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Article ; Online: Evaluating Country Performance After Transitioning From Gavi Assistance: An Applied Synthetic Control Analysis.

Kolesar, Robert John / Spruk, Rok / Tsheten, Tsheten

2023 Volume 11, Issue 4

Abstract: Introduction: Over the past decade, international development assistance for health has slowed. As donors seek to increase domestic cofinancing and ultimately transition countries from donor aid dependence, COVID-19 has severely constrained public ... ...

Abstract	Introduction: Over the past decade, international development assistance for health has slowed. As donors seek to increase domestic cofinancing and ultimately transition countries from donor aid dependence, COVID-19 has severely constrained public budgets. The evaluation of sustainability and longer-term impacts of donor withdrawal is increasingly important. We assess vaccination coverage and post-neonatal mortality to estimate country performance of these outcomes among countries that no longer received assistance from Gavi, the Vaccine Alliance (Gavi) between 2000 and 2018. Methods: Using data from all countries receiving Gavi support between 2000 and 2020, we employed a synthetic control method to generate a pre-transition counterfactual with the same characteristics as the observation of interest to predict a future that empirically never existed. The synthetic unit is constructed from the weighted average of other units with good fit to the unit of interest before transition but did not transition. Results: We found substantial heterogeneity after transitioning from Gavi assistance. China, Guyana, and Turkmenistan overperformed their expected coverage rates; Albania, Bhutan, China, Guyana, and Turkmenistan maintained coverage over 90%; and Bosnia and Herzegovina and Ukraine reported precipitous drop-offs that fell well below their synthetic controls. We also observed a vaccination coverage decline in 2020 for several countries after transitioning and most synthetic controls, which we attribute to COVID-19-related service disruptions. Conclusions: We recommend that Gavi adjust its transition model to systematically assess contextual externalities and risk. In addition, countries that no longer receive Gavi assistance can leverage technical assistance and communities of practice to mutually assist each other and other countries advancing toward transition. This could also foster intracountry accountability after transition. We also recommend that Gavi systematize post-transition assessments and evaluations that leverage the expertise and experience of graduated countries to encourage cross-learning.
MeSH term(s)	Infant, Newborn ; Humans ; COVID-19/epidemiology ; COVID-19/prevention & control ; Albania ; Budgets ; China ; Infant Mortality
Language	English
Publishing date	2023-08-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	2710875-2
ISSN	2169-575X ; 2169-575X
ISSN (online)	2169-575X
ISSN	2169-575X
DOI	10.9745/GHSP-D-22-00536
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Article ; Online: Aetiologies and Risk Factors of Prolonged Fever Admission in Samtse Hospital, Bhutan, 2020

Tsheten Tsheten / Karma Lhendup / Thinley Dorji / Kinley Wangdi

International Journal of Environmental Research and Public Health, Vol 19, Iss 7859, p

2022 Volume 7859

Abstract: Febrile illness is a common cause of hospital admission in developing countries, including Bhutan. Prolonged fever admission can add considerable strain on healthcare service delivery. Therefore, identifying the underlying cause of prolonged hospital ... ...

Abstract	Febrile illness is a common cause of hospital admission in developing countries, including Bhutan. Prolonged fever admission can add considerable strain on healthcare service delivery. Therefore, identifying the underlying cause of prolonged hospital stays can improve the quality of patient care by providing appropriate empirical treatment. Thus, the study’s aims were to evaluate the aetiologies and factors of prolonged fever admission in Samtse Hospital, Bhutan. Fever admission data from 1 January to 31 December 2020 were retrieved from the Samtse Hospital database. Prolonged hospital stay was defined as those with >5 days of hospital admission. Univariable and multivariable logistic regression was used to identify risk factors for a prolonged hospital stay. Of 290 records, 135 (46.6%) were children (≤12 years), 167 (57.6%) were males, and 237 (81.7%) patients were from rural areas. The common aetiologies for fever admissions were respiratory tract infection (85, 29.3%) and acute undifferentiated febrile illness (48, 16.6%). The prolonged stay was reported in 87 (30.0%) patients. Patients from rural areas (adjusted odds ratio [AOR] = 4.02, 95% CI = 1.58–10.24) and those with respiratory tract infections (AOR = 5.30, 95% CI = 1.11–25.39) and urinary tract infections and kidney disease (AOR = 8.16, 95% CI = 1.33–49.96) had higher odds of prolonged hospital stay. This epidemiological knowledge on prolonged hospital stay can be used by the physician for the management of fever admission in Samtse Hospital.
Keywords	developing countries ; prolonged fever admission ; infections ; health services ; epidemiology ; aetiologies ; Medicine ; R
Subject code	360
Language	English
Publishing date	2022-06-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
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Article ; Online: Risk Factors of Symptomatic COVID-19 in Samtse District, Bhutan

