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At least 19 recordsLinked to original sources
PubMed1994

Has primary health care reduced infant mortality in east Bhutan? The effects of primary health care and birth spacing on infant and child mortality patterns in east Bhutan.

In a traditional, agricultural society in East Bhutan studies of infant and child mortality were carried out in 1984 and 1991. Mothers were interviewed regarding births during the preceding 5 years and deaths among these children. A significant fall in infant mortality rate (IMR) from 145 to 49 (P < 0.001) was found. In 1991, measles was almost eliminated as a cause of death. Families with 1, 2 and 3 children, respectively, during the period studied, were found to have significantly different IMRs, with higher mortality for higher number of births (P < 0.001 for 1984 and P = 0.002 for 1991). To quantify the effect on mortality from birth intervals both the possibility of reverse causation and confounding factors, such as socio-economic conditions must be considered, but the study suggests that the association is partly causal. The living conditions of the population do not seem to have improved so greatly as to have caused the reduction in IMR. Monthly Mother and Child Health outreach clinics and a network of Village Health Workers have provided the framework necessary for implementation of different health programmes. As a result Primary Health Care has improved during the period between 1984 and 1991, and may have contributed considerably to the reduced mortality.

Bhutan↗
PubMed2006

Distribution of Assamese macaques (Macaca assamensis) in the inner Himalayan region of Bhutan and their mtDNA diversity.

The distributions of Assamese macaques (Macaca assamensis) and rhesus macaques (M. mulatta) in Bhutan have been only partially documented. In order to investigate the distribution patterns of these species, we conducted field observation and genetic assessment with mitochondrial DNA (mtDNA) typing of macaques in the Inner Himalayas of Bhutan. There were 24 sightings of macaque groups, and all were visually identified as Assamese macaques. No groups of rhesus macaques were sighted in this survey area, in contrast with the survey results in the Nepalese Himalayas. Molecular phylogenetic analysis revealed that the Bhutan macaques are closer in proximity to their counterparts in the Indo-Chinese region (Thailand and Laos) than to rhesus macaques in China, Laos and India. However, clustering results suggested the marked differentiation of the macaques in Bhutan from the Assamese macaques in Indo-China. We tentatively conclude that the macaques of the Inner Himalayan regions in Bhutan are Assamese macaques and that they appear to be of a lineage distinct from Assamese macaques in the Indo-Chinese region (subspecies M. a. assamensis). The degree of mtDNA diversity suggests that the Assamese macaques in Bhutan are of a more ancient ancestry than M. a. assamensis, thereby supporting the speciation hypothesis of the expansion of a sinica-group of macaques from South Asia to Southeast and then to East Asia (Fooden; Fieldiana Zool 45:1-44, 1988). Assignment of Assamese macaques in Bhutan to M. a. pelops is premature due to the lack of molecular data and recent taxonomic controversy. The mtDNA diversity of Assamese macaques was greater than that of rhesus macaques, suggesting the earlier speciation of Assamese macaques. The significance of the ecogeographic segregation model of macaque distribution is discussed in relation to the evolutionary range expansion into the Himalayan regions in South Asia.

Animals↗
PubMed2006

Distribution and prevalence of footrot in Bhutan.

The first cases of footrot in Bhutan were reported in sheep in 1990 at the National Sheep Breeding Centre (NSBC), which supplies breeding animals to village sheep flocks throughout Bhutan. Despite the presence of footrot at the Centre the distribution of apparently disease-free sheep continued. Cases of footrot were reported in village flocks soon after the disease was diagnosed at NSBC. A national survey was designed to establish the distribution and prevalence of footrot in Bhutan. This detected footrot in 19/94 village sheep flocks surveyed. The 19 affected flocks were distributed among nine different administrative districts whereas the villages selected were in 13 of a total of 16 sheep growing districts. The highest within-flock prevalences were among the seven flocks sampled in Bumthang district (mean 20.4%). The prevalence of the disease within flocks was generally much lower in other affected districts and in three districts a single affected animal was identified in the sample of 14 sheep examined in each village. Nationally, footrot prevalence was estimated to be 3.1% (95% CI 2.16-4.04%). There was a positive association between the receipt of animals from NSBC and the presence of footrot. The prevalence of the disease was higher in flocks with a migratory system of management than in those using a sedentary system. The relative risk of there being footrot in a migratory flock was nine-times higher than in a non-migratory flock. Only one strain of Dichelobacter nodosus (serogroup B) was identified among the 234 isolates obtained from the 19 affected flocks. Sheep with footrot healed quickly when treated with a vaccine made from this strain.

