Bhutan Health Journal
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The Impact of COVID-19 pandemic on the burden of dog bite cases at the National Referral Hospital in Bhutan
No full textIntroduction: Dog bite is a public health problem in Bhutan incurring huge cost of treatment. The general objective of the study was to see the impact of COVID-19 pandemic on the burden of dog bite cases and the profile of patients, comparing with that of the year before the COVID-19 pandemic started (2019) at the National Referral Hospital.
Methods: This is a retrospective record review of the dog bite cases in the year 2019 and 2020. The target population of the study were people living in Thimphu city. The dog bites that occurred outside Thimphu were excluded from the study. Proportion of dog bite according to demographic and clinical variables were calculated. Univariate and multivariate analysis were done to look for risk factors responsible for dog bite in 2020 compared to 2019. A statistically significant level was set at <0.01.
Results: The dog bite cases in the year 2019 and 2020 were recorded at 3.3% and 2.4% respectively There was male predominance and highest incidence of the dog bite was in age group of 20-59 years. The commonest site of bite were lower limbs and stray dog bites were highest risk exposure.
Conclusion: less dog bite cases reported in 2020 which may be due to the impact of pandemic. Majority of the cases were stray dog bites and high incidence of dog bites can be a major concern for health, social and economic wellbeing of the nation which needs urgent intervention
A case of Coats Disease presenting with Retinal Detachment in Bhutan
Get PDFCoats disease is a rare retinal disease. It is characterised by abnormal dilatation of retinal capillaries (telangiectasia) and increased vascular permeability (intraretinal and subretinal exudation). In advanced stage of disease the patient can have exudative retinal detachment where the retina detaches from its normal attachment. In some cases there will be secondary increase in intraocular pressure if not treated on time. It has a unilateral presentation in most of the cases. This article describes about a four year old boy who presented with retinal detachment due to coats disease. The patient was managed effectively with external subretinal fluid drainage along with laser and cryotherapy. It is essential to rule out aggressive eye cancer (retinoblastoma) as both can have similar presentation
COVID-19 challenges and management of human resource in health, Bhutan’s unique approach: Medical University’s contribution
Get PDFIn March 2020, the country saw its first case when a foreign tourist tested positive for COVID-19 at Thimphu. There was immediate activation of national preparedness and response plan including the requirements for surge in human resource capacity to handle the novel infection. One key emphasis of the national response was to support the existing 3500 health care workforce by partnering with community in sharing pandemic-related activities. One such initiative was training a pool of people to shoulder basic responsibilities at quarantine and non-hospital isolation facilities. Therefore, Khesar Gyalpo University of medical Sciences of Bhutan was tasked to develop a training program and thus the De-suup plus program was designed with focus on people from non-medical background. This article attempts to describe the development and implementation of the training. The training constituted basic nursing competencies, personal protective equipment and essential public health preventive measures with the purpose of serving at quarantine and non-hospital isolation facilities in the Country
Pattern and short-term outcome of pediatric kidney disease at national referral hospital in Bhutan: an observational study
Get PDFIntroduction: The epidemiology of kidney diseases in children can vary widely across geographic regions. The main purpose of this study was to determine the pattern and short-term outcome of kidney disease among children hospitalized at the national referral hospital in Bhutan.
Methods: All admitted children aged one month to 12 years with kidney disease, from January to December 2018, were included in the study. Diagnostic criteria were applied to all the patients on admission to determine study eligibility and subsequent demographic and clinical data were collected using a structured interviewer administered pro forma.
Results: A total of 128 (7.8%) children met diagnostic criteria for kidney disease among 1648 hospitalized children during the study period. The median age at presentation was 2.5 years (interquartile range 0 to 8). The commonest disease was acute kidney injury (48, 37.5%) followed by acute glomerulonephritis (37, 28.9%), urinary tract infection (37, 28.9%), congenital anomalies of kidney and urinary tract (11, 8.6%) and nephrotic syndrome (11, 8.6%). Median duration of hospital stay was 8 days (IQR 4 to 14.8). Four (3.1%) patients were referred to India for specialist care, 5 (3.9%) underwent dialysis and 28 (21.9%) died. Of the 28 patients who died, 26 (92.9%) had acute kidney injury and 2 (7.1%) had chronic kidney disease.
Conclusions: Pediatric kidney diseases comprise a significant proportion of disease burden at the national referral hospital. Education of primary healthcare providers about the epidemiologic burden of pediatric kidney diseases is needed to reduce kidney-related morbidity and mortality
Multimodal imaging in Angioid streaks with Pseudoxanthoma elasticum : a case report
Get PDFAngioid streaks refer to dehiscence in the Bruch’s membrane- retinal pigment epithelium complex. It appear as dark to brownish streaks radiating from optic nerve on funduscopy. It is a rare occurrence and pseudoxanthoma elasticum is the most common systemic association (59%-87%). Angioid streaks lead to avoidable blindness if associated with choroidal neovascular membrane. We report a case of biopsy proven Pseudoxanthoma elasticum with angioid streaks in a young lady. It is not reported in our country till now
A clinical audit report on quality of nursing documentation at Jigme dorji Wangchuck national referral Hospital, 2018
Get PDFIntroduction: Whether it is a written documentation or an oral communication, the practice and delivery of healthcare is debated to be critically dependent on effective and efficient communication. Nursing documentation is one of the principal sources of information about patient care and an important tool for communication. This descriptive study assessed both quantitative completeness and quality of nursing documentation by major in-patient units of Jigme Dorji Wangchuck National Referral Hospital.
