bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of HIV risk behaviors, practices and knowledge among people living with HIV in Bhutan, 2011
Authors: Darnal Jit B. , Doung-ngern Pawinee , Wangchuk Lungten Z. , Gurung Mongal S. , Swaddiwudhipong Witaya 
Published: December 2020

Introduction: A total of 217 HIV positive cases have been reported in Bhutan as of 2010. A descriptive study toassess the knowledge and behavioral practices among 116 of those persons living with HIV (PLHIV) was conducted in 2011.
Methods: Data on demographic characteristics, sexual behavior, alcohol consumption: mobility and HIVknowledge both before and after testing positive for HIV were collected. Responses regarding behavior before and after HIV diagnosis were compared.
Results: Of 116 participants, 52.6% were males; a majority of male PLHIV (72.1%) belonged to salaried group of people while housewife represented 47.3% among female respondents. Fortythree percent of male and 5.5% of female participants reported having exchange sex and 52.5% of male and 41.8% of female participants reported having non-exchange sex partners before HIV diagnosis. The consistent condom use had significantly increased after HIV diagnosis among males with exchange (12% vs. 60%, p=.04) and non-exchange (13% vs. 100%, p<.001) partners. Eighty-four percent of male and 61.8% of female participants reported consuming alcohol before HIV diagnosis. Only one male respondent reported injection drug use before HIV. There was a decrease in incidence of sexually transmitted infection (56.9% vs. 31.9%) after HIV diagnosis. Forty-three percent of males had traveled abroad before HIV diagnosis; among those, 30.8% reported having exchange sex while abroad.
Conclusions: Our findings indicated that high-risk sexual behavior was common before HIV diagnosis and that sexual practices changed after diagnosis. Educational campaigns aimed at increasing HIV knowledge and safe sex, are critical to reduce HIV infections in Bhutan.
Status of Thiamin deficiency in boarding school children from seven districts in Bhutan with previous history of peripheral neuropathy outbreaks: a cohort study
Authors: Dzed Laigden , Dorji Tandin , you prefer to Dorji , Dhakal Guru P. , Yangchen Pema , Wangmo Kinley 
Published: December 2020

Introduction: Peripheral neuropathy outbreaks have been a common occurrence amongst boarding schoolchildren from seven districts in Bhutan. Thiamin deficiency has always been suspected to be the cause but the status of the vitamin has never been established. This study aims to find the status of thiamin and dietary intake of micronutrients in boarding schoolchildren from seven districts with previous history of peripheral neuropathy outbreaks.
Methods: Whole blood thiamin and dietary intake of micronutrients were assessed in 448 school children for four study periods (SP). Baseline data (SP1) was collected when the school children just joined the school at the start of the school academic year. SP2 was the first half of the school year and the data was collected just before the midterm break. SP3 was the short summer break and SP4 the second half of the school academic year.
Results: 50.58% of the school children were found to be thiamin deficient at baseline which increased to 90.1% in SP2. The percentage of thiamin deficient school children increased to 91.8% in SP3 and then decreased to 79.82% in SP4. The requirements for vitamin B1, B12, vitamin A and iron were never met by dietary intakes in all the study periods.
Conclusions: In conclusion, this study found a high prevalence of Thiamin deficiency in schoolchildren at baseline and the number of school children with Thiamin deficiency increased when in schools. The school children also had inadequate dietary intake of many micronutrients.
Association of maternal serum beta human chorionic gonadotropin (B-hCG) level with intrayterine growth restriction: a case control study
Authors: Dorjey Yeshey 
Published: December 2020

