Bhutan Health Journal
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Aetiology of end-stage renal disease at the National Referral Hospital of Bhutan
Get PDFIntroduction: End stage renal disease (ESRD) is a late stage of chronic kidney disease (CKD) requiring chronic dialysis or renal transplant to survive. End stage renal disease is a growing problem worldwide. In Bhutan too, there are anecdotal evidence showing increasing number of ESRD patients every year, which has become a cause of serious concern for the country.
Methods: This retrospective descriptive study was conducted at the National Referral Hospital of Bhutan, from 2019 to 2020 to find out the aetiology of ESRD in the country. The demographic information and aetiology of ESRD were collected from the past record of the patients. A total of 202 eligible ESRD patients were enrolled in this study.
Results: The study showed that the mean age of patients was 47.3 ±13.20 years. The majority of the patients 139 (68.8%) were in the age group 24-60 years. Of the total patients, 107 (53.0%) were females. The common aetiologies of ESRD were hypertension (HTN), chronic glomerulonephritis (CGN) and Diabetes Mellitus (DM) constituting 20.8%, 12.9%, and 8.9% of the total patients respectively. In 50.0% of the patients, the aetiology of ESRD were unexplained.
Conclusions: The most common aetiologies of ESRD were HTN (20.8%), CGN (12.9%) and DM (8.9%); in 50.0% of the patients, the aetiologies remained unexplained. The majority of ESRD patients (68.8%) in this study were from middle age group, with female predominance (53.0%)
Seminal parameters among patients visiting infertility clinic at the National Referral Hospital, Bhutan
Get PDFABSTRACTIntroduction: Seminal fluid analysis is the initial investigation for any couple presenting with either primary or secondary infertility. In this study, we aim to study the seminal fluid parameters among Bhutanese patients who presented at the infertility clinic for an initial seminal fluid examination.
Methods: This retrospective descriptive study was conducted at the Infertility Clinic of the National Referral Hospital, Bhutan from January to December 2022. Using the census sampling technique, data on seminal parameters of 304 patients was extracted from the clinic’s register. A descriptive analysis of frequencies and percentages on the above data was performed using IBM Corp’s SPSS version 26.0, Armonk, NY).
Results: The result showed that the majority 217(70.4%) of the patients who came for semen analysis were in the age range between 30 and 39 years. Among 304 patients examined, 72(23.7%) showed normal semen parameters while 232(76.3%) displayed abnormalities in their semen parameters. These abnormalities were further categorised as follows: Azoospermia 14(4.6%), Oligozoospermia 109(35.9%), Asthenozoospermia 23(7.6%) and 86(28.2%) cases were Oligoasthenozoospermia.
Conclusions: This study provides a scientific data for the first time regarding seminal parameters of patients that visited infertility clinics. This data can serve as a reliable reference and valuable source of evidence for clinicians and future researchers. As the pioneering study of its kind in the country, this study generates fundamental evidence-based data for the global scientific community as well, promoting sustained research involvement in the field of reproductive medicine over the long run
Quality of Life and Health Needs among Elderly aged 60-79 years in Paro, Bhutan
Get PDFIntroduction: The global population is undergoing a significant demographic shift, with a rapidly increasing number of elderly population. As people age, their health and quality of life become increasingly important considerations. The elderly population has unique health needs that must be addressed to ensure their well-being and maximize their quality of life. In Bhutan, elderly health needs are lacking despite information on health policy and planning. This study was proposed to assess quality of life and health needs among elderly aged between 60 – 79 years old under Naja, Dogar, Shaba, and Lyungni gewogs (blocks) under Paro district, Bhutan.
Methods: An explanatory sequential mixed method design with a quantitative and descriptive qualitative was conducted in the four blocks. For quantitative component, a survey was conducted and for qualitative, focus group discussion was used. This study was carried out in four selected rural areas known as gewogs (blocks) in local language under Paro district. A representative sample of 403 respondents was selected by simple random sampling in quantitative work and 12 elderly people in focus group discussion. The demographic data were analyzed by ANOVA and data from focus group discussion were done in content analysis.
Results: The quantitative data for the overall QoL score among elderly showed a mean score of 39.01, which was considered a low level of QoL. Among the eight components of QoL, role of pain and general health showed same result level as the overall QoL. While others (physical function, body pain, vitality, social function, role of emotion, and mental health) were at average level (score 46.19-58.68).
