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  1. Article ; Online: An Exemplary National COVID-19 Vaccination: Lessons from Bhutan.

    Phuntsho, Sangay / Tshokey, Tshokey / Gurung, Mongal Singh / Wangdi, Sonam / Wangdi, Sonam / Wangchuk, Sonam

    Tropical medicine and infectious disease

    2022  Volume 7, Issue 7

    Abstract: Vaccination remains a key public health intervention against the COVID-19 pandemic. However, vaccine distribution and coverage are variable between countries due to access and implementation issues. Vaccine inequity was evident with some countries having ...

    Abstract Vaccination remains a key public health intervention against the COVID-19 pandemic. However, vaccine distribution and coverage are variable between countries due to access and implementation issues. Vaccine inequity was evident with some countries having no access to the vaccines while others have initiated multiple booster doses. We share Bhutan's approach to COVID-19 vaccination and lessons learned during the successful conduct of a nationwide vaccination program. As of 12 December 2021, 80.3% of the Bhutanese population have received at least one dose of COVID-19 vaccine and 77.0% have received at least two doses. Considering age groups, 97.2% of adults (18 years) have received at least one dose and 93.6% have received at least two doses. The first dose coverage for the adolescents 12-17 years was 99.7% and second dose coverage was 92.3% since some were not yet due for their second dose at the time of writing this report. The well-established existing national immunization program was especially useful in the implementation of the national COVID-19 vaccination program. The Bhutan Vaccine System, a digital platform for registration and monitoring of vaccination, was rapidly developed and extensively utilized during the campaign. The selfless leadership of the king, the government, and prior detailed planning with multi-sectoral collaboration and coordination, was the key in this exemplary vaccination program. Bhutan has successfully vaccinated children between 5-11 years with high coverage and no serious issues. Many adults have also received first and second booster doses, based on their risks and preferences.
    Language English
    Publishing date 2022-07-11
    Publishing country Switzerland
    Document type Journal Article
    ISSN 2414-6366
    ISSN (online) 2414-6366
    DOI 10.3390/tropicalmed7070131
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  2. Article: Redefining the Mode of HIV Transmission through Analysis of Risk Attribution among the Reported HIV Cases from 1993 to 2021 in Bhutan.

    Khandu, Lekey / Choida, Ngawang / Drukpa, Jurmi / Tsehring, Dolley / Wangdi, Sonam

    AIDS research and treatment

    2022  Volume 2022, Page(s) 2137164

    Abstract: Introduction: The detailed risk assessment of the diagnosed HIV cases in Bhutan is an opportunity to carry out the risk analysis to generate evidence of wherein, under what context, and in which population groups most new infections are occurring. The ... ...

    Abstract Introduction: The detailed risk assessment of the diagnosed HIV cases in Bhutan is an opportunity to carry out the risk analysis to generate evidence of wherein, under what context, and in which population groups most new infections are occurring. The evidence collected will help to test the current assumption of Bhutan experiencing diffused and generalized HIV epidemic.
    Methods: This is a cross-sectional study using a quantitative method to assess the risk behavior of the diagnosed HIV cases from 1993 to 2019. The study also included secondary data analysis of those cases already captured by the routine case-based surveillance from 2020 to 2021. The data collection was done from 1 to 30 January 2022 in all the twenty districts of Bhutan. Descriptive statistical analysis was used to analyze the characteristics of the study population, and relationships were established using the Chi-square Test. We have sought ethics approval and obtained participants' informed consent.
    Results: The risk attribution analysis showed that 81.94% of HIV infection among the reported HIV cases in Bhutan has occurred through high-risk heterosexuals and 8.88% through mother-to-child transmission, and parenteral transmission accounts for 1.58% and then 1.35% through homosexual. Of the 81.94% high-risk heterosexuals, 41.08% acquired through sex workers and clients of sex workers, 27.99% from HIV-infected persons, 12.64% from sex work, and 0.23% from injecting drug use.
    Conclusions: This study has shed some light on a gradual epidemic shift from the current perceived diffused and generalized to the concentrated epidemic among subpopulation groups like female sex workers and their clients.
    Language English
    Publishing date 2022-07-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2573930-X
    ISSN 2090-1259 ; 2090-1240
    ISSN (online) 2090-1259
    ISSN 2090-1240
    DOI 10.1155/2022/2137164
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  3. Article: Good fences are key to sustainable pasture management and harmonious pastoral society of Merak and Sakteng in Bhutan

    Wangdi, Sonam / Nawang Norbu

    Pastoralism. 2018 Dec., v. 8, no. 1

    2018  

    Abstract: There is limited knowledge about the traditional tsamdro management practice, particularly the building of walls and fences by the pastoral nomads of Merak and Sakteng. Conflicts related to tsamdro resource access are not a new phenomenon in Bhutanese ... ...

