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Lethro P, Nishizawa Y, Dorjee K, Zangmo K, Dorji L, Tenzin K. Determinants of Neonatal Mortality in Bhutan: A Case-Control Study. Asia Pac J Public Health 2023; 35:486-493. [PMID: 37842840 DOI: 10.1177/10105395231203112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
More than half of Bhutan's under-five mortality is attributed to neonatal deaths. Despite this, there is a lack of local evidence on determinants of neonatal mortality. It is critical to generate new evidence to accelerate interventions to achieve sufficient reduction of neonatal mortality rate in line to sustainable development goal target 3.2. Thus, this study was aimed at exploring determinants of neonatal mortality in Bhutan. A case-control study was performed with reported neonatal deaths from hospitals and primary health centers between 2018 and 2019. A total of 181 neonatal deaths were included as cases along with three corresponding controls. Epidata and STATA were used for data management and analysis, respectively. A multivariable model was fitted to identify determinants of neonatal mortality. History of obstetric complications (odds ratio [OR] = 3.53; 95% confidence interval [CI] = 1.48-8.42), intrapartum complications (OR = 3.86; 95% CI = 1.71-8.74) gestational age (OR = 8.07; 95% CI = 2.89-22.52), and Apgar 1 minute (OR = 4.40; 95% CI =1.83-10.59) were associated with neonatal death. Therefore, quality of care during pregnancy and childbirth besides promoting supportive family environment is essential to reduce neonatal mortality.
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Affiliation(s)
- Pema Lethro
- University of Western Australia, Perth, Australia
- Ministry of Health, Thimphu, Bhutan
- Royal Institute of Management, Thimphu, Bhutan
| | - Yoriko Nishizawa
- School of Medicine, University of Fukui, Fukui, Japan
- Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan
| | | | - Kencho Zangmo
- Burapha University, Thailand
- Rajiv Gandhi University of Health Sciences, Karnataka, India
| | - Lobzang Dorji
- University of Sydney, Sydney, Australia
- MAG Osmani Medical College, Bangladesh
| | - Karma Tenzin
- Royal Institute of Management, Thimphu, Bhutan
- Sherubtse College, Kanglung, Bhutan
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Dorjee K, Kathirvel S, Jeyashree K, Dorji T, Choeda T, Pelzom D, Gurung MS, Tenzin K, Wangmo S, Penjor T. Prevalence, Pattern, and Factors Associated With Self-reported Disability Among the Bhutanese Population: A Secondary Data Analysis of Population and Housing Census. Asia Pac J Public Health 2021; 34:221-229. [PMID: 34696620 DOI: 10.1177/10105395211049856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We analyzed the Population and Health Census of Bhutan (PHCB) 2017 to assess the prevalence and pattern of self-reported disability among people aged ≥15 years and the associated factors. The PHCB 2017 used the Washington Group Short Set on Functioning questionnaire to assess the disability ("lot of difficulty" or "cannot do at all") in seeing, hearing, mobility, cognition, self-care, and communication. Of the 536 443 persons included in the analysis, 384 101(71.6%) were aged <45 years, 283 453(52.8%) were men, and 206 103(38.4%) were from the rural area. The prevalence of any self-reported disability was 2.8%, among whom 34.2% reported multiple disabilities. The disability prevalence (any) was significantly higher among people aged ≥65 years, illiterate, economically inactive, permanent residents, residing in a rural area, and from central and eastern regions of the country compared with their respective counterparts. Further research on access to rehabilitation and linking with social protection schemes for the disabled is required in this country.
