Bhutan Health Journal
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Beyond COVID-19: Creating a public health system based on Comprehensive Primary Health Care
Get PDFThe World Health Organization was created in 1948. It was initially focused on medical and bio-medical issues and on the delivery of health services. The Alma Ata Declaration of 1978 brought the wider context of social determinants based on the principles of equity and community participation into discussions about how health improves1. The Global Conference on Primary Health Care in Astana, Kazakhstan in October 2018, reinforced the critical role of primary health care to ensure that everyone everywhere is able to enjoy the highest possible attainable standard of health2. Primary Health Care (PHC) became the policy of all member nations. Despite this policy, focus has remained on the delivery of health services. This siloed approach proved inadequate to address the COVID pandemic. The result has been the loss of several hundred thousand lives as well as livelihood of millions more people3
Effectiveness of different ways of presenting neuroanatomy illustration in powerpoint slides on nursing student’s short -term learning memory
Get PDFIntroduction: Neuroanatomy is considered as difficult subject as it consists mostly of complicated microscopic structures. However, understanding of the subject structure is very important for nursing students to know its functions and dysfunctions for enhancing nursing practices. To date, teaching neuroanatomy relies heavily on illustrations and the most common way is by using PowerPoint slides, but teachers are often faced with dilemma on how to use illustrations effectively. Therefore, this study was conducted to assess the effectiveness of different ways of presenting neuroanatomy illustrations in PowerPoint slides on nursing students’ short[1]term learning memory.
Methods: The quasi-experimental study was conducted at Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan between June 2020 and November 2020 by comparing an Experimental (n= 70) and a Control group (n= 69) of first year nursing students for their ability to answer questions based on those seven-way slides. Independent sample t-test was used for statistical analysis.
Results: Significant difference was found at 95% CI between the performance of the Experimental and Control groups regarding Way 1 (Sequencing of labels) and Way 6 (Magnifying from the original structure) of presentation (tWay 1(135.99) = 2.695, p= .008, d = .458, 95% CI = [0.059, .385]; tWay 6(135.61) = 2.351, p= .020, d = .399, 95% CI = .031, .355], respectively).
Conclusions: The use of different ways like sequencing the labels and magnifying from the original structure of presenting illustration in PowerPoint slides are found to be helpful in increasing short[1]term memory in students
Characteristics of people who died by suicide: record review of two and half years from the National Referral Hospital, Bhutan
Get PDFIntroduction: To address the suicide issue in the country, the Royal Government of Bhutan implemented a three year suicide prevention action plan from 1st July 2015 to 30th June 2018. As part of that action plan a national suicide registry was established under the Ministry of Health in January 2016 to collect comprehensive national data on suicide. The purpose of this study is to generate national information on suicide by analysing the suicide cases investigated and reported to suicide registry by the Forensic Department during the first two and half years.
Methods: The study is a descriptive, retrospective and quantitative analysis of the suicide cases investigated by the Forensic Department from 1st January 2016 to 30th June 2018. The variables included the characteristics of the suicide victims.
Result: Majority of the victims were young adults with no or low education and were either unemployed or employed with less income. 56.7% of the victims were women. Majority of them did not have physical illness or disability. About 45% had some form of mental health issues. Majority of them experienced some form of acute stressful event prior to committing suicide.
Conclusion: Improved socioeconomic conditions through gainful employment, easily accessible mental health services and social support networks as well as population with good social and emotional skills will contribute to prevention of suicide in the country.
Incidental diagnosis of Herlyn-Werner-Wunderlich Syndrome in a nulliparous woman: a case report in Bhutan
Get PDFHerlyn-Werner-Wunderlich syndrome (HWWS) is a rare congenital syndrome with features of uterus didelphys, ipsilateral absent kidney and obstructed hemivagina. Ultrasound findings of absent kidney or abnormalities in the kidney should alert the clinicians about the syndrome. Complications like endometriosis, infertility and pelvic inflammation occurs with late diagnosis.A 42-yearold nulliparious married woman who presented with right sided abdominal pain to the National Referral Hospital was diagnosed to have HWWS. The diagnosis was supported by ultrasound, CT and MRI findings. Patient was treated for endometriosis and had symptomatic improvement. The diagnosis of the syndrome is challenging as it is rare but clinicians should suspect the syndrome in women who present with infertility. Ultrasound scan is the basic investigation to screen the syndrome which is available in most hospitals
Are people aware of the Buddhist astrological recommendations on timing for surgery?
Get PDFIntroduction: Adhering to the astrological recommendations on timing of invasive therapies are a standard practice in gSo-wa Rig-pa based Bhutanese Traditional Medicine. The day (for La-dza, Sog-dza and Shey-dza), lunar date (for La-ney) and time within the day of surgery (for La-ney), along with Wang-thang (field of power) and Lung-ta (Horse of fortune) are important astrological recommendations. However, there are no information about the patients’ knowledge, attitude and practice on astrological recommendations for timing of surgery in an allopathic setting in Bhutan. The study was conducted to assess the knowledge, attitude and practice of considering Buddhist astrological recommendations among patients undergoing elective surgeries.