Karma Lhendup / Tsheten Tsheten / Tshewang Rinzin / Kinley Wangdi

Frontiers in Public Health, Vol

2022 Volume 10

Abstract: IntroductionAll Coronavirus disease 2019 (COVID-19) positive cases in Samtse District, Bhutan were isolated in the isolation facilities managed by the government hospitals. This study aimed to identify the socio-demographic risk factors for developing ... ...

Abstract	IntroductionAll Coronavirus disease 2019 (COVID-19) positive cases in Samtse District, Bhutan were isolated in the isolation facilities managed by the government hospitals. This study aimed to identify the socio-demographic risk factors for developing COVID-19 symptoms amongst these patients.Methods and MaterialsA secondary data of the COVID-19 positive cases from isolation facilities of Samtse District from 5 May to 7 September 2021 was used for this study. Survival analysis was carried out to estimate the cumulative probability of symptom onset time by each risk factor. Kaplan–Meier curves were used to estimate the probabilities for the onset of symptoms at different time points and a log-rank test was employed to assess the differences between covariates.ResultsA total of 449 patients were included, of which 55.2% were males and 73.3% (328) were aged >18 years. The mean age was 42 years with a range of 3 months to 83 years. Forty-seven percent (213) reported at least one symptom. Common symptoms were fever (32.3%, 145), headache (31.6%, 142), and cough (30.1%, 135), respectively. Males were 64% less likely to be symptomatic than females [adjusted hazard ratio (aHR) = 0.36, 95% confidence interval (CI) 0.183–0.917]. Farmers (aHR = 3.17, 95% CI 1.119–8.953), and drivers and loaders (aHR = 3.18, 95% CI 1.029–9.834) were 3 times more likely to be symptomatic compared to housewives. Residents of Samtse sub-districts were 5 times more likely to be symptomatic than those living in other sub-districts (aHR = 5.16, 95% CI 2.362–11.254).ConclusionThe risk of developing COVID-19 symptoms was being fe male, farmers, drivers and loaders, and residents of the Samtse sub-district. These high-risk groups should be provided additional care when in isolation facilities.
Keywords	COVID-19 ; Bhutan ; symptomatic ; risk factors ; survival analysis ; Samtse District ; Public aspects of medicine ; RA1-1270
Subject code	150
Language	English
Publishing date	2022-05-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
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Article ; Online: Risk Factors of Symptomatic COVID-19 in Samtse District, Bhutan.

Lhendup, Karma / Tsheten, Tsheten / Rinzin, Tshewang / Wangdi, Kinley

Frontiers in public health

2022 Volume 10, Page(s) 857084

Abstract: Introduction: All Coronavirus disease 2019 (COVID-19) positive cases in Samtse District, Bhutan were isolated in the isolation facilities managed by the government hospitals. This study aimed to identify the socio-demographic risk factors for developing ...

Abstract	Introduction: All Coronavirus disease 2019 (COVID-19) positive cases in Samtse District, Bhutan were isolated in the isolation facilities managed by the government hospitals. This study aimed to identify the socio-demographic risk factors for developing COVID-19 symptoms amongst these patients. Methods and materials: A secondary data of the COVID-19 positive cases from isolation facilities of Samtse District from 5 May to 7 September 2021 was used for this study. Survival analysis was carried out to estimate the cumulative probability of symptom onset time by each risk factor. Kaplan-Meier curves were used to estimate the probabilities for the onset of symptoms at different time points and a log-rank test was employed to assess the differences between covariates. Results: A total of 449 patients were included, of which 55.2% were males and 73.3% (328) were aged >18 years. The mean age was 42 years with a range of 3 months to 83 years. Forty-seven percent (213) reported at least one symptom. Common symptoms were fever (32.3%, 145), headache (31.6%, 142), and cough (30.1%, 135), respectively. Males were 64% less likely to be symptomatic than females [adjusted hazard ratio (aHR) = 0.36, 95% confidence interval (CI) 0.183-0.917]. Farmers (aHR = 3.17, 95% CI 1.119-8.953), and drivers and loaders (aHR = 3.18, 95% CI 1.029-9.834) were 3 times more likely to be symptomatic compared to housewives. Residents of Samtse sub-districts were 5 times more likely to be symptomatic than those living in other sub-districts (aHR = 5.16, 95% CI 2.362-11.254). Conclusion: The risk of developing COVID-19 symptoms was being fe male, farmers, drivers and loaders, and residents of the Samtse sub-district. These high-risk groups should be provided additional care when in isolation facilities.
MeSH term(s)	Bhutan/epidemiology ; COVID-19/epidemiology ; Cough ; Female ; Humans ; Infant ; Male ; Risk Factors ; Survival Analysis
Language	English
Publishing date	2022-05-02
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2711781-9
ISSN	2296-2565 ; 2296-2565
ISSN (online)	2296-2565
ISSN	2296-2565
DOI	10.3389/fpubh.2022.857084
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Article ; Online: Aetiologies and Risk Factors of Prolonged Fever Admission in Samtse Hospital, Bhutan, 2020.

