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Article ; Online: Efforts toward the Elimination of Visceral Leishmaniasis in South Asia: A Review of Progress in Bhutan.

Dorji, Thinley / Dorjee, Sithar / Wangdi, Tenzin / Tshokey, Tshokey / Pradhan, Ambika Rani / Penjor, Kinley / Namgay, Rinzin / Togbye, Togbye / Karunaweera, Nadira

The American journal of tropical medicine and hygiene

2024 Volume 110, Issue 4, Page(s) 633–638

Abstract: Leishmaniases are a group of diseases under the category of neglected tropical diseases targeted for global elimination. However, they continue to pose major clinical and public health problems, especially among those living in poor socioeconomic ... ...

Abstract	Leishmaniases are a group of diseases under the category of neglected tropical diseases targeted for global elimination. However, they continue to pose major clinical and public health problems, especially among those living in poor socioeconomic conditions. Here, we summarize leishmaniasis elimination efforts in Bhutan. Between 1994 and 2022, Bhutan recorded 54 cases of leishmaniasis across 14 of its 20 districts. There are seven species of Phlebotomus and three species of Sergentomyia sand flies documented in the country. At a subnational level, all endemic districts recorded a visceral leishmaniasis annual incidence <1 per 10,000 population, meeting the regional elimination targets. Serological testing with ELISA and molecular testing with polymerase chain reaction were established at the Royal Center for Disease Control in 2022. A leishmaniasis prevention and management guideline was adopted in 2023 to aid clinicians in diagnosis and management. Active and passive case surveillance was integrated with the national infectious disease early warning and response system. Risk-based entomological surveillance and control have also been prioritized. Climate change may play a major role in rendering districts in the temperate zone favorable for vector proliferation. The country's medical university introduced a diploma course in medical entomology in 2023 to augment the human resources needed for vector surveillance efforts. However, leishmaniasis elimination lacks dedicated programmatic management amid competing priorities for resources against other infectious diseases. Leishmaniasis elimination requires a targeted and programmatic approach in Bhutan, including cross-border collaborative efforts with neighboring Indian states. Bhutan remains highly committed to achieving leishmaniasis elimination targets.
MeSH term(s)	Animals ; Humans ; Leishmaniasis, Visceral/diagnosis ; Leishmaniasis, Visceral/epidemiology ; Leishmaniasis, Visceral/prevention & control ; Bhutan/epidemiology ; Phlebotomus ; Psychodidae ; Leishmaniasis/epidemiology ; Leishmaniasis/prevention & control ; Asia, Southern
Language	English
Publishing date	2024-03-12
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	2942-7
ISSN	1476-1645 ; 0002-9637
ISSN (online)	1476-1645
ISSN	0002-9637
DOI	10.4269/ajtmh.23-0642
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Article ; Online: Distribution and Seasonal Variation of Phlebotomus and Sergentomyia Sand Fly Populations in Bhutan.

Wangdi, Tenzin / Senanayake, Sanath / Dorjee, Sithar / Tobgay, Tashi / Zhou, Guofa / Piyasiri, Sachee B / Weerasinghe, W M Lakshika I / Karunaweera, Nadira

The American journal of tropical medicine and hygiene

2024

Abstract: Leishmaniasis is considered one of the neglected tropical diseases in the world. Although Bhutan is a member of the visceral leishmaniasis elimination consortium in South Asia, not much attention has been accorded to the disease because of its low ... ...

Abstract	Leishmaniasis is considered one of the neglected tropical diseases in the world. Although Bhutan is a member of the visceral leishmaniasis elimination consortium in South Asia, not much attention has been accorded to the disease because of its low incidence. The vector that transmits Leishmania remains poorly understood. In this backdrop, sand-fly surveys were regularly conducted at multiple sites where leishmaniasis cases have been reported in Bhutan. Collections were made using CDC light traps and cattle-baited net traps in 15 villages from February 2019 to May 2022. Six species of Phlebotomus and four species of Sergentomyia were identified from these sites that included two Phlebotomus and three Sergentomyia species discovered for the first time in Bhutan. Sand-fly density varied significantly from village to village, and it showed strong seasonality with peak numbers collected from June to October and almost zero from December to February. Overall, sand-fly density was highest in the basements of the houses and were higher outdoors than indoors. Cattle-baited net traps collected few sand flies during the surveillance period. This work constituted the first systematic sand-fly population surveillance conducted in Bhutan and will provide a baseline for future vector ecology and Leishmania epidemiological studies.
Language	English
Publishing date	2024-04-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	2942-7
ISSN	1476-1645 ; 0002-9637
ISSN (online)	1476-1645
ISSN	0002-9637
DOI	10.4269/ajtmh.23-0125
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Article: Demographic risk factors for extra-pulmonary tuberculosis: a rising public health threat in Bhutan.

