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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: The trend of tuberculosis case notification and predictors of unsuccessful treatment outcomes in Samdrup Jongkhar district, Bhutan: A fourteen-year retrospective study.

Penjor, Kinley / Kuenzang / Tshokey, Tshokey / Wangdi, Kinley

Heliyon

2021 Volume 7, Issue 3, Page(s) e06573

Abstract: Tuberculosis (TB) continues to be an important public health issue in Bhutan. This study aims to describe the trend of tuberculosis and investigate factors associated with a unsuccessful treatment outcome in Samdrup Jongkhar District in Bhutan. A ... ...

Abstract	Tuberculosis (TB) continues to be an important public health issue in Bhutan. This study aims to describe the trend of tuberculosis and investigate factors associated with a unsuccessful treatment outcome in Samdrup Jongkhar District in Bhutan. A fourteen-year (2004-2017) case records in two TB centres of Dewathang and Samdrup Jongkhar Hospitals were reviewed and analyzed to examine trends in case notification and treatment outcomes. Univariable and multivariable logistic regression analysis was undertaken to identify covariates of unsuccessful TB treatment. Of the total of 820 TB cases registered in surveillance record, 729 cases were analysed. Males made up 53.8% (397) of total cases and the median age was 29 years (range: 2-87 years). A gradual downward trend in TB case notification was noticed in the district with overall case notification rate of 139/100,000 during the study period. The annual treatment success rate was over 90% except for years 2013-2015 with overall treatment success rate for the study period at 93%. A re-treatment TB patient, sputum-positive at the second month of treatment and being of Indian nationality were significant correlates of unsuccessful treatment outcomes. The overall TB inclidence has declined and TB treatment success rate was above WHO recommended 90% in Samdrup Jongkhar District during the study period. A special attention should be paid to the poor treatment outcome predictors including re-treatment cases and failed sputum conversion at the second month of treatment.
Language	English
Publishing date	2021-03-25
Publishing country	England
Document type	Journal Article
ZDB-ID	2835763-2
ISSN	2405-8440
ISSN	2405-8440
DOI	10.1016/j.heliyon.2021.e06573
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Article ; Online: Imported malaria and its implication to achievement of malaria-free Bhutan.

Penjor, Kinley / Zangpo, Ugyen / Tshering, Dorji / Ley, Benedikt / Price, Ric N / Wangdi, Kinley

Journal of travel medicine

2023 Volume 30, Issue 3

MeSH term(s)	Humans ; Bhutan/epidemiology ; Malaria/epidemiology ; Malaria/prevention & control ; Travel ; China
Language	English
Publishing date	2023-04-04
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1212504-0
ISSN	1708-8305 ; 1195-1982
ISSN (online)	1708-8305
ISSN	1195-1982
DOI	10.1093/jtm/taad044
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Article ; Online: The trend of tuberculosis case notification and predictors of unsuccessful treatment outcomes in Samdrup Jongkhar district, Bhutan: A fourteen-year retrospective study

Penjor, Kinley / Kuenzang / Tshokey, Tshokey / Kinley Wangdi

Heliyon. 2021 Mar., v. 7, no. 3 p.e06573-

2021

Abstract	Tuberculosis (TB) continues to be an important public health issue in Bhutan. This study aims to describe the trend of tuberculosis and investigate factors associated with a unsuccessful treatment outcome in Samdrup Jongkhar District in Bhutan.A fourteen-year (2004–2017) case records in two TB centres of Dewathang and Samdrup Jongkhar Hospitals were reviewed and analyzed to examine trends in case notification and treatment outcomes. Univariable and multivariable logistic regression analysis was undertaken to identify covariates of unsuccessful TB treatment.Of the total of 820 TB cases registered in surveillance record, 729 cases were analysed. Males made up 53.8% (397) of total cases and the median age was 29 years (range: 2–87 years). A gradual downward trend in TB case notification was noticed in the district with overall case notification rate of 139/100,000 during the study period. The annual treatment success rate was over 90% except for years 2013–2015 with overall treatment success rate for the study period at 93%. A re-treatment TB patient, sputum-positive at the second month of treatment and being of Indian nationality were significant correlates of unsuccessful treatment outcomes. The overall TB inclidence has declined and TB treatment success rate was above WHO recommended 90% in Samdrup Jongkhar District during the study period. A special attention should be paid to the poor treatment outcome predictors including re-treatment cases and failed sputum conversion at the second month of treatment.
Keywords	monitoring ; nationalities and ethnic groups ; patients ; public health ; regression analysis ; retrospective studies ; tuberculosis ; Bhutan ; Tuberculosis ; Infection ; Risk factors ; Modelling
Language	English
Dates of publication	2021-03
Publishing place	Elsevier Ltd
Document type	Article ; Online
ZDB-ID	2835763-2
ISSN	2405-8440
ISSN	2405-8440
DOI	10.1016/j.heliyon.2021.e06573
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: Identifying socio-ecological drivers of common cold in Bhutan: a national surveillance data analysis.