Methods: This cross-sectional study used D-catch tool. Data of randomly selected 317 patient records from six major in-patient units were entered into EpiData file. Using STATA version IC/14, descriptive statistics and multi variable analysis were carried out.
Results: Overall quantitative completeness (M-3.4, SD-.59) of the nursing documentation was higher compared to the quality of the documents maintained (M-2.8, SD-.79). The basic and less time-consuming information such as admission data and vital signs charting are documented better compared to the more time consuming and complex documentation such as nursing care process.
Conclusion: Systems should not only be in place to enhance documentation quantitatively but also consider uplifting the quality of the documents maintained. Initiating centralized admission system in the hospital may reduce nurses’ burden of clerical documentation, which will allow them to focus on quality nursing documentation and overall nursing care of patients
Effectiveness of lignocaine-dexamethasone periauricular injection on treating tinnitus
Get PDFTinnitus is a highly prevalent disorder with no effective treatment. The various topical treatment used are ineffective and the benefits are mainly due to its placebo effect. A study on a series of twelve patients was carried out in a tertiary hospital in Bhutan to see the effectiveness of lignocaine-dexamethasone periauricular injection on treating tinnitus. To remove the bias in recording tinnitus by subjective response, we used a single patient as both case and control for the first time in such studies. The study found that there was no significant difference in reduction in tinnitus severity in both case and control ears even after eliminating the subjective response bias
Emerging Infectious Disease: Coronavirus Disease of 2019 (COVID- 19): What we know and what remains to be known?
Get PDFOral Health Status of 3- to 5 -Year-old Children Attending Early Childhood Care and Development Centers in Bhutan: A Pilot Study: Oral Health Status of 3- to 5 -Year-old Children Attending Early Childhood Care and Development Centers in Bhutan: A Pilot Study
No full textIntroduction: Early Childhood Caries (ECC) is a common childhood dental disease worldwide. To date, dental disease prevalence in children in Bhutan is unknown. Objectives: This study was conducted to estimate the prevalence of early childhood caries and its modifiable risk factors.
Methods: We conducted a cross-sectional survey in 3-5-years old children attending Early Childhood Care and Development Centers in Bhutan. Mouth examination recorded teeth with decay (d), missing due to decay (m) and filled (f), to calculate caries experience (mean dmft and standard deviation=SD). Parents and caregivers were interviewed about their children’s oral health status, oral hygiene practices and diets among others. The prevalence of modifiable risk factors for disease was described based on parental responses. The association between decay and selected sociodemographic characteristics and oral health variables were investigated with bivariate analyses (X2).
Results: Overall, 80.5% children had caries experience with mean dmft + or - SD (4.9 + 4.2). In fact, 79.9% had untreated decay. Only few had fillings as an evidence for availing dental care with mean filled 0.2 (SD=0.7). The percentage of decay increased significantly as maternal education increased and with low socioeconomic status (p=0.02).
Conclusions: Early Childhood Caries are highly prevalent in Bhutan. Very few young children sought dental care. We recommend engaging relevant stakeholders in efforts to promote dental care and educate parents to use fluoridated toothpastes
Knowledge, Attitude and Practice of nurse-midwives on the use of partograph in health care centres of Bhutan
Get PDFIntroduction: World Health Organization recommends using partograph to reduce maternal and neonatal deaths due to obstetric complications. Proper utilization of partograph by health care providers was noted to be good when it is associated with better knowledge and a positive attitude towards partograph. There is a paucity of scientific study about knowledge, attitude and practice on the use of partograph among healthcare providers in Bhutan. Therefore, this study aimed to assess the knowledge, attitude and practice of nurse-midwives on the use and completeness of partograph in seven hospitals and one Basic Health Unit grade I.
Methods: A descriptive study was carried out from September 2017 to February 2018. Non-probability sampling method was used to survey all nurse-midwives who attended deliveries in the selected health facilities using a standard semi-structured questionnaire. All partographs filled three months before the data collection was selected purposefully and reviewed using a checklist.
Results: A total of 96 participants consisting of 66 (68.8%) females and 30(31.3%) males consented for the survey. Good knowledge of partograph was reported among 48(50%) of the participants with a mean score of 12.1 (SD: ± 1.52). Attitude on the usage of partograph was found to be favorable with a median of 42 (range 32-48). Partograph usage was reported by 86 (89.6%) while only 10.4% reported having received in-service training on partograph. Out of 426 partographs reviewed, only 68 (16.0%) were found to be complete.
Conclusions: Despite the encouraging findings on the use of partograph, completeness of the partograph was very low. This study therefore, recommends the reinforcement of knowledge and practice through periodic continuous medical education and auditing of the partographs