Conclusions: Overall QoL of elderly people in Paro district is lower than the average at 47.84 (CI 45.87 – 49.81). Mental health was in average level compared to physical health, which is at a lower level
Containment of a local outbreak of COVID-19 through community isolation and quarantine in rural Bhutan: An experience
Get PDFABSTRACTIntroduction: Bhutan experienced the third and a larger outbreak of COVID-19 in the summer of 2021, with huge surge of cases from several districts on the southern border. A remote sub-district of Jomotshangkha in Samdrup Jongkhar district, was suddenly caught with a large number of cases in May 2021. All the COVID-19 cases during the outbreak were successfully managed at the community level or with home isolation without the need for sophisticated infrastructure and specialized manpower. In this article, we discuss the advantages of community-level management of COVID-19 in the context of Bhutan’s health system.
Patient safety culture among healthcare professionals in Bhutan
Get PDFIntroduction: There is dearth of information regarding the status of patient safety culture in Bhutanese healthcare system. The aim of the study was to assess the baseline patient safety culture among the healthcare professionals working in different levels of hospitals in Bhutan.
Methods: A cross-sectional study was conducted using the Hospital Survey on Patient Safety, version 2 (HSOPS2) questionnaire in 2021 in six District Hospitals (DHs), two Regional Referral Hospitals (RRHs), and one National Referral Hospital (NRH) in Bhutan. A total of 782 healthcare professionals were recruited into the study. EpiData version 3.0 and Statistical Package for Social Science (SPSS) version 28.0 were used to process data and conduct the statistical analysis on survey data including descriptive statistics and validity and reliability of survey. The internal consistency reliability of each composite measure was assessed by calculating Cronbach’s alpha score.
Results: The overall level of patient safety culture was 61.28% (95% CI: 113.26, 115.27) and the percentage scores for the ten patient safety dimensions ranged from 45.13% to 82.65%. The dimension, “Teamwork within the hospital units” had the highest positive score while the dimensions, “Staffing and work pace” and “Reporting patient safety events” had the lowest positive scores.
Conclusions: The healthcare professionals working in hospitals in Bhutan had average patient safety culture. To improve patient safety culture, more emphasis should be given on human resource management, patient safety event reporting system, hospital management support for patient safety and quality improvement initiatives and creating an environment that promote just and learning culture.
Outcome of Pterygium surgery with conjunctival autologous graft using suture and tissue glue at the tertiary eye center, Thimphu, Bhutan
Get PDFABSTRACTIntroduction: Pterygium is a degenerative condition of the conjunctiva characterized by fibro vascular growth of tissue onto the cornea, often necessitating surgical treatment. Currently the conjunctival autograft technique using either suture or fibrin glue is the preferred method of treatment. The aim of the study was to evaluate the outcome of Pterygium surgery using sutures and glue to fix the graft.
Methods: This observational study was carried out at the tertiary eye hospital, involving fifty-one patients (51 eyes) with primary Pterygium who underwent Pterygium surgery using either suture (19 eyes) or fibrin glue(32 eyes).The outcome measures were operative time, post-operative symptoms (pain, photophobia, foreign body sensation), and graft complications (displaced, edema, hemorrhage). Patients were followed up on day1, day 7, and day 28 after the surgery as per the standard protocol.
Results: The study consisted of 17 males and 34 females, with mean ages of 51.95 (SD 9.82) in the suture group and 51.75 (SD 5.77) in the fibrin glue group. In the suture group, mean operation time was 14.16 (SD 2.71) minutes, and in the fibrin glue group, it was 13.72 (SD 4.54) minutes. With regard to the post- operative symptoms, the intensity of foreign body sensation was found to be higher in the suture group on day 1 and day 7 (p<0.003 and p<0.001, respectively). However the foreign body sensation was not observed in both groups on day 28. There was no significant difference in symptoms like Pain and photophobia. Notably, no graft complications were observed in either group on day 28. All patients completed the required follow ups.