Animals↗
PubMed2006

Corneal ulceration in South East Asia. I: a model for the prevention of bacterial ulcers at the village level in rural Bhutan.

AIM: To prove that antibiotic distribution by grassroots volunteer village health workers (VVHWs) in Bhutan is an effective and efficient public health intervention for the prevention of post-traumatic corneal ulceration. METHODS: 55 villages in two districts in Bhutan were selected for the study. A defined population of 10 139 individuals was followed prospectively for 18 months by 31 VVHWs who were trained to identify post-traumatic corneal abrasions with fluorescein dye and a blue torch and to administer 1% chloramphenicol ointment three times a day for 3 days to the eyes of individuals who fulfilled the eligibility criteria. RESULTS: During the 18 month period 135 individuals reported to VVHWs with an ocular injury and 115 were found to have a corneal abrasion. All 115 were treated with 1% chloramphenicol ointment three times a day for 3 days and all healed without sequelae CONCLUSIONS: Corneal ulcers that occur following traumatic corneal abrasions can be effectively prevented, even in the setting of isolated rural conditions such as those that exist in villages in Bhutan, by using relatively simple preventative measures that local VVHWs can easily be taught to employ.

Adolescent↗
PubMed2002

On-site investigation of the early phase of Bhutan Health Telematics Project.

Telemedicine is valuable to many developing countries. International use of telemedicine is widespread. Telemedicine can improve health care in the developing countries by removing time and distance barrier, and optimize the use of limited health services in developing countries. The purpose of this paper is to investigate the current situation of healthcare services and telecommunications infrastructure in Bhutan. It summarizes the experience gained from a previous telemedicine pilot project initiated and implemented by the Telecommunication Development Bureau, International Telecommunication Union (BDT/ITU). It also introduces the priorities of telemedicine development set out by the local health authorities as well as the international organizations. By analyzing the common and most urgent problems in the country, which could be alleviated by using telemedicine, it formulates several recommendations concerning the future development strategy of telemedicine in Bhutan.

Bhutan↗
PubMed2002

Orthopaedics in the Buddhist kingdom of Bhutan.

Volunteering as the only orthopaedic surgeon in the small Asian country of Bhutan provided a fascinating introduction to international work. The orthopaedic work predominantly was trauma and osteomyelitis. Treatment of most problems was complicated by patient delays in obtaining medical care, usually related to transportation difficulties in a steep mountainous land with few roads. The complexities of enhancing orthopaedic care in developing countries include patient access to care, availability of adequate sterility for implantation of fixation devices, and determining in concert with the local government what is a sustainable level of care that can be taught to interested physicians in the country. Among the developing nations, Bhutan is one with a strong interest in the welfare of its people and has an economy that can afford to invest in healthcare. Despite these strengths, there remain interesting challenges for the orthopaedic volunteer. Exposure of the volunteer to the people and their culture enhanced the experience and provides a lure to continue volunteering.

Bhutan↗
PubMed2004

Epidemiology of soil-transmitted helminths in the western region of Bhutan.

In May 2003, a survey was conducted in the western region of Bhutan to assess the prevalence and intensity of soil-transmitted helminth (STH) infections after 15 years of school deworming in the country. Five schools were randomly selected in the region and 266 schoolchildren were examined. Stool samples were collected from each child as well as nutritional indicators and general information on each school. The survey found a cumulative prevalence of 16.5% STH (4.8% in schools treated in the last three months and 24% in the untreated schools). An unexpected finding was that the tapeworm infection rate of 6.7%. These results indicate a high reinfection rate in this area. WHO recommends a 50% prevalence as the threshold for the establishment of community intervention. However, in our view, Bhutan needs to continue its deworming program because the present, relatively low, prevalence level was found despite a long period of intervention; an interruption of the control activities will result in a return to very high levels of prevalence and intensity of infection.