Zangpo, Tandin / Tsheten / Tenzin, Phurpa / Dorji, Chencho / Nima, Gaki / Dorjee, Sithar / Sultana, Rabeya

The Indian journal of tuberculosis

2023 Volume 71, Issue 2, Page(s) 137–146

Abstract: Background: Recently, extra-pulmonary tuberculosis (EPTB) has been increasingly reported in Bhutan, rising from 26% in 2001 to 39% in 2010. In 2016, almost half (49%) of all reported TB cases were classified as EPTB. Thus, this study was conducted to ... ...

Abstract	Background: Recently, extra-pulmonary tuberculosis (EPTB) has been increasingly reported in Bhutan, rising from 26% in 2001 to 39% in 2010. In 2016, almost half (49%) of all reported TB cases were classified as EPTB. Thus, this study was conducted to understand the epidemiology and identify risk factors contributing to increasing notification of EPTB in Bhutan. Methods: A case-control study was conducted by recruiting all 110 cases of nationally notified EPTB (Extrapulmonary bacteriologically confirmed/EPBC) as cases and 235 Pulmonary TB (Pulmonary bacteriologically confirmed/PBC) as controls. Data were collected on socio-demography, clinical and diagnostic, behavioral and lifestyle and environmental exposures using a structured questionnaire between April and September, 2018. Results: The median age of the cases was 25 years, ranged 9-79 years. Lymphatic TB was predominant (n = 78; 70.91%) followed by genitourinary TB (n = 4 (3.64%). The likelihood of EPTB decreased with increase in age (p = 0.023). The odds of EPTB in females was 1.65 times higher than the males (p = 0.038). Increase in Body Mass Index (adjusted odds ratio (AOR): 1.1; 95% confidence interval (CI): 1.052-1.200) and urban residency were (AOR 1.6; 95% CI 1.016-2.805) were found to have higher odds of developing EPTB. Conclusion: Females, urban residents, and those with higher BMI are at increased risk of developing EPTB. These at-risk groups can be used to target limited public health resources to control EPTB in Bhutan.
MeSH term(s)	Male ; Female ; Humans ; Child ; Adolescent ; Young Adult ; Adult ; Middle Aged ; Aged ; Case-Control Studies ; Public Health ; Bhutan/epidemiology ; Risk Factors ; Tuberculosis, Extrapulmonary ; Tuberculosis, Lymph Node/epidemiology ; Retrospective Studies ; Demography
Language	English
Publishing date	2023-04-25
Publishing country	India
Document type	Journal Article
ZDB-ID	603129-8
ISSN	0019-5707 ; 0019-5705
ISSN	0019-5707 ; 0019-5705
DOI	10.1016/j.ijtb.2023.04.016
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Article ; Online: Human rabies encephalomyelitis in the background of rabies outbreak in animals in Gelephu, Bhutan, 2023: a case report.

Dorji, Thinley / Lamichaney, Jeewanath / Gyaltshen, Choeda / Lungten, Lungten / Dhakal, Guru Prasad / Dorjee, Sithar / Mynak, Mimi Lhamu

Infectious diseases of poverty

2023 Volume 12, Issue 1, Page(s) 94

Abstract: Background: Rabies continues to pose significant public health challenges in many developing countries including Bhutan. A probable case of rabies was admitted to our hospital and its reporting led to the uncovering of an outbreak in domestic and wild ... ...