Conclusions: The use of fibrin glue in Pterygium surgery with conjunctival autografts relatively reduces surgery time and decreases early post-operative foreign body sensation thus improving early post-operative patient comfort compared to sutures
Clinico-Demographic profile of incomplete miscarriage at National Referral Hospital, Bhutan
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Introduction: Miscarriage is a leading health concern that causes maternal morbidity and mortality. According to the World Health Organization (WHO), the incidence of miscarriage is 39 per 1000 women aged between 15-49 years. There is no reliable information regarding miscarriage in Bhutan. This investigation attempts to study the clinical and demographic profile of incomplete miscarriages and their outcome at the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Bhutan.
Methods: An observational study was carried out from February 2020 to February 2021 including 132 women with incomplete miscarriage at JDWNRH. Purposive sampling was done and patient with incomplete miscarriage presenting to the JDWNRH was interviewed using structured questionnaire after diagnosis or before they were discharged from hospital.
Results: The study found that the proportion of incomplete miscarriage was 25.4 per 1000 pregnant women at JDWNRH. The common age group was 21-30 years with a mean age of 29.9 years. Of them, 65.91% were married, 55.3% had a stable job and 90% were gravida 2 and above. Nearly 80% reported that it was an unplanned pregnancy and 73.5% due to lack of awareness of contraceptive use. Nearly 92% required hospital admission and 88.64% received surgical management.
Conclusions: Women with incomplete miscarriages had mostly unintended pregnancies. The majority had surgical management with no mortality
Epidemiological Profile of traumatic spinal cord injuries in the National Referral Hospital, Bhutan
Get PDFIntroduction: The number of traumatic spinal cord injuries associated with a fracture is on rise which is compounded by rise in number of motor vehicle accidents in the country. The aim of the study was to assess frequency, cause, pattern, and demographic profile of traumatic spinal cord injuries in the Bhutanese population.
Methods: A retrospective study was conducted at National Referral Hospital from 2018 to 2020. Hospital records of patients, treated for traumatic spinal cord injury were reviewed.
Results: Of the total of 100 patients with traumatic spinal injury admitted during study period, there were 69 males (69%) and 31 females (31%). The mean age was 44.18 years (±16.625 SD). Falls (61%) was most common cause of spine injury followed by road traffic accident (27%). Lumbar spine injury was most common (42%) followed by cervical spine (31%) and thoracic spine (23%) injuries. Of 100 patients with spinal injury 63 patients did not have associated cord injuries while 37% of patients had associated spinal cord injuries and of those with spinal injuries, 20% of them had complete spinal cord injury (SCI) and 17% had incomplete SCI. Regarding treatment, 42% of spine injury patients underwent surgical procedures while 58% were managed conservatively. The mean length of hospital stay after spinal injury was 6.62 days (± 26.06 SD, range 1-215).
Conclusions: The study found that most common cause of spine and associated cord injuries were falls followed by road traffic accidents. By collaborating with traffic and road safety division, our study findings have potential to significantly reduce road traffic accidents and enhance preventive measures. Additionally, we can provide valuable education to families regarding rehabilitation and social support, ultimately leading to improved outcomes and better quality of life for individuals living with spinal cord injuries
Knowledge and preventive practice on Sexually Transmitted Infections among first year students in Nursing Colleges of Bhutan
Get PDFIntroduction: Sexually Transmitted Infections (STIs) are increasing globally and became the public health concerns particularly in adolescents. The adolescents are prone to get STI’s due to involvements of unhealthy behavior. However, adolescents having deficiency in identifying the signs and symptoms of STIs, could lead to complications such as infertility, Pelvic Inflammatory Disease (PID). No studies have been conducted among nursing students regarding knowledge and preventive practice on STI. Therefore, this study was aimed at determining the information about nursing college students’ knowledge and preventive practice on STIs.
Methods: A cross-sectional study was conducted among first-year nursing students among four nursing colleges of Bhutan. Purposive sampling was used. Self-administrative questionnaire including information on demographic characteristics, knowledge and preventive practice on STI was given.
Results: A total of 372 first year students from four nursing colleges in the age group of 18-22 years, participated in this study with 100% response rate. The mean age was 20.08 (±SD-1.83) years. Teacher (62.26%) was the main source of information on STI prevention. Majority of students (83%) knew that the most common methods of contraception (barrier) was condom. Half of the students (50.27%) had fair/intermediate level of knowledge, while less than 35% of the students had poor level of knowledge.
Conclusions: Students knowledge level on STI was fair and found that condom was known as an effective barrier contraception