Introduction: Intrauterine growth restriction (IUGR) is a major cause of perinatal morbidity and mortality. The human chorionic gonadotropin (B-hCG) is suggested to be released in large amounts into the maternal circulation due to placental dysfunction. Studies have shown that raised levels of B-hCG was associated with IUGR in the first and second trimesters. However, no study was done during the third trimester. Therefore, the objective of the study was to determine the association of B-hCG level with IUGR during 3rd trimester.
Methods: A case-control one year-period study completed in the Department of Obstetrics and Gynaecology, BSMMU, Bangladesh. Pregnant mothers diagnosed with IUGR were taken as case (n=55) and mothers without IUGR as control (n=55). Serum B-hCG levels of these two groups were measured. The data was analysed with SPSS-16 software. Chi-square test was used for analysis.
Results: The mean estimated fetal weight (EFW) of case was significantly less as compared to control (p<0.001). Out of 55 pregnancies with IUGR, 14 (25.5%) had raised level of B-hCG as compared to only 4(7.3%) of control had raised B-hCG level. The odds ratio (OR) of developing IUGR in pregnant women with raised B-hCG level was found to be 4.4 fold (95% CI: 1.331- 14.237) higher than the pregnant women with normal level of B-hCG.
Conclusions: The study concluded a significant association between the raised levels of B-hCG with IUGR.
Department of pathology and laboratory medicine at Jigme Dorji Wangchuck National Referral Hospital striving for quality: external quality assessment scheme in hematology
Authors: Dorji Kuenzang , Jamtsho Rixin , Samal Puja D. , Rai Partab , Wangchuk Dorji 
Published: December 2020

Introduction: Quality Assurance comprising External Quality Assessment Scheme (EQAS) and Internal Quality Control (IQC) is an indispensible part of the laboratory analytical process to ensure reliable results from the laboratories. However, due to various challenges in many developing countries such as limitations in resources and manpower, EQAS samples are often given less importance at laboratories. The objective of this study is to assess performance on hematology EQAS samples received from Pacific Paramedical Training Center- External Quality Assesment Scheme (PPTC-EQAS) and International External Quality Assesment Scheme-United Kingdom (IEQAS-UK)since 2007 and 2008 respectively. The findings from this study will be helpful to establish an effective system to ensure timely follow up and corrective actions to improve the quality of laboratory services.
Methods:The feedback of the EQAS results submitted thrice a year to the PPTC-EQAS and six times a year to the IEQAS-UK since 2007 and 2008 respectively were reviewed to assess the laboratory’s performance and to determine the effectiveness of EQAS participation for improving the performance of laboratory hematology in Bhutan.
Results:For PPTC-EQAS, the average yearly scores were 69.00%, 75.00%, 87.66%, 87.50%, 70.00%, 80.33%, 80.50%, 85.00% for the years 2007-2014. For IEQAS-UK, the average yearly scores were 76.66%, 75.95%, 77.91%, 85.83%, 92.50%, 63.88% and 98.14% for the years 2008-2014. Our results show inconsistent performances on both EQAS samples despite gradual improvement over the last seven years.
Conclusions:We conclude that, strengthening the system for regular follow up and implementing corrective actions for the outlying results in addition to replacement of the equipment could improve the trend and ensure consistency of the performance.
National oral health survey in 6- and 12-year-old Bhutanese school children
Authors: Ngedup Sonam 
Published: December 2020

Introduction: Dental caries is a highly prevalent and a significant public health problem affecting 70% to 95% of children, including adults in member states of the South East Asia region. Epidemiological data on the prevalence of dental caries amongst Bhutanese children at the national level is non-existent. The objective of this study was to determine the prevalence of dental caries, periodontal status, traumatic dental injuries and fluorosis in 6-and 12-year-old school children.
Methods: A descriptive cross-sectional survey in two age groups of school children in Bhutan was conducted in 2014. A total of 2904 students participated in the survey. A multistage cluster random sampling method was adopted that included samples from both urban and rural schools. The assessments for dental caries and periodontal conditions were done as per modified WHO methodology and criteria. Dental trauma and fluorosis were identified as present or absent irrespective of severity levels.
Results: Dental caries prevalence was 41.90% and 83.80% with mean DMFT/ dmft 0.80 and 5.54 for 12-and 6-year-olds respectively. Urban students had more caries than their rural counterparts. Overall, 13.00% of 12-year-olds had healthy gingiva but more calculus was detected in rural children. Dental trauma and fluorosis were very low (0.01% to 5.00%) in both the age groups.
Conclusions: Caries prevalence was very high in 6-year-olds while periodontal status in 12-year-olds was poor. Rural school children had lower caries levels compared to their urban counterparts. Imparting oral health awareness among parents can lower caries severity in younger children.
Research Ethics Board of Health: a seven year review of the only ethics review board in Bhutan
Authors: Gurung Mongal S. , Dema Tashi , Pelzom Dorji , Tobgay Tashi , Drukpa Pakila 
Published: December 2020