Tsheten, Tsheten / Lhendup, Karma / Dorji, Thinley / Wangdi, Kinley

International journal of environmental research and public health

2022 Volume 19, Issue 13

Abstract	Febrile illness is a common cause of hospital admission in developing countries, including Bhutan. Prolonged fever admission can add considerable strain on healthcare service delivery. Therefore, identifying the underlying cause of prolonged hospital stays can improve the quality of patient care by providing appropriate empirical treatment. Thus, the study’s aims were to evaluate the aetiologies and factors of prolonged fever admission in Samtse Hospital, Bhutan. Fever admission data from 1 January to 31 December 2020 were retrieved from the Samtse Hospital database. Prolonged hospital stay was defined as those with >5 days of hospital admission. Univariable and multivariable logistic regression was used to identify risk factors for a prolonged hospital stay. Of 290 records, 135 (46.6%) were children (≤12 years), 167 (57.6%) were males, and 237 (81.7%) patients were from rural areas. The common aetiologies for fever admissions were respiratory tract infection (85, 29.3%) and acute undifferentiated febrile illness (48, 16.6%). The prolonged stay was reported in 87 (30.0%) patients. Patients from rural areas (adjusted odds ratio [AOR] = 4.02, 95% CI = 1.58−10.24) and those with respiratory tract infections (AOR = 5.30, 95% CI = 1.11−25.39) and urinary tract infections and kidney disease (AOR = 8.16, 95% CI = 1.33−49.96) had higher odds of prolonged hospital stay. This epidemiological knowledge on prolonged hospital stay can be used by the physician for the management of fever admission in Samtse Hospital.
MeSH term(s)	Bhutan/epidemiology ; Child ; Female ; Fever/epidemiology ; Fever/etiology ; Hospitalization ; Hospitals ; Humans ; Length of Stay ; Male ; Respiratory Tract Infections ; Risk Factors
Language	English
Publishing date	2022-06-27
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2175195-X
ISSN	1660-4601 ; 1661-7827
ISSN (online)	1660-4601
ISSN	1661-7827
DOI	10.3390/ijerph19137859
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Article: Individual- and Community-Level Factors Associated with Diarrhea in Children Younger Than Age 5 Years in Bangladesh: Evidence from the 2014 Bangladesh Demographic and Health Survey.

Kamal, Md Moustafa / Tewabe, Tilahun / Tsheten, Tsheten / Hossain, Syeda Z

Current therapeutic research, clinical and experimental

2022 Volume 97, Page(s) 100686

Abstract: Background: Diarrheal disease is among the leading causes of morbidity and mortality among children younger than age 5 years in Bangladesh.: Objective: The objective of this study is to assess the prevalence of diarrhea among children younger than ... ...

Abstract	Background: Diarrheal disease is among the leading causes of morbidity and mortality among children younger than age 5 years in Bangladesh. Objective: The objective of this study is to assess the prevalence of diarrhea among children younger than age 5 years and its associated risk factors. Methods: Data were sourced from the Bangladesh Demographic and Health Survey, a nationally representative study conducted in 2014. We used multilevel logistic regression models to identify factors associated with diarrheal disease. Results: Children aged 6 to11 months (odds ratio = 2.26; 95% CI, 1.50-3.42), and 12 to 23 months (odds ratio = 2.31; 95% CI, 1.62-3.31) were more likely to have diarrhea than older children. Other significant risk factors for diarrheal infection included households without access to drinking water (odds ratio = 1.39; 95% CI, 1.03-1.88) and mothers lacking mass media access (odds ratio = 1.32; 55% CI, 1.01-1.73). Conclusions: Childhood diarrhea in Bangladesh was associated with individual- and community-level factors. The finding of this study suggests that diarrhea prevention programs in the country can effectively be delivered by targeting young children through expanding community-based education and increasing access to health information through mass media.
Language	English
Publishing date	2022-09-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	205697-5
ISSN	1879-0313 ; 0011-393X
ISSN (online)	1879-0313
ISSN	0011-393X
DOI	10.1016/j.curtheres.2022.100686
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Article ; Online: Effectiveness of nutritional support to improve treatment adherence in patients with tuberculosis: a systematic review.