    Abstract There is limited knowledge about the traditional tsamdro management practice, particularly the building of walls and fences by the pastoral nomads of Merak and Sakteng. Conflicts related to tsamdro resource access are not a new phenomenon in Bhutanese pastoral communities. In the recent past, as an adaptive response to external economic, political, social and ecological changes, the tsamdro was nationalized. This change in policies brought a host of challenges specifically in managing the existing and building new tsamdro border structures.The objective of the study was to elucidate the motives and purposes behind the building of tsamdro structures, and to explore the historical development, significance and future of yak farming by Brokpas. We used a semi-structured questionnaire and face-to-face interview for collecting both quantitative and qualitative data from 40 yak herders opportunistically selected from both Merak and Sakteng gewogs, village block, refers to a group of villages in Bhutan Trashigang district.The study revealed that tsamdro border structures were primarily built to ensure harmony within the Brokpa society by reducing conflicts caused by livestock trespassing, but structures indirectly assisted in tsamdro management. The structures were one of the encashable family assets passed across generations and played a critical role in shaping the socio-economic developments of Brokpas. Though the tsamdro was nationalized, the Brokpas still continue to hold tsamdro ownership rights and build new tsamdro border structures to protect their livelihood. The contradiction between the government’s policy and Brokpas’ livelihood pattern will have a detrimental effect on both the social harmony of nomadic herders and the traditional tsamdro management practice. We suggest the government develop nomadic-centered policies that encourage tsamdro resource sharing within the Brokpa communities. Socio-economic development incentives are required to address the trespassing conflicts.
    Keywords assets ; fences ; issues and policy ; livelihood ; ownership ; pastoralism ; pasture management ; politics ; questionnaires ; socioeconomic development ; villages ; yaks ; Bhutan
    Language English
    Dates of publication 2018-12
    Size p. 4.
    Publishing place Springer Berlin Heidelberg
    Document type Article
    ZDB-ID 2769408-2
    ISSN 2041-7136
    ISSN 2041-7136
    DOI 10.1186/s13570-017-0106-0
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  4. Article ; Online: Barriers to Institutional Delivery Services in Districts With the Lowest Institutional Delivery Coverage in Bhutan.

    Gurung, Mongal Singh / Wangdi, Sonam / Lethro, Pema / Tshomo, Tashi / Dema, Tashi / Pelzom, Dorji

    Asia-Pacific journal of public health

    2020  Volume 33, Issue 1, Page(s) 84–92

    Abstract: 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 ... ...

    Abstract 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.
    MeSH term(s) Adolescent ; Adult ; Bhutan ; Delivery, Obstetric/statistics & numerical data ; Female ; Focus Groups ; Health Services Accessibility ; Home Childbirth/statistics & numerical data ; Humans ; Middle Aged ; Pregnancy ; Qualitative Research ; Socioeconomic Factors ; Young Adult
    Language English
    Publishing date 2020-11-09
    Publishing country China
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1025444-4
    ISSN 1941-2479 ; 1010-5395
    ISSN (online) 1941-2479
    ISSN 1010-5395
    DOI 10.1177/1010539520969236
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  5. Article: Twenty-two years of HIV infection in Bhutan: epidemiological profile.

    Tshering, Pandup / Lhazeen, Karma / Wangdi, Sonam / Tshering, Namgay

    Journal of virus eradication

    2016  Volume 2, Issue Suppl 4, Page(s) 45–48

    Abstract: Aims: To describe the HIV epidemiology in Bhutan.: Methods: Data from the database of people living with HIV infection in Bhutan, survey reports from the National STI and HIV/AIDS Control Programme from the Ministry of Health and published literature ...

    Abstract Aims: To describe the HIV epidemiology in Bhutan.
    Methods: Data from the database of people living with HIV infection in Bhutan, survey reports from the National STI and HIV/AIDS Control Programme from the Ministry of Health and published literature on HIV in Bhutan were reviewed.
    Results: Bhutan continues to have a low HIV prevalence with only 470 cases reported by the end of 2015. However, there is a slow but steady recent increase in the number of cases. The main mode of transmission is unsafe heterosexual practice in the general population and is occurring mostly in urban and business districts. More than half of cases have been diagnosed in only three districts. Although the number of cases among key populations such as sex workers and intravenous drug users remains significantly low, the information available remains very limited. There is only scarce published literature on HIV in Bhutan and an absence of a strategic surveillance system. A high level of sexually transmitted infections and multiple sexual relationships represent the existing threats that may fuel a larger epidemic.
    Conclusions: Bhutan has a maintained a low HIV prevalence over the past two decades, which is reflected in the national response to HIV. However, with the presence of existing and newly emerging risk factors, this response needs to adapt continually. To ensure that HIV prevalence remains low, it is crucial to invest in a strategic information system to monitor rates of infections to guide the public health response.
    Language English
    Publishing date 2016-11-28
    Publishing country England
    Document type Editorial
    ZDB-ID 2868549-0
    ISSN 2055-6659 ; 2055-6640
    ISSN (online) 2055-6659
    ISSN 2055-6640
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  6. Article ; Online: Factors associated with delivery at home in Bhutan: findings from the National Health Survey 2012.