Introduction: Research Ethics Board of Health (REBH), established in 2009, is the only ethics review board in Bhutan. The REBH was certified by the Strategic Initiative for Developing Capacity in Ethical Review (SIDCER), Forum for Ethical Review Committees in the Asian and Western Pacific Regions (FERCAP) in 2010 and recertified in 2013, and it received the Federal Wide Assurance (FWA) from the Office for Human Research Protections (OHRP), USA, in 2010 and in 2013. All researchers conducting health related research in Bhutan have to seek prior ethical clearance from REBH under the requirements of the National Health Policy 2011. Objective: The article aims to describe the performance of REBH, its standard and review procedure.
Methods: A descriptive study of records and database of REBH from 2009 to 2015.
Results: As of December 2015, the REBH has received 227 protocols with an average of 32 protocols per year. The median number of days for the initial review was 21 days (Min 0 days; Max 85 days). The median duration for approval of protocols from the date of receiving the application was 48 days. The average number of times the protocols were reviewed before issuing the approval letter was 2.
Conclusions: There has been a progressive increase in the number of protocols submitted to REBH. This indicated an increasing research culture in Bhutan. It takes about one and half months to get an approval from REBH; therefore, researchers have to consider the time required for ethical clearance process while planning research projects.
Alcohol consumption and academic performance among higher secondary students in Thimphu, Bhutan
Authors: Dendup Tashi 
Published: December 2020

Introduction: Despite known alcohol abuse among adolescence, precise information on the prevalence and pattern of drinking in Bhutan remain sparse. This study, therefore, assesses the pattern of alcohol drinking and consequences including its effects on academic performance among high school students in Thimphu.
Methods: Multistage random sampling was employed and a survey was conducted in November 2014 using a self-administered semi-structured questionnaire. A total of 403 students were invited, however, 3 students were absent during the time of survey and 13 respondents were rejected due to incompleteness of the questionnaire. Thus, the findings are based on a sample size of 387.
Results: Prevalence of long term alcohol drinkers were 38.8% and 26.6% were current drinkers. The mean age of onset of alcohol use was 15.5 (± 2.6). Binge drinking (greater than or less than four times a week) and GPA (Grade Point Average) were significantly orrelated (p less than or equal to 0.01, r = - 0.120). Therefore, students involved in binge drinking greater than or equal to four times a week are likely to obtain less GPA.
Conclusions: Students, comprising both males and females, drink alcohol and those who are involved in frequent binge drinking are more likely to have lower GPA.
Management of corrosive oesophageal injuries: a review
Authors: Ray Samrat , Mehta Naimish , Lalwani Shailendra , Mangla Vivek , Mehrotra Siddharth , Nundy Samiran 
Published: December 2020

With the increasing incidence of corrosive oesophageal injuries, especially in the developing countries, understanding thepathophysiology and the approach to its management in the emergency and elective settings has become of paramount importance for the surgeon. The approach to the management varies depending on the time of the diagnosis and the location of injury. Endoscopy plays a key role as the first step in the evaluation of such patients in the emergency as well as late elective setting. With the advancement in endoscopic interventions, there has been a shift of preference towards the less invasive and less morbid endoscopic techniques to address the late sequelae of corrosive oesophageal injuries. Refractory cases eventually merit surgery, even at the cost of the morbidity and mortality associated with such rocedures. The surgical approach also varies depending on the location of the stricture, with the proximal 1/3rd strictures epresenting the most challenging location. A regular follow up and endoscopic surveillance are needed in these patients to screen for any late complications such as cancer or dysmotility.
Prevalence of Gestational Diabetes Mellitus and its association with pregnancy outcomes in three referral hospitals in Bhutan
Authors: Phurb Phurb , Jamtsho Sonam , Gyeltshen Nidup , Chhezom Kunzang , Choden Karma 
Published: December 2020