Adolescent↗
PubMed2006

Seasonal phenology of Bactrocera minax (Diptera: Tephritidae) in western Bhutan.

The Chinese citrus fruit fly, Bactrocera (Tetradacus) minax (Enderlein), is one of the major citrus pests in Bhutan and can cause >50% mandarin (Citrus reticulata Blanco) fruit drop. As part of the development of a management strategy for the fly in mandarin orchards, population monitoring and experimental manipulations were carried out to determine: (i) adult emergence period; (ii) adult phenology patterns; (iii) period of crop susceptibility; and (iv) period from fruit drop to pupation. In western Bhutan, adult flies emerge from the overwintering pupal stage in late April/early May. Most flies are mature by the end of May and it is inferred that mating occurs at this time: from the beginning of June males rapidly disappear from the population and by mid- to late June are rare or absent from traps. Mature females are present in the mandarin crop at the beginning of June, but very little oviposition occurs until mid-June, while most damage has occurred by mid-July. Initiation of oviposition into mandarins is almost certainly linked to crop phenology. Adult flies disappear from the orchard system during August. After fruit drop, larvae were recorded leaving the fruit to pupate within 13 days. The use of early to mid-season protein bait sprays and/or targeted use of systemic insecticides during the one month oviposition period, plus the removal of fallen fruit once every 10 days, are recommended as control strategies.

Animals↗
PubMed1987

A paediatric report on Bhutan.

These data from Thimphu General Hospital constitute the first published report of child health in the Kingdom of Bhutan. The unique geopolitical, social and health situation of the children of Bhutan is little known to the West. Hospital data from 1980 to 1982 provided the descriptive setting for the establishment of a paediatric referral service in 1983. Western medical care is gradually being introduced to the people, who live in stable traditional social structures and patterns. An understanding of the pre-existing health care systems and practices is essential to planning appropriate integration of acute medical care into the rich culture with minimal social dislocation and maximal medical efficacy.

Bhutan↗
PubMed2006

Allele frequency distribution for 21 autosomal STR loci in Bhutan.

We studied the allele frequency distribution of 21 autosomal STR loci contained in the AmpFlSTR Identifiler (Applied Biosystems), the Powerplex 16 (Promega) and the FFFL (Promega) multiplex PCR kits among 936 individuals from the Royal Kingdom of Bhutan. As such these are the first published autosomal DNA results from this country.

Bhutan↗
PubMed2005

The use of an autogenous Dichelobacter nodosus vaccine to eliminate clinical signs of virulent footrot in a sheep flock in Bhutan.

An outbreak of virulent footrot was investigated in a flock of 605 Merino cross-bred sheep in Bhutan. Conventional control methods in the preceding eight years had reduced its prevalence from 36-79% in different components of the flock to about 15% overall. Only one serogroup (B) of Dichelobacter nodosus was identified among 40 isolates cultured from affected sheep. A vaccine prepared from this strain was used in a pilot trial to compare the response of 14 treated and 14 untreated sheep. All affected, vaccinated animals in this trial healed quickly and were protected against re-infection while additional cases developed among untreated sheep during a period favourable for the spread of footrot. The serogroup B vaccine was administered to the whole flock for two successive years. No other footrot treatment was given during these or subsequent years. The whole flock was examined three times, foot by foot, for two years and twice yearly for another two years. When vaccination began there were 88 affected sheep in the flock, an affected sheep being defined as an animal with a foot-score of 2 or greater in one or more feet. There were neither affected sheep in the flock 30 days after the first dose of vaccine nor were any identified in later inspections. Virulent footrot, originating from the farm under investigation, persisted in neighbouring village flocks during this period. It was concluded that whole flock specific D. nodosus vaccination made a major contribution to the elimination of all clinical signs of footrot from the flock of 605 sheep where the condition had previously persisted for 10 years.