Wagnew, Fasil / Gray, Darren / Tsheten, Tsheten / Kelly, Matthew / Clements, Archie C A / Alene, Kefyalew Addis

Nutrition reviews

2023

Abstract: Context: Nutritional interventions substantially improve tuberculosis (TB) treatment outcomes and prevent complications. However, there is limited evidence about the connections between having nutritional support and TB treatment adherence.: Objective! ...

Abstract	Context: Nutritional interventions substantially improve tuberculosis (TB) treatment outcomes and prevent complications. However, there is limited evidence about the connections between having nutritional support and TB treatment adherence. Objective: The aim of this study was to determine the effectiveness of nutritional support in improving treatment adherence among patients with TB. Data sources: Databases, including PubMed, Embase (Ovid), Web of Science, and Scopus, were comprehensively reviewed to identify relevant studies reporting the impacts of nutritional support on TB treatment adherence. Data extraction: Two authors independently screened the title, abstracts, and full article texts to identify eligible studies and assess the risk of bias. Observational and interventional studies were included. Data analysis: A narrative synthesis approach was used to summarize the findings qualitatively. Results: From the search, 3059 publications were identified; of these, 8 studies were included in this systematic review. Three types of nutritional interventions were identified: food baskets (eg, energy, micronutrient- or macronutrient-enriched food support), nutritional advice and guidance, and incentives for buying foods. Although 5 studies reported that nutritional support significantly improved treatment adherence in patients with TB, 3 studies showed that nutritional support had no effect on TB treatment adherence. Conclusions: Providing nutritional support may improve adherence to TB treatment. However, more well-powered, high-quality trials are warranted to demonstrate the effect of nutrition support on cost-effectively improving adherence to TB treatment. Systematic review registration: PROSPERO registration no. CRD42023392162.
Language	English
Publishing date	2023-09-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	82067-2
ISSN	1753-4887 ; 0029-6643
ISSN (online)	1753-4887
ISSN	0029-6643
DOI	10.1093/nutrit/nuad120
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Article ; Online: Survival Analysis of Symptomatic COVID-19 in Phuentsholing Municipality, Bhutan

Kinley Gyeltshen / Tsheten Tsheten / Sither Dorji / Thinley Pelzang / Kinley Wangdi

International Journal of Environmental Research and Public Health, Vol 18, Iss 10929, p

2021 Volume 10929

Abstract: COVID-19 is a disease that is caused by a highly transmissible and pathogenic novel coronavirus: severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). All of the COVID-19 positive cases in Bhutanese travellers returning via the Phuentsholing ... ...

Abstract	COVID-19 is a disease that is caused by a highly transmissible and pathogenic novel coronavirus: severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). All of the COVID-19 positive cases in Bhutanese travellers returning via the Phuentsholing point of entry, the local population, and Indian nationals were isolated in the Phuentsholing COVID-19 isolation ward, Bhutan. This study aimed to identify the risk factors for developing symptoms among COVID-19 positive patients in this ward. A retrospective cohort study was conducted using the data regarding COVID-19 positive cases in the Phuentsholing COVID-19 isolation ward from 28 May 2020 to 31 May 2021. The Cox proportional hazards regression model was used to identify the risk factors of developing COVID-19 symptoms. There were 521 patients in the study; 368 (70.6%) were males and 153 (29.4%) were females. The mean age was 32 years (with a range of 1–78 years), and 290 (56.0%) reported at least one symptom. The median length of isolation was eight days (with a range of 3–48 days). The common symptoms were: cough (162, 31.0%), fever (135, 26.0%), and headache (101, 19.0%). In the multivariable Cox regression, vaccinated patients were 77.0% ( p = 0.047) less likely to develop symptoms compared to those who were not vaccinated. The front line workers and the mini-dry port (MDP) workers were 15 ( p = 0.031) and 41 ( p < 0.001) times more likely to be symptomatic compared to returning travellers. The young and economically active population group was most commonly affected by COVID-19. The presence of risk factors, such as being front line workers, MDP workers, or not being vaccinated against COVID-19, meant that patients had a higher probability of developing symptoms of COVID-19.
Keywords	COVID-19 ; patients ; Bhutan ; survival ; analysis ; symptomatic ; Medicine ; R
Language	English
Publishing date	2021-10-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
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Article ; Online: Dengue risk assessment using multicriteria decision analysis: A case study of Bhutan.

