Bhutan Health Journal

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Pediatric tele-echocardiography in the diagnosis of congenital heart diseases in a regional referral hospital in eastern Bhutan.
(2015-11) Bhandari, Purushotam; Morawakkorala, Ruwan
Introduction: 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 required early 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.
Balancing traditional beliefs and medical science: mental health care in Bhutan.
(2015-11) Nirola, Damber Kumar; Durham, Judith C; Kraus, Kurt L
In the Kingdom where Gross National Happiness is the most precious commodity, there is a growing awareness of the individual and communal toll that unmet mental health needs bring to bear on Bhutanese society. Even though mental illnesses are becoming public health issue, there is a tendency to neglect the care of mentally ill person in the general setting. The reason for the neglect is due to lack of understanding and poor management of mental illness by the health professionals and community at large. This article emphasizes the need to balance the traditional beliefs and medical science in order to provide a comprehensive mental health care in Bhutan.
Primary Tuberculosis of pharynx-diagnostic difficulties, complications and treatment.
(2015-11) Adhikari, Tika Ram; Omar, Rahmat
Primary 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.
Status of Thiamin deficiency in boarding school children from seven districts in Bhutan with previous history of peripheral neuropathy outbreaks: a cohort study.
(2015-11) Dzed, Laigden; Dorji, Tandin; Pelzom, Dorji; Dhakal, Guru P; Yangchen, Pemba; Wangmo, Kinley
Introduction: 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.
Prevalence and socio-cultural determinants of domestic violence among married women in Thimphu, Bhutan.
(2015-11) Wangmo, Kencho
Introduction: Domestic violence is a public health problem all over the world, yet its prevalence is under-reported in a pervasive “culture of silence”. Bhutan is not likely to be an exception; however, data on the prevalence, forms and determinants of domestic violence are scant. The purpose of this study is to measure the prevalence and characterize factors associated with domestic violence among women in Thimphu, Bhutan’s capital. Methods: A population-based, household cross-sectional survey was conducted in January-May, 2012. A multistage sampling method was used to obtain a representative sample of 300 married women. The chi-square test was used to identify factors associated with increased likelihood of experiencing the four forms of domestic violence. Results: The overall prevalence of any domestic violence was 44%. By type of violence, the most common was emotional (36%), followed by control (30%), physical (20%) and sexual (14%). Sexual violence was reported more often by young adolescent women. Women from urban areas reported more emotional violence compared to women from rural areas. Women agreed with many situations in which force might be used by their husbands and with many of the traditional roles of women in society. Nonetheless, many women objected to the use of force in many situations and rejected certain constraining roles of women. Conclusions: This study supports the importance of advocacy for education and programs to prevent and mitigate harm from domestic abuse experienced by women in Bhutan.
Prevalence, determinants and outcomes of unplanned pregnancy and perspectives on termination of pregnancy among women in Nganglam, Bhutan.
(2015-11) Choden, Jigme; Pem, Rinzin; Pathak, Abhijeet
Introduction: 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, χ2 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 promote 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.
The effects of a behavioral change program in reducing the house index of mosquito larvae in households in Phetcabun province, Thailand.
(2015-11) Tshering, Ugyen; Pooma, Kamonchanok; Meksaengsee, Kiratikarn; Aiemsa-ard, Nongnooch
Introduction: 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.
Average birth weight of term newborn babies: a hospital based study in Thimphu, Bhutan.
(2015-11) Dorji, Phurb
Introduction: The birth weight of every new born is a key predictor of its immediate outcome and indirect indicator for later development. There were no studies done in Bhutan to look at the average term birth weight. This study was under taken to estimate the average term birth weight of new born in Jigme Dorji Wangchuck National Referral Hospital in Thimphu and to study its correlation with maternal factors and sex of the new born. Methods: This was a retrospective study with data collected from the birthing center record for those delivered between January 2011 to December 2014. A total of 13,647 singleton babies were included. Other variables studied maternal age, parity, education level, family income, antenatal booking visits, sex of baby and maternal ethnic origins. Data were analysed for correlations. Results: From the 13,647 singleton cases, the overall average term birth weight for new born was 3,177± 435 g with boys (mean weight 3,228± 435g) being heavier than girls (mean weight 3,121 ± 429 g). This study also proved the expectation that birth weight will improve with improvements in economic situation and female literacy level. The term birth weight was positively correlated with parity, number of antenatal visits, family income, maternal education level and age. Conclusions: The average term birth weight of new born in JDWNRH is 3,177± 435 g. The mean birth of North Bhutanese (mean as 3,260 ± 436g) is heavier by 200g than the South Bhutanese (mean as 3,060 ± 411 g).
Bhutan Health Journal : intiating a new era in Bhutan.
(2015-11) Dorji, Phurb

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