Introduction: Gestational Diabetes Mellitus (GDM) has been defined as any degree of glucose intolerance with onset or first recognition during pregnancy. There is no national data on the prevalence of gestational diabetes mellitus, and there is no routine screening system for diabetes in pregnancy in Bhutan. This study was carried out to determine the prevalence of GDM and its association with pregnancy outcomes in three referral hospitals in Bhutan.
Methods: This was a prospective study done between March and December 2016 in three referral hospitals in Bhutan, with 726 participants recruited between 24 to 28 weeks of pregnancy. Two blood samples were taken, one in a fasting state to test fasting blood sugar and another to test blood sugar level 2 hours after drinking 75g glucose in 300ml water. They were analyzed in the Clinical Biochemistry laboratories in the respective hospitals. Cut-off levels of 5.6mmol/ L (101mg/ dL) for fasting blood sugar and 8.5-mmol/L (153-mg/dL) for 2 hours blood sugar report were used. Women diagnosed with GDM were closely followed up throughout the pregnancy up till delivery. At delivery, information on mother and the baby were collected.
Results: The prevalence of GDM in the three referral hospitals in Bhutan was 15%. The prevalence of GDM cases in the three hospitals was similar and statistically was not significant. Conclusions: Universal screening of pregnant women is recommended to detect hyperglycemia and to achieve euglycemia in order to prevent complications in both mothers and babies.
Assess Knowledge, Attitude and Practices of Respectful Maternity Care among nurse midwives in Referral Hospitals of Bhutan
Authors: Deki Sonam , Choden Jigme 
Published: December 2020

Introduction: Respectful Maternity Care (RMC) acknowledges that respects for woman’s rights, choices and dignity during labor and childbirth is vital component of health care quality. This cross-sectional descriptive study intended to gain in-depth understanding on knowledge, attitude and practices of nurse midwives working in referral hospitals of Bhutan on RMC. The study also looked into determinants of RMC.
Methods: The sample consisted of 83 nurse midwives who were working in birthing and maternity unit of three regional referral hospitals of Bhutan. The sites were chosen purposefully due to their high delivery volume. A survey instrument was piloted in Paro hospital prior to study. Data was collected from July to October 2017. Analysis was mainly descriptive, simple percentages were used to calculate frequency distribution of aspects and determinants of respectful maternity care.
Results: Four in five of the respondents knew and practiced woman’s right to information and communication during childbirth process. However, providers were found lacking on some aspects of the knowledge and practices related to respecting choices and rights of the women during childbirth and recounted their experiences of observing events which are described as abusive in maternal health literatures. Inadequate facilities, overworked staffs and limited trainings were found as detrimental factors.
Conclusion: Aspects of RMC were not duly practiced. Providers must be made aware of the woman’s right to respectful care which is crucial to improve maternal health services. Individual Health Facility must provide conducive environment to practice RMC. Future studies on RMC from receiver end are recommended.
Factors associated with exclusive breastfeeding practices in western Bhutan
Authors: Pokhrel Hari Prasad , Pavadhgul Patcharanee , Srisorrachatr Suwat 
Published: December 2020

Introduction: Breastfeeding is widely accepted in Bhutan but there are wide range of practices, some of which are not in accordance with the recommendations of WHO. In 2015 the prevalence of exclusive breastfeeding under six months of age, in western region was only 33.8% while the national rate was 51.4%. This study aimed to identify the factors associated with exclusive breastfeeding practices in western Bhutan.
Methods: A cross-sectional study was conducted involving 220 mothers with children 6-12 months of age attending the Maternal and Child Health clinics of three hospitals in western Bhutan. Data collection was done by a face-to-face interview in April 2017. Chi-square test was used to assess the association and all the significant variables were included in the multivariate model adjusting for potential confounders.
Results: The prevalence of exclusive breastfeeding at six months was 35.9%. Multivariate logistic regression detected significant association of exclusive breastfeeding with parity(ORadjusted 2.80; 95% CI 1.36-5.78), knowledge (ORadjusted 2.09; 95% CI 1.09-4.00), family income (ORadjusted 2.26; 95% CI 1.10- 4.65), early initiation of breastfeeding (ORadjusted 6.28; 95% CI 1.90-20.70), and care giver (ORadjusted 3.56; 95% CI 1.19-10.59). Mothers’ perception that the child feels thirsty was the most important reason to stop exclusive breastfeeding.
Conclusions: The study identified breastfeeding education as a definite measure to improve the rates of exclusive breastfeeding in western Bhutan. The study recommends to educate mothers that water is not required for the baby until six months of age and to include fathers in breastfeeding education sessions. The study also recommends to strengthen lactation management clinic.
Maternal Oral Health: An Examination Survey Conducted in Three Referral Hospitals in Bhutan
Authors: Ngedup Sonam , Lee Mary Alice , Phurpa Dorji , Wangmo Neyzang 
Published: December 2020