Animals↗
PubMed1996

The struggle of weaning: factors determining breastfeeding duration in east Bhutan.

This paper presents the qualitative part of a project in a traditional community in East Bhutan, which, among other items, investigates the effects on child health of breastfeeding, weaning and subsequent pregnancy of the mother. Quantitative data from the project have shown that children who are weaned during a subsequent pregnancy of the mother have a reduced weight gain and an increased incidence of infectious diseases during weaning, while this is not so for children weaned from non-pregnant mothers. In-depth interviews with 35 women with experience from breastfeeding were carried out in the local language in order to obtain qualitative data regarding the processes underlying the motherś decisions during weaning. Breastfeeding was found to fulfil a valuable social function in addition to its biological and emotional properties. The breastfed child had an undebatable "right of access" to the mother's care, not only her breast, whenever it wanted. This child also assumed a status in the family in which both its vulnerability, its special needs and its value were clearly recognized. The mothers expressed a basic motivation to breastfeed "as long as possible". There were, however, important limitations as to how this was manifested in the practical weaning process. If the mother was pregnant at the time of weaning, these limitations tended to be mother-centred. Most of the women had experienced tenderness of the breasts and a reduced milk production from the start of the next pregnancy. It was believed that the breast milk of a pregnant woman could "rot" and cause disease in the child. In spite of this belief, concurrent breastfeeding and pregnancy were common, but a pregnant mother whose breastfed child got ill, e.g. with diarrhoea, would immediately stop breastfeeding. The child would thereby abruptly loose the most important protection against the negative effects of the disease, when this protection was most needed. Concurrent pregnancy and lactation are common in many areas of the poor world. This has important consequences for the health of mothers and children, and has only recently been given the attention it derserves.

Adult↗
PubMed1995

Premature weaning in east Bhutan: only if mother is pregnant again.

The relationship between breast-feeding and subsequent pregnancy in East Bhutan is examined, against the background of local attitudes to family planning. Ninety-eight mothers who had given birth 30-36 months earlier were interviewed. Semisolid supplementary feeding was introduced at a median age of 3 months. Median total duration of breast-feeding was 28 months, and day and night breast-feeding on demand was continued throughout. Median duration of postpartum amenorrhoea was 12 months, and was associated with the timing of the introduction of supplementary foods. There was a significant association between the occurrence of a subsequent pregnancy and early termination of breast-feeding. The relationships between breast-feeding pattern and pregnancy interval are complex, and their relative influence changes with time. During the first year postpartum, infertility during lactational amenorrhoea is important. During the second year there is a strong negative effect on lactation from the next pregnancy. The only important reason for ceasing to breast-feed within 2 years seems to be a new pregnancy.

Amenorrhea↗
PubMed2006

Mental health and psychosocial aspects of disaster preparedness in Bhutan.

Bhutan has taken the initiative in developing a comprehensive guideline on disaster risk preparedness and management in response to several minor disasters, namely earthquakes and flash floods in the country during the last couple of years. It is now widely accepted that the psychological symptoms of trauma resulting from devastation to lives and livelihood of affected people remain much longer and sometimes throughout their entire life span unless taken care of. Therefore, it is important to include psychosocial components of mental health protection and treatment of the affected persons in disaster risk preparedness and management to make it a comprehensive package. A four-tier system of mental health intervention and counselling has been proposed in line with the existing healthcare system and resources available in the country to make it sustainable. At the core of this programme is the mobilizing and training of volunteers from the community on psychosocial intervention, counselling and rehabilitation, backed up by three layers of trained health workers and mental health professionals.

Bhutan↗
PubMed2006

Epidemic of HIV coupled with hepatitis C virus among injecting drug users of Himalayan West Bengal, Eastern India, Bordering Nepal, Bhutan, and Bangladesh.