    Gurung, Mongal Singh / Pelzom, Dorji / Wangdi, Sonam / Tshomo, Tashi / Lethro, Pema / Dema, Tashi

    WHO South-East Asia journal of public health

    2018  Volume 7, Issue 1, Page(s) 36–42

    Abstract: Background: Despite Bhutan's remarkable progress in the area of maternal and child health during the era of the Millennium Development Goals, a large proportion of pregnant women are still delivering at home with no skilled attendant. Limited empirical ... ...

    Abstract Background: Despite Bhutan's remarkable progress in the area of maternal and child health during the era of the Millennium Development Goals, a large proportion of pregnant women are still delivering at home with no skilled attendant. Limited empirical studies have been carried out to understand the factors associated with delivery at home in Bhutan.
    Methods: This cross-sectional analytical study used secondary data collected in the nationally representative National Health Survey 2012. The survey included a total of 2213 women aged 15-49 years who had a live birth in the 2 years preceding the survey and were selected using multistage stratified cluster sampling. Weighted analysis was done to evaluate determinants for the place of delivery. Unadjusted and adjusted prevalence ratios with 95% confidence intervals (CIs) were calculated to assess the possible association of factors with home delivery.
    Results: Out of 2213 women aged 15-49 years who had a live birth in the 2 years preceding the survey, 73.7% had an institutional delivery. Coverage of institutional delivery ranged from 49.4% in Zhemgang district to 96.1% in Paro district. Women in the poorest wealth quintile were 7.35 times more likely to have a birth at home compared to women in the richest quintile (adjusted prevalence ratio [aPR]: 7.35, 95% CI: 2.59-20.9). The older mothers aged 30-49 years were 0.79 times (aPR: 0.79, 95% CI: 0.70-0.88) less likely to have a home delivery than mothers aged 15-19 years. Women who had fewer than four antenatal care visits were 1.50 times (aPR: 1.50, 95% CI: 1.35-1.66) more likely to give birth at home compared to those who had four or more visits. The mothers giving birth for a third or more time were 1.88 times (aPR: 1.88, 95% CI: 1.60-2.22) more likely to give birth at home compared to those giving birth for the first time. Women living in rural areas were 2.87 times (aPR: 2.87, 95% CI: 1.42-5.77) more likely to deliver at home compared to those living in urban areas and women living in the eastern region of the country were 1.35 times (aPR: 1.35, 95% CI: 1.17-1.55) more likely to have a home delivery compared to those living in the western region.
    Conclusion: Lower socioeconomic status, rural location, eastern location, non- first birth, and having fewer than four antenatal visits were significant factors associated with home delivery. These findings should inform further research and policy to build on Bhutan's progress in promoting institutional delivery as the key strategy towards improving maternal and child health and achieving the relevant targets of Sustainable Development Goal 3.
    MeSH term(s) Adolescent ; Adult ; Bhutan ; Cross-Sectional Studies ; Delivery, Obstetric/statistics & numerical data ; Female ; Health Surveys ; Home Childbirth/statistics & numerical data ; Humans ; Middle Aged ; Pregnancy ; Socioeconomic Factors ; Young Adult
    Language English
    Publishing date 2018
    Publishing country India
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2676354-0
    ISSN 2304-5272 ; 2224-3151 ; 2224-3151
    ISSN (online) 2304-5272 ; 2224-3151
    ISSN 2224-3151
    DOI 10.4103/2224-3151.228426
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  7. Article: Measles and rubella immunity in the population of Bhutan, 2017

    Wangchuk, Sonam / Nogareda, Francisco / Tshering, Namgay / Khandu, Lekey / Pelden, Sonam / Wannemuehler, Kathleen / Wangdi, Sonam / Wangchuk, Ugyen / Mulders, Mick / Tamang, Tshewang / Patel, Minal K

    Vaccine. 2019 Oct. 08, v. 37, no. 43

    2019  

    Abstract: In 2017, measles elimination was verified in Bhutan, and the country appears to have sufficiently high vaccination coverage to achieve rubella elimination. However, a measles and rubella serosurvey was conducted to find if any hidden immunity gaps ... ...