Background: Good oral health is important for women during pregnancy and throughout their lives. Mothers with good oral health are less likely to transmit cariogenic bacteria to their infants and toddlers. Thus, maternal oral health is directly related to family health.
Objective: To determine the prevalence of dental caries, periodontal diseases and modifiable risk factors among pregnant women seeking antenatal care in three referral hospitals in Bhutan.
Methods: A descriptive cross-sectional survey of pregnant women was conducted in April-May 2017. We used a non-probability sampling method to recruit pregnant women (n=443). Oral examinations were done according to methods recommended by the WHO. Participants completed a questionnaire for modifiable risk factors.
Results: Overall, caries prevalence was 40% among pregnant women, ranging from 54% in those under 25 to 81% in women 35 and older. The mean decayed, missing and filled permanent teeth (DMFT) was 1.93 (SD=2.66). Nearly 72% of women had calculus on their teeth. Just over 2% had periodontitis. Most women rated their oral health as good to excellent (89%) versus poor (11%). Just 11% reported having had dental care during pregnancy.
Conclusions: There is an urgent need for professional dental care during pregnancy, especially among older and multiparous women. Increasing awareness on the importance of oral health during pregnancy will improve maternal health and the health of their young children.
Prevalence of ear cleaning and its characteristic physical findings in patients visiting tertiary care center in Bhutan
Authors: Adhikari Tika Ram , Jamtsho Sonam 
Published: December 2020

Introduction: Many studies have been done on prevalence and complications of ear bud across the globe but very few talk about the characteristics physical findings associated with ear cleaning. We aim to find the prevalence and characteristic physical findings of cotton bud usage in patients visiting a tertiary care center in Bhutan.
Methods: A cross sectional study in a tertiary care center in Bhutan over a period of one month.
Results: The prevalence of ear cleaning was 92.15%. The most common physical finding was shiny external auditory canal (66%), excoriations in the external auditory canal (longitudinal furrowing along the floor or Circular scratch marks)(52%), erythema and edema of ear canal (46.6%), wax in the bony canal near tympanic membrane(9.3%), stenosed external auditory canal (3.8%), cotton wool remnants in ear canal(2.8%).
Conclusions: It is important to recognize these characteristic clinical findings of cleaning the ear so that proper counseling can be given against its usage and prevent undue complications associated with it.
Prevalence of intestinal parasitic infection in patients attending National Referral Hospital, Thimphu, from 2013 to 2015: A retrospective study
Authors: Norbu Karma , Mongar Adeep , Dorji Nima , Drukpa Leki D. 
Published: December 2020

Introduction: Infection with intestinal parasites continues to be a significant public health problem worldwide. There is no information on the prevalence of these intestinal parasites in patients visiting the National Referral Hospital, Thimphu, Bhutan.
Methods: The study utilized information of stool data from 2013 to 2015 and was analyzed using SPSS 16.0. Wet and Iodine mount technique were used for identification.
Results: The overall intestinal prevalence rate was 2.1%. Out of 5919 stool samples, Giardia lamblia has the highest rate of 0.93%, followed by Entamoeba coli 0.15%, Trichomonahomonis 0.19% and Taeniaspp. 0.17%.Giardia lamblia infection was 1.03% in males and 0.85% in females. The overall prevalence rate of parasitic infections was highest in >56 years age group with 2.83% in females and 2.0% in males.
Conclusion: The overall prevalence of intestinal parasites is a concern in the country. Furthermore, this study provides insights to develop effective public health intervention for reducing parasitic infections in the country.