Laboratory and clinico-demographic profile of patients investigated for tuberculosis in the National Referral Hospital of Bhutan

Tuberculosis (TB), caused by the bacterium Mycobacterium tuberculosis, is an important public health problem in Bhutan. Microscopy is the primary method of diagnosis of TB in developing countries including Bhutan. Performance of microscopy in the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), has never been assessed. A retrospective review of laboratory records for three years (2014-2016) was performed to determine the laboratory profile of patients investigated for different types of TB at the JDWNRH. A total of 10,821 sputum and 3,495 non-sputum samples were examined for pulmonary TB (PTB) and extrapulmonary TB (EPTB) respectively. The commonest EPTB samples were Fine Needle Aspiration Cytology (FNAC), urine and sterile fluids. About 6% (127/2163), 5 % (130/2390) and 5% (289/5310) were positive for PTB in 2014, 2015 and 2016 respectively and EPTB positivity was about 7% in all years. During follow-up a significant number of patients remained sputum positive. Sputum sample satisfactory rate (quality) varied between 51 % to 79% in the primary samples. Sample completeness (number) ranged between 62.3% to 94.6% but dropped sequentially in the follow-up cases. Sample completeness of urine samples for EPTB ranged between 75-90%. EPTB positivity rate was highest in FNAC, followed by urine, pleural fluid and ascitic fluid samples. Higher number of patients were investigated for TB in subsequent years from 2014 to 2016. TB positivity rates for PTB and EPTB remained consistent over three years at about 5-6% and 7% respectively. There was a significant variation in sputum sample adequateness (by quality and number). Sputum conversion in the follow-up cases was lower than other countries. Educating the patients on the importance of providing adequate samples can improve TB diagnosis, enhance early treatment, reduce transmission and contribute significantly towards TB elimination

Pneumonia in children admitted to the national referral hospital in Bhutan: a prospective cohort study

Objectives The study aim was to describe the etiological profile and clinical characteristics of pneumonia among children hospitalized in Thimphu, Bhutan. Methods This prospective study enrolled children aged 2–59 months admitted to the Jigme Dorji Wangchuck National Referral Hospital with World Health Organization (WHO)-defined clinical pneumonia. Demographic and clinico-radiological data were collected through questionnaires, physical examination, and chest radiography. Blood samples and nasopharyngeal washing were collected for microbiological analysis including culture and molecular methods. Results From July 2017 to June 2018, 189 children were enrolled, of which 53.4% were infants. Pneumonia-related admissions were less frequent over the winter. Chest radiographies were obtained in 149 children; endpoints included pneumonia in 39 cases (26.2%), other infiltrates in 31 (20.8%), and were normal in 79 children (53.0%). Non-contaminated bacterial growth was detected in 8/152 (5.3%) blood cultures, with only two cases of Streptococcus pneumoniae. Viral detection in upper respiratory secretions was common, with at least one virus detected in 103/115 (89.6%). The three most-commonly isolated viruses were respiratory syncytial virus (52/115; 45.2%), rhinovirus (42/115; 36.5%), and human parainfluenza virus (19/115; 16.5%). A third of patients with viral infections showed mixed infections. Case fatality rate was 3.2% (6/189). Conclusion Respiratory viral infections predominated among this cohort of WHO-defined clinical pneumonia cases, whereas bacterial aetiologies were uncommon, highlighting the epidemiologic transition that Bhutan seems to have reached

A Discussion on the Singing Dialogue Tsangmo : Bridging Culture Between Bhutan and Japan, from the Past to the Future

Bhutanese tsangmo is a unique cultural heritage that has been at the heart of folk culture in many regions of Bhutan. It was considered to be on the verge of extinction due to the trends toward globalization and modernization. However, new attempts have already been made in schools, through radio programming, teacher education, and other means to ensure its continuation. These attempts involve wisely transformed styles of traditional ways of playing. Our research group has been investigating the real-life circumstances and unique value of these songs since 2010. In this paper, we describe our findings and exchange opinions between Bhutanese and Japanese, each discussing tsangmo from our own viewpoints, including the cultural heritage in Bhutan, the language as it relates to tsangmo, new attempts to promote passing on tsangmo, Bhutanese creative dialogue and Japanese education, and finally, understanding the importance of tsangmo within the prospects for Asia from the perspective of ethnomusicology. Through our discussion we hope to shine a light on the remarkable and rich cultural heritage of Bhutan so that it may thrive in future generations.This work was supported by JSPS KAKENHI Grant Number JP 26301043

Dog Bites in Humans and Estimating Human Rabies Mortality in Rabies Endemic Areas of Bhutan

Dog bites in humans are a public health problem worldwide. We conducted a hospital based questionnaire survey and described the incidence and risk factors for human dog bites in Bhutan. We also estimated the human death rate attributable to rabies in two rabies endemic areas of south Bhutan. Our study shows that dog bites incidents in humans are common in the survey areas. There were significant gender and age differences in bite incidents; males and the children are affected the most. The majority of the victims were bitten by stray dogs, increasing the risk of rabies infection if not treated in time. Our decision tree model predicted 2.23 (95% CI: 1.20–3.59) human deaths from rabies/year, equivalent to an annual incidence of 4.67 (95% CI: 2.53–7.53) deaths/100,000 in the two rabies endemic areas of south Bhutan. In the absence of post exposure prophylaxis, the model predicted 19.24 (95% CI: 13.69–25.14) deaths/year in these two areas. The public should be encouraged to visit hospitals for post exposure prophylaxis following dog bite injury in south Bhutan

Research Ethics Board of Health: a seven year review of the only ethics review board in Bhutan