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Affiliation(s)
- Kinley Dorjee
- Sustainable Development, Health Management Information System and Research Unit, Ministry of Health, Thimphu, Bhutan
| | - Soundappan Kathirvel
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education & Research, Chandigarh, Chandigarh, India
| | | | - Thinley Dorji
- Kidu Medical Unit, His Majesty's People's Project, Thimphu, Bhutan
| | - Tshering Choeda
- Gyesar Gyalpo University of Medical Sciences, Royal Government of Bhutan, Thimphu, Bhutan
| | - Dorji Pelzom
- Health Management Information System and Research Unit, Ministry of Health, Thimphu, Bhutan
| | - Mongal Singh Gurung
- Health Management Information System and Research Unit, Ministry of Health, Thimphu, Bhutan
| | - Karma Tenzin
- Gyesar Gyalpo University of Medical Sciences, Royal Government of Bhutan, Thimphu, Bhutan
| | | | - Tashi Penjor
- Policy and Planning Division, Ministry of Health, Bhutan
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Choeda T, Jeyashree K, Kathirvel S, Dorji T, Dorjee K, Tenzin K, Thinley S, Tenzin T, Gurung MS. Dietary behavior of school-going adolescents in Bhutan: Findings from the global school-based student health survey in 2016. Nutrition 2021; 90:111290. [PMID: 34111832 DOI: 10.1016/j.nut.2021.111290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 04/16/2021] [Accepted: 04/18/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Bhutan is experiencing a dual burden of undernutrition and overnutrition among adolescents. Understanding dietary behavior is vital to designing evidence-based interventions to improve adolescent nutrition and prevent non-communicable diseases in adults. The aim of this study was to assess the pattern of dietary behavior and associated sociodemographic, behavioral, and metabolic risk factors among school-going adolescents in Bhutan. METHODS The Bhutan Global School-based Student Health Survey 2016 studied students in grades 7 to 11 (N = 7576), sampled from 50 schools, randomly selected based on probability proportional to enrollment size, using a standardized self-administered questionnaire. Consumption of adequate fruits and vegetables (each at least twice daily, or a combination of at least five times daily), high-protein food at least twice weekly) in the past 30 d, no fast food in the past week, and no carbonated/sweetened drinks in the past 30 d were studied. Weighted prevalence of dietary behaviors and adjusted prevalence ratio (95% confidence interval) for factors associated with them were calculated. RESULTS Of 5809 students from 13 to 17 y of age comprising 3255 (56%) girls and 3184 (54.8%) day students, 1166 (20.1%) were underweight, 1655 (28.5%) were tobacco users, and 1349 (23.2%) were alcohol users. Adequate fruit and vegetable intake, high protein consumption, not consuming fast foods and carbonated beverages were reported by 29.6%, 31.8%, 9.6%, and 14.9%, respectively. Being a day student, sex, and not reporting health risk behaviors were significantly associated with any healthy dietary behavior. CONCLUSION Healthy eating behavior was low among Bhutanese adolescents. Policies influencing availability, affordability, and acceptability of healthy diets through peer-led, school- and community-based interventions are required to promote adolescent health and prevent non-communicable diseases.
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Affiliation(s)
- Tshering Choeda
- Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan.
| | | | - Soundappan Kathirvel
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Thinley Dorji
- Kidu Medical Unit, His Majesty's People's Project, Thimphu, Bhutan; Jigme Dorji Wangchuck National Referral Hospital, Ministry of Health, Thimphu, Bhutan
| | - Kinley Dorjee
- Policy and Planning Division, Ministry of Health, Thimphu, Bhutan
| | - Karma Tenzin
- Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | | | - Tashi Tenzin
- Faculty of Postgraduate Medicine, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan; Jigme Dorji Wangchuck National Referral Hospital, Ministry of Health, Thimphu, Bhutan
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Tshokey T, Choden J, Dorjee K, Pempa P, Yangzom P, Gyeltshen W, Wangchuk S, Dorji T, Wangmo D. Limited Secondary Transmission of the Novel Coronavirus (SARS-CoV-2) by Asymptomatic and Mild COVID-19 Patients in Bhutan. Am J Trop Med Hyg 2020; 104:490-495. [PMID: 33308385 PMCID: PMC7866324 DOI: 10.4269/ajtmh.20-0672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 12/01/2020] [Indexed: 12/21/2022] Open
Abstract
As the COVID-19 pandemic continues, there is growing concordance and persisting conflicts on the virus and the disease process. We discuss limited transmissibility of the virus by asymptomatic and mild cases of COVID-19 patients in Bhutan. We followed up the secondary transmission of SARS-CoV-2 in the contacts of asymptomatic and mild COVID-19 patients in Bhutan. Bhutan had 33 confirmed COVID-19 cases in the country as of May 29, 2020. Of these, 22 (67%) were females. Except the first two cases (American tourists), the rest were Bhutanese living outside the country. The mean age of the Bhutanese patients was 26.3 (range 16-33) years. Close contacts of 27 of the 33 cases were followed up for signs and symptoms and COVID-19 positivity. The first two cases had 73 and 97 primary contacts, respectively, and equal number of secondary contacts (224). From the third case, a mandatory 21-day facility quarantine was instituted, all primary contacts were facility quarantined, and there were no secondary contacts. In total, the 27 cases had 1,095 primary contacts and 448 secondary contacts. Of these, 75 individuals were categorized as definite high-risk contacts. Secondary transmission occurred in seven high-risk contacts. Therefore, the overall secondary transmission was 9.0% (7/75) and 0.6% (7/1,095) among the high-risk and primary contacts, respectively. No transmission occurred in the secondary contacts. In contrast to several reports indicating high transmissibility of SARS-CoV-2 in contacts of confirmed cases, the mostly young, asymptomatic, and mild cases of COVID-19 in Bhutan showed limited secondary transmission.