Abstract	Background: Rabies continues to pose significant public health challenges in many developing countries including Bhutan. A probable case of rabies was admitted to our hospital and its reporting led to the uncovering of an outbreak in domestic and wild animals. We discuss the challenges in the diagnosis and management of rabies in a resource-limited setting. Case presentation: A 35-year-old male presented with intermittent fever, bilateral lower limb weakness that was rapidly progressive, urinary incontinence with episodes of palpitations and sweating. He had sustained a Category III bite on the right lower thigh with four bite marks, inflicted by a stray dog. He had received post-exposure prophylaxis with intra-dermal anti-rabies vaccine. On initial examination, the patient was in distress but cooperative for the interview. He had pulse rate ranging from 60 to 100/min with episodes of diaphoresis and palpitations, but with normal capillary blood glucose. In the lower limb, the muscle power was zero with absent tendon reflexes in the lower limb and impaired abdominal reflex below T Conclusions: This case called for a serious evaluation of the country's efforts in achieving zero rabies deaths by 2030. The management of this case identified several critical areas of context-specific interventions in Bhutan. There is also an urgent need to improve diagnostic capabilities at the national reference laboratory and enhance the technical competencies of healthcare workers in the management of dog bite cases.
MeSH term(s)	Male ; Humans ; Animals ; Dogs ; Adult ; Rabies/epidemiology ; Rabies/veterinary ; Bhutan/epidemiology ; Rabies Vaccines ; Bites and Stings ; Animals, Wild ; Disease Outbreaks ; Encephalomyelitis/complications ; Encephalomyelitis/epidemiology
Chemical Substances	Rabies Vaccines
Language	English
Publishing date	2023-10-16
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	2689396-4
ISSN	2049-9957 ; 2049-9957
ISSN (online)	2049-9957
ISSN	2049-9957
DOI	10.1186/s40249-023-01148-2
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Article ; Online: Environmental, Occupational, and Demographic Risk Factors for Clinical Scrub Typhus, Bhutan.

Zangpo, Tandin / Phuentshok, Yoenten / Dorji, Kezang / Dorjee, Chencho / Dorjee, Sithar / Jolly, Peter / Morris, Roger / Marquetoux, Nelly / McKenzie, Joanna

Emerging infectious diseases

2023 Volume 29, Issue 5, Page(s) 909–918

Abstract: Underdiagnosis and underreporting of scrub typhus has increasingly affected public health in Bhutan since its initial detection in 2008. Identifying scrub typhus risk factors would support early diagnosis and treatment for this nonspecific febrile ... ...

Abstract	Underdiagnosis and underreporting of scrub typhus has increasingly affected public health in Bhutan since its initial detection in 2008. Identifying scrub typhus risk factors would support early diagnosis and treatment for this nonspecific febrile disease, reducing the incidence of potentially fatal complications. We conducted a hospital-based, case‒control study during October‒December 2015 in 11 scrub typhus‒prone districts. We identified harvesting cardamom as the major risk factor (odds ratio 1,519; p<0.001); other factors were traditional housing, largely caused by an outside toilet location, as well as owning a goat and frequently sitting on grass. Harvesting vegetables, herding cattle in the forest, and female sex were protective. Age had a nonlinear effect; children and the elderly were more likely to seek treatment for clinical scrub typhus. This study has informed public health policies and awareness programs for healthcare workers through development of National Guidelines for Prevention, Treatment and Control of Scrub Typhus in Bhutan.
MeSH term(s)	Female ; Animals ; Cattle ; Scrub Typhus/diagnosis ; Scrub Typhus/epidemiology ; Orientia tsutsugamushi ; Case-Control Studies ; Bhutan/epidemiology ; Risk Factors ; Demography
Language	English
Publishing date	2023-04-20
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1380686-5
ISSN	1080-6059 ; 1080-6040
ISSN (online)	1080-6059
ISSN	1080-6040
DOI	10.3201/eid2905.221430
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Article: Epidemiological and histopathological characteristics of head and neck cancers in Bhutan from 2011 to 2017: a retrospective descriptive study.

Tshering, Phub / Dorjee, Sithar / Dendup, Tshering / Dorji, Thinley / Wangmo, Dechen

Ecancermedicalscience

2020 Volume 14, Page(s) 1024

Abstract: Background: Head and neck cancers are among the commonest cancers in the developing world. Personal habits, such as the use of tobacco, betel nut and alcohol are strongly associated with the development of head and neck cancers at certain sites. ... ...