Methods: A cross-sectional study with convenient sampling was conducted at the National Referral Hospital, Thimphu from April to May 2018. Data were collected using a pretested interviewer-administered questionnaire. Ethical clearance was obtained from the Research Ethics Board of Health, Bhutan.
Results: From 420 participants (response rate 99.5%), 188 (44.8%) were aware that there are astrologically determined good timings to undergo elective surgeries. Only four persons (1.0%) were aware about La-ney. Among those who believed in such astrological recommendations, the attitude were more favourable towards the areas in which they had higher knowledge.
Conclusion: The patients had very poor knowledge about the astrological recommendations to choose the timing for surgery. A well designed study on the effect of astrological recommendations on the surgical outcomes is recommended for generating evidence for further action
Blood Lead Levels in children 2 through 59 months old in Bhutan
Get PDFIntroduction: Pediatric lead exposure has long-term health, public health, and economic consequences; however, it is an underrecognized problem in low and middle-income countries. Our objective was to determine the prevalence of elevated blood lead levels (EBLLs) (greater than or equal to 5mg/dL) and evaluate risk factors for EBLLs in infants and children in two cities in Bhutan.
Methods: A cross-sectional study of children 2 through 59 months old was conducted in Thimphu and Phuentsholing, Bhutan during 2018. Blood was obtained by finger-stick and tested using a LeadCare II analyzer (Meridian Bioscience). Data were double entered in EpiData 3.1 and validated. Excel, Prism8, and STATA/IC 15.1 were used for analysis.
Results: Among 531 participants, the prevalence of EBLLs was 43.88%. The prevalence of EBLLs in girls and boys was 37.40% (n=262) and 50.19% (n=269), respectively (p= 0.004). The prevalence in Thimphu was 52.35% (n=361), compared to 25.88% (n=170) in Phuentsholing (p less than 0.001). In Thimphu, 70.47% (n=149) of 1 - 4 year old children tested in spring had EBLLs, compared to 51.45% (n=138) in autumn (p=0.001). Of the risk factors assessed, only regularly eating with fingers or hands was significantly associated with EBLLs (p < 0.001).
Conclusions: Nearly half of participants in two cities in Bhutan had elevated blood lead levels. Seasonal exposure to lead appears to be present. The high prevalence in this study is alarming. Further studies are urgently needed to both characterize the sources of lead and validate these findings on a larger scale
Prostheses Use and Satisfaction among People with Lower-limb Amputation in 10 districts of Bhutan
No full textIntroduction: The use of lower-limb prostheses restores functional mobility and improves quality of life for people with lower limb amputation. However, the use of prostheses is significantly impacted by users’ satisfaction with their prostheses and service delivery. Therefore, the excellence of prosthetic rehabilitation is not only assessed by the number of prostheses users but is also determined by the level of satisfaction with the prostheses and services received. The study was conducted to determine prostheses use and satisfaction among people with lower-limb amputation.
Methods: A cross-sectional study was conducted among lower-limb prosthetic users in 10 districts of Bhutan. Data was collected by face-to-face interview using the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) questionnaire. Participants were recruited by purposive sampling.
Results: The study found that 96.4% of persons with lower-limb amputation currently used prostheses and 79% of them have used it for more than 7 hours/day. However, 44% of prostheses needed repair. The total QUEST score of satisfaction was 4.0 (SD 0.5).
Conclusion: Majority of lower-limb prostheses are in use and the users reported being quite satisfied with their prostheses and service delivery. The study recommends initiating follow-up services to improve prosthetic use and overall satisfaction scores for both prostheses and service delivery
Prevalence of Occupational noise induced hearing loss (ONIHL) among industrial workers in Bhutan.
No full textIntroduction: Exposure to any type of noise has a potential risk. Higher the level of noise and longer duration of exposure, the more the risk for the hearing sensitivity and health as a whole. The objective of the study is to determine the prevalence of Occupational Noise Induced Hearing Loss (ONIHL) among the industrial workers in Bhutan and to ascertain high risk establishment and vulnerable occupations.
Methods: The hearing assessment was conducted among 1638 workers considering different types of industries and occupations to ascertain the prevalence of occupational noise induced hearing loss and vulnerable group amongdifferent industries and occupations. Descriptive statistics and binary logistic regression were performed to test the significance of ONIHL among the various independent variables.
Results: The study found that the prevalence of ONIHL stands at 27.9% among industrial workers in Bhutan. 42.45% of candidates who had ONIHL reported with tinnitus in either or both ears. This study founda significant association between the exposure duration and the severity of ONIHL among the industrial workers. Considering the type of industry, wood based industry, hydro services, cement and polymer were found to have a higher prevalence of ONIHL and similarly, higher prevalence of ONIHL were found among occupations such as blaster, chipper, carpenters, dryer (knife grinder) and crusher operators.
Conclusions: This study conduces that prevalence of ONIHL among industrial workers is found to be at the higher side and some of the occupations and industries impose higher risk. The study suggests that there is need for intervention such as strict enforcement of the permissible exposure limit, monitor and evaluate hearing conservation programs, and providing advice and recommendation to address such issues by the relevant agencies and industrie