acute on chronic inflammation with no epitheloid granuloma and no acid fast bacilli was found on Ziehl-Nielsen staining of the biopsy. As a result of delay in diagnosis the disease progressed to involve the soft palate, valopharyngeal isthmus, and supraglottis compromising the airway and needed emergency tracheostomy. Where there is strong clinical suspicion repeat biopsy should be performed. The life threatening complication of pharyngeal tuberculosis such as stenosis and adhesion leading to airway compromise can occur during the course of treatment and should be closely monitored . It can be managed effectively with radiofrequency uvulopalatoplasty as demonstrated in the case report
Preference of place of delivery and its determinants: a cross-sectional study in Chukha district, Bhutan
Get PDFIntroduction: The estimated global maternal deaths in 2013 was 289000. In Bhutan, Maternal Mortality Ratio has remarkably declined from 770 deaths per 100,000 live births in 1984 to 86 in 2012. However, the maternal mortality ratio still remains high and a high proportion of delivery still take place at homes (26%) despite of adopting 100%institutional delivery policy ever since 2005. This study was carried out to determine the important factors that prevent women from coming to the health facilities for safe delivery.
Methods: A cross-sectional study among the women who delivered in Chukha District in 2013 was carried out after seeking ethical approval from Research Ethics Board of Health and World Health Organization. Chukha is a district with the second highest number of population in Bhutan where 55.7% of the people live in rural villages.
Results: Out of 899 eligible listed women, 78.1% participated in the study and among the participants 11.5% had delivered at home. The number of home deliveries was higher in rural areas, 17.3%, as compared to urban places, 6.4%. Women who were delivering for third or more times are 2.42 times more likely to give birth at home compared to women who were delivering for the first time. Women residing at places more than three hours away from the health facility were 2.58 times more likely to give birth at home compared to women residing less than three hours away. During their last pregnancy, 99.4% of the participants have sought at least one ANC.
Conclusions: This study suggests that the two most important factors associated with home delivery are the distance to health facility from their residences and the parity