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

PLoS neglected tropical diseases

2021 Volume 15, Issue 2, Page(s) e0009021

Abstract: Background: Dengue is the most rapidly spreading vector-borne disease globally, with a 30-fold increase in global incidence over the last 50 years. In Bhutan, dengue incidence has been on the rise since 2004, with numerous outbreaks reported across the ... ...

Abstract	Background: Dengue is the most rapidly spreading vector-borne disease globally, with a 30-fold increase in global incidence over the last 50 years. In Bhutan, dengue incidence has been on the rise since 2004, with numerous outbreaks reported across the country. The aim of this study was to identify and map areas that are vulnerable to dengue in Bhutan. Methodology/principal findings: We conducted a multicriteria decision analysis (MCDA) using a weighted linear combination (WLC) to obtain a vulnerability map of dengue. Risk factors (criteria) were identified and assigned with membership values for vulnerability according to the available literature. Sensitivity analysis and validation of the model was conducted to improve the robustness and predictive ability of the map. Our study revealed marked differences in geographical vulnerability to dengue by location and season. Low-lying areas and those located along the southern border were consistently found to be at higher risk of dengue. The vulnerability extended to higher elevation areas including some areas in the Capital city Thimphu during the summer season. The higher risk was mostly associated with relatively high population density, agricultural and built-up landscapes and relatively good road connectivity. Conclusions: Using MCDA, our study identified vulnerable areas in Bhutan during specific seasons when and where the transmission of dengue is most likely to occur. This study provides evidence for the National Vector-borne Disease Control programme to optimize the use of limited public health resources for surveillance and vector control, to mitigate the public health threat of dengue.
MeSH term(s)	Aedes/virology ; Animals ; Bhutan/epidemiology ; Decision Making ; Decision Support Techniques ; Dengue/epidemiology ; Ecosystem ; Environment ; Humans ; Mosquito Vectors/virology ; Risk Assessment/methods ; Risk Factors ; Vector Borne Diseases/virology
Language	English
Publishing date	2021-02-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	2429704-5
ISSN	1935-2735 ; 1935-2727
ISSN (online)	1935-2735
ISSN	1935-2727
DOI	10.1371/journal.pntd.0009021
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Article ; Online: Survival Analysis of Symptomatic COVID-19 in Phuentsholing Municipality, Bhutan.

Gyeltshen, Kinley / Tsheten, Tsheten / Dorji, Sither / Pelzang, Thinley / Wangdi, Kinley

International journal of environmental research and public health

2021 Volume 18, Issue 20

Abstract	COVID-19 is a disease that is caused by a highly transmissible and pathogenic novel coronavirus: severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). All of the COVID-19 positive cases in Bhutanese travellers returning via the Phuentsholing point of entry, the local population, and Indian nationals were isolated in the Phuentsholing COVID-19 isolation ward, Bhutan. This study aimed to identify the risk factors for developing symptoms among COVID-19 positive patients in this ward. A retrospective cohort study was conducted using the data regarding COVID-19 positive cases in the Phuentsholing COVID-19 isolation ward from 28 May 2020 to 31 May 2021. The Cox proportional hazards regression model was used to identify the risk factors of developing COVID-19 symptoms. There were 521 patients in the study; 368 (70.6%) were males and 153 (29.4%) were females. The mean age was 32 years (with a range of 1-78 years), and 290 (56.0%) reported at least one symptom. The median length of isolation was eight days (with a range of 3-48 days). The common symptoms were: cough (162, 31.0%), fever (135, 26.0%), and headache (101, 19.0%). In the multivariable Cox regression, vaccinated patients were 77.0% (
MeSH term(s)	Adolescent ; Adult ; Aged ; Bhutan/epidemiology ; COVID-19 ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Middle Aged ; Retrospective Studies ; SARS-CoV-2 ; Survival Analysis ; Young Adult
Language	English
Publishing date	2021-10-18
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2175195-X
ISSN	1660-4601 ; 1661-7827
ISSN (online)	1660-4601
ISSN	1661-7827
DOI	10.3390/ijerph182010929
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