Tsheten, Tsheten / Penjor, Kinley / Tshering, Chachu / Clements, Archie C A / Gray, Darren J / Wangdi, Kinley

Scientific reports

2022 Volume 12, Issue 1, Page(s) 11716

Abstract: The common cold is a leading cause of morbidity and contributes significantly to the health costs in Bhutan. The study utilized multivariate Zero-inflated Poisson regression in a Bayesian framework to identify climatic variability and spatial and ... ...

Abstract	The common cold is a leading cause of morbidity and contributes significantly to the health costs in Bhutan. The study utilized multivariate Zero-inflated Poisson regression in a Bayesian framework to identify climatic variability and spatial and temporal patterns of the common cold in Bhutan. There were 2,480,509 notifications of common cold between 2010 and 2018. Children aged < 15 years were twice (95% credible interval [CrI] 2.2, 2.5) as likely to get common cold than adults, and males were 12.4% (95 CrI 5.5%, 18.7%) less likely to get common cold than females. A 10 mm increase in rainfall lagged one month, and each 1 °C increase of maximum temperature was associated with a 5.1% (95% CrI 4.2%, 6.1%) and 2.6% (95% CrI 2.3%, 2.8%) increase in the risk of cold respectively. An increase in elevation of 100 m and 1% increase in relative humidity lagged three months were associated with a decrease in risk of common cold by 0.1% (95% CrI 0.1%, 0.2%) and 0.3% (95% CrI 0.2%, 0.3%) respectively. Seasonality and spatial heterogeneity can partly be explained by the association of common cold to climatic variables. There was statistically significant residual clustering after accounting for covariates. The finding highlights the influence of climatic variables on common cold and suggests that prioritizing control strategies for acute respiratory infection program to subdistricts and times of the year when climatic variables are associated with common cold may be an effective strategy.
MeSH term(s)	Adult ; Bayes Theorem ; Bhutan/epidemiology ; Child ; Common Cold/epidemiology ; Data Analysis ; Female ; Humans ; Incidence ; Male ; Spatio-Temporal Analysis
Language	English
Publishing date	2022-07-09
Publishing country	England
Document type	Journal Article
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-022-16069-7
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Article ; Online: Determinants of health seeking behavior of animal bite victims in rabies endemic South Bhutan: a community-based contact-tracing survey.

Penjor, Kinley / Tenzin, Tenzin / Jamtsho, Rinzin Kinga

BMC public health

2019 Volume 19, Issue 1, Page(s) 237

Abstract: Background: Dog bites are the main source of rabies infection and death in humans, contributing up to 99% of all cases. We conducted a contact-tracing study to evaluate the health seeking and treatment compliance behaviors of people following potential ... ...

Abstract	Background: Dog bites are the main source of rabies infection and death in humans, contributing up to 99% of all cases. We conducted a contact-tracing study to evaluate the health seeking and treatment compliance behaviors of people following potential exposure to rabies in rabies endemic south Bhutan. Methods: Using information from the rabies post exposure prophylaxis (PEP) register, animal-exposed victims who had visited five hospitals in south Bhutan between January and March 2017 were traced and further data were collected from them using a structured questionnaire. A snowballing technique was used to identify victims who did not seek PEP.The survey was conducted between April and June 2017. Logistic regression was performed to assess factors associated with PEP-seeking and compliance behavior by the victims. Results: Amongst 630 who reported to hospitals, 70% (444) of people could be traced and additional 8% (39) who did not seek PEP was identified through contact tracing. Therefore, a total of 483 people were interviewed. Seventy one percent (344/483) of exposure were due to animal bites of which 80% (365/455) were considered to be provoked incidents. Common reasons for not seeking health care included assumptions that risks of infection were minor if bitten by an owned or vaccinated dog. The victims who are male (OR: 0.36; 95% CI: 0.16-0.77) and educated (OR: 0.41; 95% CI: 0.17-0.96) were less likely to seek PEP, while those that experienced unprovoked bite (OR: 5.10; 95% CI: 1.20-21.77) were more likely to seek PEP in the hospitals. Overall, 82% of the victims sought PEP from the hospitals within 24 h after exposure. Eighty three percent completed the PEP course prescribed by the physician. The respondents living in urban areas (OR: 2.67; 95% CI: 1.34-5.30) were more likely to complete the prescribed PEP course than rural dwellers. Conclusions: There is high risk of rabies infection in southern Bhutan. It is critical to bridge knowledge gaps and dispel existing myths which will help to improve PEP seeking and compliance behavior of people exposed to rabies infection from animals. A risk-based advocacy program is necessary to prevent dog-mediated human rabies deaths.
MeSH term(s)	Adolescent ; Adult ; Animals ; Bhutan/epidemiology ; Bites and Stings/epidemiology ; Child ; Child, Preschool ; Dogs ; Endemic Diseases/statistics & numerical data ; Female ; Health Behavior ; Hospitals/statistics & numerical data ; Humans ; Infant ; Infant, Newborn ; Logistic Models ; Male ; Middle Aged ; Ownership/statistics & numerical data ; Patient Acceptance of Health Care/statistics & numerical data ; Patient Compliance ; Rabies/epidemiology ; Registries ; Rural Population ; Surveys and Questionnaires ; Young Adult
Language	English
Publishing date	2019-02-27
Publishing country	England
Document type	Journal Article
ISSN	1471-2458
ISSN (online)	1471-2458
DOI	10.1186/s12889-019-6559-x
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Article ; Online: Has COVID19 derailed Bhutan's national malaria elimination goal? A commentary.