Abstract	Background: Head and neck cancers are among the commonest cancers in the developing world. Personal habits, such as the use of tobacco, betel nut and alcohol are strongly associated with the development of head and neck cancers at certain sites. Therefore, they are among the preventable cancers. In Bhutan, there has not yet been a study conducted on head and neck cancers. Objective: To describe baseline epidemiological and histopathological characteristics of head and neck cancers in Bhutan. Methods: This is a 7-year descriptive study of all cases of head and neck cancers presented at the Jigme Dorji Wangchuk National Referral Hospital from 2011 to 2017. The data were collected from the hospital's medical records section, histopathology records, patient referral unit and some treatment centres in India. Prior approval was sought from the Research and Ethics Board for Health, the Ministry of Health and the hospital management. Results: There were a total of 515 cases of head and neck cancers from 2011 to 2017. The crude incidence rate was 10 per 100,000 and the overall age adjusted rate was 12.3 (95% CI 9.5-15.1) per 100,000 population. The prevalence during this 7-year period was 69.1 per 100,000 population. The commonest cancers are thyroid, oral cavity, hypopharyngeal, laryngeal and nasopharyngeal cancer in decreasing order. Head and neck cancers are more common in males than females in the majority of sites except thyroid, salivary gland and sinonasal malignancies. Thyroid cancers and nasopharyngeal cancers are found to affect younger age groups. Tashigang (48) followed by Paro (43) recorded the highest number of cases. Squamous cell carcinoma is the commonest histopathology type in almost all the cases, while papillary carcinoma is the commonest among thyroid cancers. Personal habits, such as smoking, chewing tobacco, betel nut and alcohol consumption, were found to be more common among patients suffering from oral cavity, laryngeal, hypopharyngeal and oropharyngeal cancers. Conclusion: Head and neck cancers are the third most common cancer in Bhutan after stomach cancer and cervical cancer. Thyroid, oral cavity and hypopharynx are the top three anatomical sites for head and neck cancers in Bhutan. The current epidemiological and histopathological profile of head and neck cancers will form a baseline of information and basis for further research on head and neck cancers in Bhutan.
Language	English
Publishing date	2020-04-15
Publishing country	England
Document type	Journal Article
ISSN	1754-6605
ISSN	1754-6605
DOI	10.3332/ecancer.2020.1024
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Article: Atypical Presentation of Post-Kala-Azar Dermal Leishmaniasis in Bhutan.

Pradhan, Ambika / Tobgay, Tashi / Dorjee, Sithar / Wangdi, Tenzin / Zhou, Guofa / Karunaweera, Nadira D

Case reports in dermatological medicine

2020 Volume 2020, Page(s) 8899586

Abstract: This article describes an atypical case of post-kala-azar dermal leishmaniasis associated with complications due to delayed diagnosis and poor case management. The grave consequences of the prolonged disease process that continued for over 2 decades with ...

Abstract	This article describes an atypical case of post-kala-azar dermal leishmaniasis associated with complications due to delayed diagnosis and poor case management. The grave consequences of the prolonged disease process that continued for over 2 decades with eventual healing included facial disfigurement, visual impairment, and mental distress both to the patient and the family. The persistent infection within the skin over a lengthy period with likely increased risk of infection spread in the community highlights its potential negative impact on the ongoing leishmaniasis elimination program in the Indian subcontinent. Bhutan is a member of the leishmaniasis elimination network in Asia, and the government continues to invest in maintenance of the national healthcare system. The case study reveals the gaps in the healthcare system with hardships faced by a patient to access quality healthcare and poor patient outcome used as proxy indicators. It also points to the need to enhance access to healthcare to ensure early diagnosis and effective treatment for leishmaniasis patients including those who live in remote areas, in order to achieve the planned disease elimination targets. It also points towards the key challenges faced by a resource poor nation such as Bhutan in achieving universal health coverage and reaching the set goals for disease elimination. The findings underscore the need for a careful review of the national health care system and to address the deficiencies.
Language	English
Publishing date	2020-08-21
Publishing country	United States
Document type	Case Reports
ZDB-ID	2684644-5
ISSN	2090-6471 ; 2090-6463
ISSN (online)	2090-6471
ISSN	2090-6463
DOI	10.1155/2020/8899586
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Book ; Online: Bhutan

Tobgay, Tashi / Yangchen, Sonam / Chozom, Tashi / Tshering, Ugyen / Wangchuk, Sonam / Tshokey, Jigme Dorji Wangchuck / Dorjee, Sithar

a primary health care case study in the context of the COVID-19 pandemic

2023

Abstract: vi, 17 p. ...

Abstract	vi, 17 p.
Keywords	COVID-19 ; Betacoronavirus ; Disease Outbreaks ; Primary Health Care ; Case Reports ; Bhutan
Language	English
Publisher	World Health Organization
Document type	Book ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Antibiotic Prescription in Veterinary Consultations in Bhutan: A Retrospective Cross-Sectional Study.