    Abstract In 2017, measles elimination was verified in Bhutan, and the country appears to have sufficiently high vaccination coverage to achieve rubella elimination. However, a measles and rubella serosurvey was conducted to find if any hidden immunity gaps existed that could threaten Bhutan’s elimination status.A nationwide, three-stage, cluster seroprevalence survey was conducted among individuals aged 1–4, 5–17, and >20 years in 2017. Demographic information and children’s vaccination history were collected, and a blood specimen was drawn. Serum was tested for measles and rubella immunoglobulin G (IgG). Frequencies, weighted proportions, and prevalence ratios for measles and rubella seropositivity were calculated by demographic and vaccination history, taking into account the study design.Of the 1325 individuals tested, 1045 (81%, 95% CI 78%–85%) were measles IgG seropositive, and 1290 (97%, 95% CI 95%–99%) were rubella IgG seropositive. Rubella IgG seropositivity was high in all three age strata, but only 47% of those aged 5–17 years were measles IgG seropositive. Additionally, only 41% of those aged 5–17 years who had documented receipt of two doses of measles– or measles-rubella–containing vaccine were seropositive for measles IgG, but almost all these children were rubella IgG seropositive.An unexpected measles immunity gap was identified among children 5–17 years of age. It is unclear why this immunity gap exists; however, it could have led to a large outbreak and threatened sustaining of measles elimination in Bhutan. Based on this finding, a mass vaccination campaign was conducted to close the immunity gap.
    Keywords blood serum ; children ; immunity ; immunoglobulin G ; measles ; seroprevalence ; surveys ; vaccination ; vaccines ; Bhutan
    Language English
    Dates of publication 2019-1008
    Size p. 6463-6469.
    Publishing place Elsevier Ltd
    Document type Article
    ZDB-ID 605674-x
    ISSN 1873-2518 ; 0264-410X
    ISSN (online) 1873-2518
    ISSN 0264-410X
    DOI 10.1016/j.vaccine.2019.08.085
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  8. Article: Cerebral cysticercosis in a wild Bengal tiger

    Phuentshok, Yoenten / Choden, Kinley / Alvarez Rojas, Cristian A / Deplazes, Peter / Wangdi, Sonam / Gyeltshen, Kuenzang / Rinzin, Karma / Thapa, Nirmal Kumar / Tenzinla, Tenzinla / Dorjee, Dechen / Valitutto, Marc / Gilbert, Martin / Siriaroonrat, Boripat / Jairak, Waleemas / Piewbang, Chutchai / Sharma, Puspa Maya / Dema, Tshewang / Gurung, Ratna Bahadur

    International journal for parasitology. Parasites and wildlife

    2021  Volume 14, Page(s) 150–156

    Abstract: The endangered Bengal tiger ( ...

    Abstract The endangered Bengal tiger (
    Language English
    Publishing date 2021-02-10
    Publishing country England
    Document type Case Reports
    ZDB-ID 2715239-X
    ISSN 2213-2244
    ISSN 2213-2244
    DOI 10.1016/j.ijppaw.2021.02.003
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  9. Article ; Online: Conservation threats to the endangered golden langur (Trachypithecus geei, Khajuria 1956) in Bhutan.

    Thinley, Phuntsho / Norbu, Tshewang / Rajaratnam, Rajanathan / Vernes, Karl / Dhendup, Phub / Tenzin, Jigme / Choki, Karma / Wangchuk, Singye / Wangchuk, Tshering / Wangdi, Sonam / Chhetri, Dambar Bahadur / Powrel, Reta Bahadur / Dorji, Kezang / Rinchen, Kado / Dorji, Namgay

    Primates; journal of primatology

    2019  Volume 61, Issue 2, Page(s) 257–266

    Abstract: Threat assessment is critical to species conservation and management planning, because prior identification and assessment of key threats to conservation planning can assist in developing appropriate interventions or strategies. Comprehensive threat ... ...