Penjor, Kinley / Tobgyal / Zangpo, Tandin / Clements, Archie C A / Gray, Darren J / Wangdi, Kinley

Malaria journal

2021 Volume 20, Issue 1, Page(s) 20

Abstract: The COVID-19 pandemic has resulted in massive global disruptions with considerable impact on the delivery of health services and national health programmes. Since the detection of the first COVID-19 case on 5th March 2020, the Royal Government of Bhutan ... ...

Abstract	The COVID-19 pandemic has resulted in massive global disruptions with considerable impact on the delivery of health services and national health programmes. Since the detection of the first COVID-19 case on 5th March 2020, the Royal Government of Bhutan implemented a number of containment measures including border closure and national lockdowns. Against the backdrop of this global COVID-19 pandemic response, there was a sudden surge of locally-transmitted malaria cases between June to August 2020. There were 20 indigenous cases (zero Plasmodium falciparum and 20 Plasmodium vivax) from a total of 49 cases (seven P. falciparum and 42 P. vivax) in 2020 compared to just two from a total of 42 in 2019. Over 80% of the cases were clustered in malaria endemic district of Sarpang. This spike of malaria cases was attributed to the delay in the delivery of routine malaria preventive interventions due to the COVID-19 pandemic. As a result, Bhutan is unlikely to achieve the national goal of malaria elimination by 2020.
MeSH term(s)	Bhutan/epidemiology ; COVID-19/epidemiology ; COVID-19/virology ; Goals ; Humans ; Malaria/prevention & control ; Preventive Health Services ; Public Health ; SARS-CoV-2/isolation & purification
Language	English
Publishing date	2021-01-06
Publishing country	England
Document type	Letter
ISSN	1475-2875
ISSN (online)	1475-2875
DOI	10.1186/s12936-020-03562-5
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Article ; Online: Evaluation of post-exposure prophylaxis practices to improve the cost-effectiveness of rabies control in human cases potentially exposed to rabies in southern Bhutan.

Penjor, Kinley / Marquetoux, Nelly / Dorji, Chendu / Penjor, Kinley / Dorjee, Sithar / Dorjee, Chencho / Jolly, P D / Morris, R S / McKenzie, J S

BMC infectious diseases

2020 Volume 20, Issue 1, Page(s) 203

Abstract: Background: Rabies is endemic in southern Bhutan, associated with 1-2 human deaths and high post exposure prophylaxis (PEP) costs annually. Evaluation of clinicians' management of human cases potentially exposed to rabies could contribute to improving ... ...