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Affiliation(s)
- Tshokey Tshokey
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
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Hauc SC, Tshering D, Feliciano J, Atayde AMP, Aboukhater LM, Dorjee K, Dukpa T, Rinchen P, Yoezer N, Luc CM, Adhikari RN, Lhamo K, Khoshnood K. A Cross-Sectional Survey Analyzing Community Perception and Utilization of Village Health Workers Stratified by the Urban-Rural Divide Within the Kingdom of Bhutan. Asia Pac J Public Health 2020; 33:113-116. [PMID: 33174437 DOI: 10.1177/1010539520969232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Village health workers (VHWs) serve as an integral health resource for many resource limited nations, including the Kingdom of Bhutan. As such, we aimed to identify community perceptions as well as utilization rates and types with relation to VHWs based on the urban-rural divide. Our team conducted a randomized survey of 429 community members in 14 villages within the Western region of Bhutan. Our findings indicate VHWs in rural communities are requested for their services twice as much as their urban counterparts. More specifically, urban VHWs are utilized 2.5 times more for general community services, while rural VHWs are utilized more for accessing medications. Additionally, our research indicates a need to increase training of VHWs as well as overall program promotion relating to the specific services that VHWs can provide. These investigations indicate the importance of differentially allocating resources, programming, and training based on the urban-rural divide.
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Affiliation(s)
| | | | | | | | | | | | - Tshering Dukpa
- Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | - Pema Rinchen
- Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | - Neema Yoezer
- Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
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Salvo F, Dorjee K, Dierberg K, Cronin W, Sadutshang TD, Migliori GB, Rodrigues C, Trentini F, Di Serio C, Chaisson R, Cirillo DM. Survey of tuberculosis drug resistance among Tibetan refugees in India. Int J Tuberc Lung Dis 2015; 18:655-62. [PMID: 24903934 DOI: 10.5588/ijtld.13.0516] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Tuberculosis (TB) is a major health problem among Tibetans living in exile in India. Although drug-resistant TB is considered common in clinical practice, precise data are lacking. OBJECTIVE To determine the proportion of drug-resistant cases among new and previously treated Tibetan TB patients. DESIGN In a drug resistance survey in five Tibetan settlements in India, culture and drug susceptibility testing (DST) for first-line drugs were performed among all consecutive new and previously treated TB cases from April 2010 to September 2011. DST against kanamycin (KM), ethionamide, para-aminosalicylic acid and ofloxacin (OFX) was performed on multidrug-resistant TB (MDR-TB) isolates. RESULTS Of 307 patients enrolled in the study, 264 (193 new and 71 previously treated) were culture-positive and had DST available. All patients tested for the human immunodeficiency virus (n = 250) were negative. Among new TB cases, 14.5% had MDR-TB and 5.7% were isoniazid (INH) monoresistant. Among previously treated cases, 31.4% had MDR-TB and 12.7% were INH-monoresistant. Of the MDR-TB isolates, 28.6% of new and 26.1% of previously treated cases were OFX-resistant, while 7.1% of new cases and 8.7% of previously treated cases were KM-resistant. Three patients had extensively drug-resistant TB. CONCLUSIONS MDR-TB is common in new and previously treated Tibetans in India, who also show additional complex resistance patterns. Of particular concern is the high percentage of MDR-TB strains resistant to OFX, KM or both.
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Affiliation(s)
- F Salvo
- Emerging Pathogens Unit, San Raffaele Scientific Institute, Milan, Italy
| | - K Dorjee
- Tibetan Delek Hospital, Central Tibetan Administration, Dharamsala, India
| | - K Dierberg
- Division of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - W Cronin
- Maryland Department of Health and Mental Hygiene, Baltimore, Maryland, USA
| | - T D Sadutshang
- Tibetan Delek Hospital, Central Tibetan Administration, Dharamsala, India
| | - G B Migliori
- WHO Collaborating Centre for TB and Lung Diseases, Fondazione S Maugeri, Care and Research Institute, Tradate, Italy
| | - C Rodrigues
- Department of Microbiology, Parmanand Deepchand Hinduja Hospital and Medical Research Centre, Mumbai, India
| | - F Trentini
- University Center for Statistics in the Biomedical Sciences, Università Vita-Salute San Raffaele, Milan, Italy
| | - C Di Serio
- University Center for Statistics in the Biomedical Sciences, Università Vita-Salute San Raffaele, Milan, Italy
| | - R Chaisson
- Division of Infectious Diseases, Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - D M Cirillo
- Emerging Pathogens Unit, San Raffaele Scientific Institute, Milan, Italy
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