    Abstract Threat assessment is critical to species conservation and management planning, because prior identification and assessment of key threats to conservation planning can assist in developing appropriate interventions or strategies. Comprehensive threat assessments are currently lacking for many threatened primates. In this paper, we classify and rank all direct threats to the endangered golden langur (Trachypithecus geei) in Bhutan in order to provide a practical guide to future conservation of the species. Information on threats was based on interviews with local people, discussion with field forestry staff, and social media interaction. We classified threats to golden langur habitats and populations, and ranked them using Miradi™, an analytical software for the adaptive management of conservation projects. We identified five habitat threats: (1) hydropower development, (2) road development, (3) housing development, (4) resource extraction, and (5) agricultural expansion. We also identified seven population threats: (1) electrocution, (2) road kill, (3) road injury, (4) dog kill, (5) retaliatory killing, (6) illegal pet keeping, and (7) hybridization with capped langurs. We rated the overall threat to golden langurs in Bhutan as 'medium'. Hydropower, road, and housing development constituted 'high' impact, while agricultural expansion, resource extraction, electrocution, and road kill had 'medium' impact; the remaining threats had 'low' impact. To immediately mitigate threats to golden langurs, we recommend: (a) installing speed limit signage and speed breakers with strict enforcement of speed limits; (b) installing insulated electric cables and fencing around power transformers; and (c) reducing and restraining domestic dog populations.
    MeSH term(s) Accidents, Traffic ; Agriculture ; Animals ; Bhutan ; Conservation of Natural Resources/methods ; Construction Industry ; Dogs ; Ecosystem ; Electric Injuries/veterinary ; Endangered Species ; Hybridization, Genetic ; Presbytini ; Risk Assessment
    Language English
    Publishing date 2019-12-05
    Publishing country Japan
    Document type Journal Article
    ZDB-ID 2100453-5
    ISSN 1610-7365 ; 0032-8332
    ISSN (online) 1610-7365
    ISSN 0032-8332
    DOI 10.1007/s10329-019-00777-2
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  10. Article ; Online: Measles and rubella immunity in the population of Bhutan, 2017.

    Wangchuk, Sonam / Nogareda, Francisco / Tshering, Namgay / Khandu, Lekey / Pelden, Sonam / Wannemuehler, Kathleen / Wangdi, Sonam / Wangchuk, Ugyen / Mulders, Mick / Tamang, Tshewang / Patel, Minal K

    Vaccine

    2019  Volume 37, Issue 43, Page(s) 6463–6469

    Abstract: Background: In 2017, measles elimination was verified in Bhutan, and the country appears to have sufficiently high vaccination coverage to achieve rubella elimination. However, a measles and rubella serosurvey was conducted to find if any hidden ... ...

    Abstract Background: In 2017, measles elimination was verified in Bhutan, and the country appears to have sufficiently high vaccination coverage to achieve rubella elimination. However, a measles and rubella serosurvey was conducted to find if any hidden immunity gaps existed that could threaten Bhutan's elimination status.
    Methods: A nationwide, three-stage, cluster seroprevalence survey was conducted among individuals aged 1-4, 5-17, and >20 years in 2017. Demographic information and children's vaccination history were collected, and a blood specimen was drawn. Serum was tested for measles and rubella immunoglobulin G (IgG). Frequencies, weighted proportions, and prevalence ratios for measles and rubella seropositivity were calculated by demographic and vaccination history, taking into account the study design.
    Results: Of the 1325 individuals tested, 1045 (81%, 95% CI 78%-85%) were measles IgG seropositive, and 1290 (97%, 95% CI 95%-99%) were rubella IgG seropositive. Rubella IgG seropositivity was high in all three age strata, but only 47% of those aged 5-17 years were measles IgG seropositive. Additionally, only 41% of those aged 5-17 years who had documented receipt of two doses of measles- or measles-rubella-containing vaccine were seropositive for measles IgG, but almost all these children were rubella IgG seropositive.
    Conclusions: An unexpected measles immunity gap was identified among children 5-17 years of age. It is unclear why this immunity gap exists; however, it could have led to a large outbreak and threatened sustaining of measles elimination in Bhutan. Based on this finding, a mass vaccination campaign was conducted to close the immunity gap.
    MeSH term(s) Adolescent ; Bhutan ; Child ; Child, Preschool ; Cross-Sectional Studies ; Disease Eradication ; Female ; Humans ; Immunoglobulin G/blood ; Infant ; Male ; Measles/immunology ; Measles/prevention & control ; Measles Vaccine/immunology ; Rubella/immunology ; Rubella/prevention & control ; Rubella Vaccine/immunology ; Seroepidemiologic Studies ; Vaccination/statistics & numerical data ; Young Adult
    Chemical Substances Immunoglobulin G ; Measles Vaccine ; Rubella Vaccine
    Language English
    Publishing date 2019-09-06
    Publishing country Netherlands
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 605674-x
    ISSN 1873-2518 ; 0264-410X
    ISSN (online) 1873-2518
    ISSN 0264-410X
    DOI 10.1016/j.vaccine.2019.08.085
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