Abstract	Background: Rabies is endemic in southern Bhutan, associated with 1-2 human deaths and high post exposure prophylaxis (PEP) costs annually. Evaluation of clinicians' management of human cases potentially exposed to rabies could contribute to improving PEP prescribing practices to both reduce unnecessary costs associated with PEP and reach the target of zero human deaths due to rabies by 2023. Methods: A cross-sectional survey of 50 clinicians' management of human cases potentially exposed to rabies was conducted in 13 health centers in high-rabies-risk areas of Bhutan during February-March 2016. Results: Data were collected on clinicians' management of 273 human cases potentially exposed to rabies. The 50 clinicians comprised health assistants or clinical officers (55%) and medical doctors (45%) with a respective median of 19, 21 and 2 years' experience. There was poor agreement between clinicians' rabies risk assessment compared with an independent assessment for each case based on criteria in the National Rabies Management Guidelines (NRMG). Of the 194 cases for which clinicians recorded a rabies risk category, only 53% were correctly classified when compared with the NRMG. Clinicians were more likely to underestimate the risk of exposure to rabies and appeared to prescribe PEP independently of their risk classification.. Male health assistants performed the most accurate risk assessments while female health assistants performed the least accurate. Clinicians in Basic Health Units performed less accurate risk assessments compared with those in hospitals. Conclusions: This study highlights important discrepancies between clinicians' management of human cases potentially exposed to rabies and recommendations in the NRMG. In particular, clinicians were not accurately assessing rabies risk in potentially exposed cases and were not basing their PEP treatment on the basis of their risk assessment. This has significant implications for achieving the national goal of eliminating dog-mediated human rabies by 2030 and may result in unnecessary costs associated with PEP. Recommendations to improve clinician's management of human cases potentially exposed to rabies include: reviewing and updating the NRMG, providing clinicians with regular and appropriately targeted training about rabies risk assessment and PEP prescription, and regularly reviewing clinicians' practices.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Animals ; Bhutan/epidemiology ; Bites and Stings ; Child ; Child, Preschool ; Cost-Benefit Analysis ; Cross-Sectional Studies ; Female ; Humans ; Male ; Middle Aged ; Physicians/psychology ; Post-Exposure Prophylaxis ; Prescriptions ; Rabies/diagnosis ; Rabies/economics ; Rabies/epidemiology ; Rabies/prevention & control ; Rabies Vaccines/immunology ; Referral and Consultation ; Risk Assessment ; Young Adult
Chemical Substances	Rabies Vaccines
Language	English
Publishing date	2020-03-06
Publishing country	England
Document type	Journal Article
ISSN	1471-2334
ISSN (online)	1471-2334
DOI	10.1186/s12879-020-4926-y
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Article ; Online: Author Correction: Spatio-temporal patterns of childhood pneumonia in Bhutan: a Bayesian analysis.

Wangdi, Kinley / Penjor, Kinley / Tsheten, Tsheten / Tshering, Chachu / Gething, Peter / Gray, Darren J / Clements, Archie C A

Scientific reports

2021 Volume 11, Issue 1, Page(s) 22549

Language	English
Publishing date	2021-11-15
Publishing country	England
Document type	Published Erratum
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-021-01075-y
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Article ; Online: Spatio-temporal patterns of childhood pneumonia in Bhutan: a Bayesian analysis.

Wangdi, Kinley / Penjor, Kinley / Tsheten, Tsheten / Tshering, Chachu / Gething, Peter / Gray, Darren J / Clements, Archie C A

Scientific reports

2021 Volume 11, Issue 1, Page(s) 20422

Abstract: Pneumonia is one of the top 10 diseases by morbidity in Bhutan. This study aimed to investigate the spatial and temporal trends and risk factors of childhood pneumonia in Bhutan. A multivariable Zero-inflated Poisson regression model using a Bayesian ... ...

Abstract	Pneumonia is one of the top 10 diseases by morbidity in Bhutan. This study aimed to investigate the spatial and temporal trends and risk factors of childhood pneumonia in Bhutan. A multivariable Zero-inflated Poisson regression model using a Bayesian Markov chain Monte Carlo simulation was undertaken to quantify associations of age, sex, altitude, rainfall, maximum temperature and relative humidity with monthly pneumonia incidence and to identify the underlying spatial structure of the data. Overall childhood pneumonia incidence was 143.57 and 10.01 per 1000 persons over 108 months of observation in children aged < 5 years and 5-14 years, respectively. Children < 5 years or male sex were more likely to develop pneumonia than those 5-14 years and females. Each 1 °C increase in maximum temperature was associated with a 1.3% (95% (credible interval [CrI] 1.27%, 1.4%) increase in pneumonia cases. Each 10% increase in relative humidity was associated with a 1.2% (95% CrI 1.1%, 1.4%) reduction in the incidence of pneumonia. Pneumonia decreased by 0.3% (CrI 0.26%, 0.34%) every month. There was no statistical spatial clustering after accounting for the covariates. Seasonality and spatial heterogeneity can partly be explained by the association of pneumonia risk to climatic factors including maximum temperature and relative humidity.
MeSH term(s)	Adolescent ; Age Factors ; Bayes Theorem ; Bhutan/epidemiology ; Child ; Child, Preschool ; Female ; Humans ; Incidence ; Male ; Markov Chains ; Monte Carlo Method ; Pneumonia/epidemiology ; Pneumonia/etiology ; Risk Factors ; Sex Factors ; Spatio-Temporal Analysis ; Weather
Language	English
Publishing date	2021-10-14
Publishing country	England
Document type	Journal Article
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-021-99137-8
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