Villanueva-Cabezas, Juan Pablo / Rinzin, Karma / Dorjee, Sithar / Tshewang, Pema / Namgyel, Ugyen / Sharma, Puspa Maya / Stevenson, Mark A / McVernon, Jodie

Frontiers in veterinary science

2021 Volume 8, Page(s) 641488

Abstract: The veterinary prescription of antibiotics in low- and middle-income countries (LMIC) remains largely undocumented. In Bhutan, however, the national veterinary service keeps records of their activities and prescriptions, which offer an opportunity to ... ...

Abstract	The veterinary prescription of antibiotics in low- and middle-income countries (LMIC) remains largely undocumented. In Bhutan, however, the national veterinary service keeps records of their activities and prescriptions, which offer an opportunity to establish a benchmark to assess the use of these agents in this and other LMIC. A cross-sectional retrospective study was designed and 2,266 handwritten veterinary records from 2017 were sampled from 23 animal health premises (AHPs) to estimate individual and an overall proportion of consultations that resulted in an antibiotic prescription. The frequency of antibiotic prescription per species, type of AHP, and according to WHO's AWaRe index and OIE list of priority antimicrobials were also explored. It was estimated that 31% (95% confidence interval: 29-33%; intracluster correlation: 0.03) of the veterinary consultations resulted in an antibiotic prescription. The incidence of antibiotic prescription was highest in consultations of poultry across AHP. Across species,
Language	English
Publishing date	2021-05-28
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2834243-4
ISSN	2297-1769
ISSN	2297-1769
DOI	10.3389/fvets.2021.641488
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Article ; Online: A knowledge, attitudes, and practices study on ticks and tick-borne diseases in cattle among farmers in a selected area of eastern Bhutan.

Namgyal, Jamyang / Tenzin, Tenzin / Checkley, Sylvia / Lysyk, Tim J / Rinchen, Sangay / Gurung, Ratna B / Dorjee, Sithar / Couloigner, Isabelle / Cork, Susan C

PloS one

2021 Volume 16, Issue 2, Page(s) e0247302

Abstract: Livestock farming plays an important role in supporting the livelihood of resource-poor subsistence farmers in Bhutan. However, ticks and tick-borne diseases (TBDs) are one of the major constraints to livestock farming due to their negative effect on ... ...

Abstract	Livestock farming plays an important role in supporting the livelihood of resource-poor subsistence farmers in Bhutan. However, ticks and tick-borne diseases (TBDs) are one of the major constraints to livestock farming due to their negative effect on health and production. To date, no study has been conducted in Bhutan to assess farmers' knowledge, attitude, and practices (KAP) about ticks and TBDs in cattle, although such information is essential in ensuring the development and adoption of effective prevention and control measures. Therefore, a KAP survey was conducted among 246 cattle owners in the Samkhar sub-district of eastern Bhutan in June 2019, using a structured questionnaire. Based on our scoring criteria, 52% [95%CI: 45.5-58.4] had adequate knowledge about ticks as potential vectors of diseases. Logistic regression analysis showed that the individuals who practiced a stall-feeding system of cattle rearing were 2.8 times [OR = 2.8 (95%CI: 1.66-4.78)] more likely to have adequate knowledge than others. Sixty-eight percent [95%CI: 62.5-74.4] had a favorable attitude toward tick prevention and control programs. Men were 1.95 times [OR = 1.95 (95%CI: 1.09-3.55)] more likely to have a favorable attitude than women, and the individuals who practiced a stall-feeding system were 2.59 times [OR = 2.59 95%CI: 1.45-4.78)] more likely to have a favorable attitude than others, after adjusting for the effect of other variables in the model. Overall, only 38% [95%CI 32.5-45] of the respondents reported tick infestation as one of the most important animal health problems, but 100% reported using acaricides to control ticks in cattle. Despite a high level of acaricide usage, the level of knowledge was low among the farmers interviewed. Findings from this study underline the importance of considering identified knowledge gaps and initiating education efforts to improve the adoption of effective tick prevention and control measures among farmers.
MeSH term(s)	Acaricides/pharmacology ; Adolescent ; Adult ; Animals ; Bhutan ; Cattle ; Cattle Diseases/prevention & control ; Farmers/statistics & numerical data ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Male ; Middle Aged ; Surveys and Questionnaires ; Tick Control/statistics & numerical data ; Tick Infestations/prevention & control ; Tick Infestations/veterinary ; Tick-Borne Diseases/prevention & control ; Tick-Borne Diseases/veterinary ; Ticks/drug effects ; Young Adult
Chemical Substances	Acaricides
Language	English
Publishing date	2021-02-22
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0247302
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