Introduction: Research Ethics Board of Health (REBH), established in 2009, is the only ethics review board in Bhutan. The REBH was certified by the Strategic Initiative for Developing Capacity in Ethical Review (SIDCER), Forum for Ethical Review Committees in the Asian and Western Pacific Regions (FERCAP) in 2010 and recertified in 2013, and it received the Federal Wide Assurance (FWA) from the Office for Human Research Protections (OHRP), USA, in 2010 and in 2013. All researchers conducting health related research in Bhutan have to seek prior ethical clearance from REBH under the requirements of the National Health Policy 2011. Objective: The article aims to describe the performance of REBH, its standard and review procedure.&#x0D; Methods: A descriptive study of records and database of REBH from 2009 to 2015.&#x0D; Results: As of December 2015, the REBH has received 227 protocols with an average of 32 protocols per year. The median number of days for the initial review was 21 days (Min 0 days; Max 85 days). The median duration for approval of protocols from the date of receiving the application was 48 days. The average number of times the protocols were reviewed before issuing the approval letter was 2.&#x0D; Conclusions: There has been a progressive increase in the number of protocols submitted to REBH. This indicated an increasing research culture in Bhutan. It takes about one and half months to get an approval from REBH; therefore, researchers have to consider the time required for ethical clearance process while planning research projects.</jats:p

Assessment of Performance and Oil Recovery (%) in Existing Groundnut (Arachis Hypogaea L.) Accessions

Groundnut cultivation in Bhutan is predominantly restricted to few farmers for its kernels whereby oil is usually not extracted. The rich agro-ecological diversity hosts a multitude of groundnut accessions that have not been studied so far. Based on geographical location, seed colour, seed shape or pattern, five local accessions, namely Chalipa badam, Bartshampa white badam, Yangbrangpa red badam, Yangbrangpa white and purple badam, and Nanongpa badam were identified in eastern Bhutan. A multi-location trial using RCB design was conducted across four agro-ecologically diverse locations namely; ARDC-Wengkhar, ARDSC-Lingmethang, ARDC-Samtenling, and ARDSC-Tsirang in April 2019. Days to 50 % flowering, plant height, number of pods per plant, thousand-seed weight, shelling %, yield, and oil recovery % were assessed. The yield performance of all five accessions was poor in the low/hot environment as compared to that in the mid/cool environment where all accessions, except Nanongpa badam which was marginally low yielding, gave satisfactory and similar yields. Correlation between the number of pods per plant and yield showed a high positive relationship (r = 0.75) whereas that between plant height and yield was negative (r=-0.57).</jats:p

Barriers to Institutional Delivery Services in Districts With the Lowest Institutional Delivery Coverage in Bhutan

Bhutan aims to achieve 100% institutional delivery coverage. While evidence indicates improved institutional delivery coverage over the years, coverage in some of the districts is only 49%. This study was aimed at exploring barriers to institutional delivery in three low-coverage districts. In-depth qualitative interviews and six focus group discussions were conducted in December 2015. The analysis was done as per the Braun and Clarke’s 6-phase guide to doing thematic analysis. This study sheds light on 15 barriers for institutional deliveries, which include hesitancy to seek health care when the pregnancy is out of wedlock, the restriction of alcohol consumption at health centers, fear of hypothermia in cold places, pastoralism, health care providers shortage, lack of maternity waiting home and food, distance, difficult terrain, lack of transportation services, and financial constraints. Some of these barriers could be unique to Bhutan. The coverage could be improved considerably if the recommendations in this article are implemented. </jats:p

Sweet potato varieties to diversify cultivars in Bhutan

Sweet potato (Ipomea batatas (L.) Lam) is an important root crop grown in the world. It provides carbohydrates, proteins, vitamins, fibre and essential minerals. With limited varieties available, and the crop being undocumented thus far, sweet potato production in Bhutan is insignificant and has not gained scope in agricultural food systems. For nutrient and crop diversification, three improved varieties from Japan, and a local variety as a check were evaluated under three different agro-ecological zones to ascertain their performance in terms of yield and other yield attributes. The experiment was laid out using Randomized Complete Block Design with four treatments each with three replications. There was no significant difference in yields between the varieties. Nonetheless, it was observed that orange flesh variety (Bajo kewa ngam II) outyielded (13.8t/ac) all other experimented varieties across all experimental sites. The variety orange flesh (Bajo kewa ngam II) followed by Beni Azumi (Bajo kewa ngam I) and Gorojima were the most preferred variety based on their yield potential, pests and diseases tolerance, organoleptic test (taste, texture and colour) and yield attributes. All the three varieties showed good yield stability.</jats:p

Design of Electronic Voting System for Visually Impaired Persons Using Arduino Mega 2560

People with visual impairment, even if they are availed to voting, they do not have the privilege to vote confidentially, because of their physical disability. Therefore, a user-friendly and confidential voting system is necessary for visually impaired people. In this paper, we build an electronic voting system for visually impaired people is a user-friendly device which can help those group of people vote independently with sound. The system is built on an Arduino Mega 2560 microcontroller board, a SD card module, an LCD module, several buttons, a buzzer, GSM SIM 900A and a headset. The system has a special voice feature stored in SD card to familiarize them with names of candidates. Also, the voice is passed through a headset for secrecy. In addition, a control unit of the system for polling officials is designed separately from a voting unit for the smooth election procedural. Once user votes, a buzzer is turned on and the system cannot accept the voting. If a control button is pushed, the buzzer is turned off and the system accepts voting. This mechanism is to avoid double voting. A result button is implemented to display final votes for each candidate and store them in the SD card. GSM SIM900A is interfaced with Arduino Mega 2560 to disseminate final results. We can encourage mass participation equally in democracy through the system electronic voting system.</jats:p