A study was conducted in June 2004 to find out the epidemiology of HIV infection among injecting drug users (IDUs) of Darjeeling District of West Bengal, eastern India. The district headquarter, Darjeeling town, also known as "Queen of Hills," is a beautiful spot situated in Himalayan West Bengal that attracts a large number of tourists each year from all over the world. Another unique feature of the district is that it has international boundaries with three countries, Nepal, Bhutan, and Bangladesh. Siliguri, the part of the district on plains, acts as a transit station for these countries as well as to the entire Himalayan region of West Bengal and neighboring state, Sikkim. It is also a transit point to all northeastern states of India: Assam, Arunachal Pradesh, Nagaland, Manipur, Mizoram, Meghalaya, and Tripura. Two hundred twenty-eight study subjects (IDUs) were included in this community-based cross-sectional study from all four subdivisions of the district. Informed consent was obtained, and then personal interviews, followed by blood testing were performed using unlinked anonymous procedure. The study revealed that overall HIV seroprevalence among IDUs was 11.8% (n = 27; 95% confidence interval, 7.9-16.7), whereas seroprevalence of hepatitis C was found to be 47.7% (n = 97). Prevalence of HIV was higher in subjects from hill districts (13.5%) compared with subjects from the plains (9.2%). It also revealed that most IDUs (75.3%) used "brown sugar," an impure form of heroin, as their major addictive substance followed by injection norphine. Sharing of injecting equipment was found to be as high as 67% among IDUs, and sharing of drugs from common ampules was found to be 35.5% of the studied subjects (n = 93). Most subjects (96%) were found to clean their injecting paraphernalia with plain water. Most IDUs (98%) were found to inject intravenously. About 52% of IDUs visited sex workers one or more times within the last 1 year, and 15% of the interviewed subjects (n = 93) reported to suffer from sexually transmitted diseases during the same period. All the IDUs knew about HIV/AIDS. About 69% of the subjects knew that apparently healthy looking person might have HIV infection. HIV was found to be associated significantly with age of the injectors and duration of injecting practices. The study revealed the epidemic of HIV and hepatitis C among IDU populations at this bordering district of West Bengal for the first time that requires urgent intervention at local, national, and international levels.

Adolescent↗
PubMed1995

Breast feeding and seasonal determinants of child growth in weight in east Bhutan.

In a prospective study of 113 children in rural Bhutan, morbidity, nutritional status and feeding practices were recorded monthly over a period of 32 months. This information was related to seasonal variations in rainfall. Diarrhoea had a negative impact on growth, as measured in monthly intervals, during the second and third years of life, reducing daily weight gain by 4.4 +/- 2.0 g (p<0.0001). this impact was largest during the monsoon season. For respiratory tract infections the value was 2.6 +/- 1.7 g (p<0.01). Growth in weight was lowest during the monsoon period (p<0.0001). Continued breast feeding was associated with an odds ration for diarrhoea of 0.51 (95% CI 0.34-0.78), and for respiratory tract infections of 0.63 (95% CI 0.40, 0.99). Growth in weight was less reduced during the monsoon season for children who were breast fed (2.5 +/- 1.7 g/day) than for those not breast fed (7.5 +/- 3.5 g/day) (p<0.01). We conclude that breast feeding is of particular importance throughout the warm and rainy season.

Bhutan↗
PubMed1996

Frequent diarrhoeas in early childhood have sustained effects on the height, weight and head circumference of children in East Bhutan.

Episodes of diarrhoea and nutritional status of 113 children in East Bhutan were recorded monthly from 7 to 36 months of age. A re-examination was carried out 20 months later. The load of diarrhoeal diseases in early childhood was negatively associated with the parameters of children's long-term nutritional status 20 months later. Also, when early nutritional status and socioeconomic factors are included in the model, the diarrhoea variable explains a significant part of the variation in height for age (p = 0.04, delta R2 = 0.035), weight for age (p = 0.03, delta R2 = 0.030) and head circumference (p = 0.0007, delta R2 = 0.077). This is not so for the variation in weight for height or mid-upper arm circumference (p > 0.1, delta R2 < 0.005). Stunting is widespread in the area, and the effects of diarrhoea on nutritional status are more likely to be sustained in settings where dietary intake is marginal.

Bhutan↗