Malaria elimination in Bhutan: asymptomatic malaria cases in the Bhutanese population living in malaria-risk areas and in migrant workers from India

In 2018, Bhutan reported 54 cases of malaria, of which six were indigenous, 14 introduced and 34 imported. Considering the continuous reduction in the number of indigenous cases, Bhutan plans to eliminate malaria by 2025 under the Bhutan Malaria Elimination Strategy. The study was conducted to assess the presence of asymptomatic plasmodial infection in both, Bhutanese population living in malaria-risk areas and in migrant workers to guide the elimination strategies. A cross-sectional study was conducted from April to May 2016 in 750 Bhutanese people and 473 migrant workers. Plasmodium falciparum and Plasmodium vivax infections were investigated by using a rapid diagnostic test (RDT) and the polymerase chain reaction (PCR). Prevalence of asymptomatic plasmodial infection based on PCR was 0.27% (95% CI: 0.05–1.07%) among Bhutanese people with a mean age of 43 years old. The proportions of males and females were 45% and 55%, respectively. Among migrant workers, the prevalence of asymptomatic plasmodial infection was 0.42% (95% CI: 0.07– 1.69%) with a mean age of 30 years old. The majority of migrant workers were from the neighboring Indian State of West Bengal (57.51%), followed by Assam (12.26%). RDT in both study groups did not detect any plasmodial infection. The presence of a low prevalence of asymptomatic plasmodial infection indicates that the current elimination strategies and interventions are effective

A Discussion on the Singing Dialogue Tsangmo : Bridging Culture Between Bhutan and Japan, from the Past to the Future

Bhutanese tsangmo is a unique cultural heritage that has been at the heart of folk culture in many regions of Bhutan. It was considered to be on the verge of extinction due to the trends toward globalization and modernization. However, new attempts have already been made in schools, through radio programming, teacher education, and other means to ensure its continuation. These attempts involve wisely transformed styles of traditional ways of playing. Our research group has been investigating the real-life circumstances and unique value of these songs since 2010. In this paper, we describe our findings and exchange opinions between Bhutanese and Japanese, each discussing tsangmo from our own viewpoints, including the cultural heritage in Bhutan, the language as it relates to tsangmo, new attempts to promote passing on tsangmo, Bhutanese creative dialogue and Japanese education, and finally, understanding the importance of tsangmo within the prospects for Asia from the perspective of ethnomusicology. Through our discussion we hope to shine a light on the remarkable and rich cultural heritage of Bhutan so that it may thrive in future generations.This work was supported by JSPS KAKENHI Grant Number JP 26301043

Cardiotoxic effects of poisoning from aconite root in a middle-aged man in Bhutan: a case report

Introduction: Poisoning is a major global health concern and a preventable cause of death. Aconite, an alkaloid found in the aconitum genus frequently leads to poisoning in Asian countries including Bhutan owing to its use in traditional medicine and religious items. Case presentation: A 47-year-old male consumed a tincture of aconite plant root and experienced vomiting, blurred vision, paraesthesia, and light headedness. On presentation to the emergency department, his vitals were normal but on subsequent close monitoring, he had premature ventricular contractions and sinus bradycardia leading to hypotension and shock. He was admitted to the intensive care unit for continuous cardiac monitoring and supportive treatment including atropine and noradrenaline. He reported subjective improvement, his vital signs improved and ECG returned to normal, enabling discharge after 5 days of admission. Conclusion: There is no specific antidote to aconite toxicity so the treatment is mainly supportive. It is imperative to implement proactive measures such as public awareness programs and dedicated research efforts to mitigate the risk of inadvertent toxicity resulting from aconite use

A qualitative study on knowledge, perception, and practice related to non-communicable diseases in relation to happiness among rural and urban residents in Bhutan.

PurposeBhutan, known as a country of happiness, has experienced rapid social changes and the increasing burden of non-communicable diseases (NCDs) that can impact health and happiness. To inform future NCD prevention programs in Bhutan, this study explores knowledge, perception, and the practices of Bhutanese related to NCDs in the context of the philosophy of happiness.MethodologyResearch was conducted in rural and urban communities of Bhutan in 2017 among 79 inhabitants of both genders, aged ≥18. Participants were recruited through purposive sampling with the data collected by in-depth interviews, participatory observation, and anthropometric measurements. Data were analyzed by thematic analysis.Results/discussionAcross participants, health was considered as an important element of "happiness". However, lifestyle-related NCD risk factors prevailed due to the lack of effective education programs on NCDs and thus the lack of practical knowledge for NCD prevention across society. We further found that the value of happiness "finding happiness in any situation is virtue" was universal as well as other traditional values and customs, shaping people's health behaviors. From these observations, it is recommended that more practical NCD education/prevention programs should be urgently introduced in Bhutan that involve multiple generations, religion authorities, educational settings, and medical services.OriginalityThis is the first comprehensive qualitative study on the NCD-related lifestyle risks among Bhutanese concerning the concept of happiness

Malaria elimination in Bhutan: asymptomatic malaria cases in the Bhutanese population living in malaria-risk areas and in migrant workers from India

ABSTRACT In 2018, Bhutan reported 54 cases of malaria, of which six were indigenous, 14 introduced and 34 imported. Considering the continuous reduction in the number of indigenous cases, Bhutan plans to eliminate malaria by 2025 under the Bhutan Malaria Elimination Strategy. The study was conducted to assess the presence of asymptomatic plasmodial infection in both, Bhutanese population living in malaria-risk areas and in migrant workers to guide the elimination strategies. A cross-sectional study was conducted from April to May 2016 in 750 Bhutanese people and 473 migrant workers. Plasmodium falciparum and Plasmodium vivax infections were investigated by using a rapid diagnostic test (RDT) and the polymerase chain reaction (PCR). Prevalence of asymptomatic plasmodial infection based on PCR was 0.27% (95% CI: 0.05–1.07%) among Bhutanese people with a mean age of 43 years old. The proportions of males and females were 45% and 55%, respectively. Among migrant workers, the prevalence of asymptomatic plasmodial infection was 0.42% (95% CI: 0.07–1.69%) with a mean age of 30 years old. The majority of migrant workers were from the neighboring Indian State of West Bengal (57.51%), followed by Assam (12.26%). RDT in both study groups did not detect any plasmodial infection. The presence of a low prevalence of asymptomatic plasmodial infection indicates that the current elimination strategies and interventions are effective

Where chloroquine still works: the genetic make-up and susceptibility of Plasmodium vivax to chloroquine plus primaquine in Bhutan

Bhutan has made substantial progress in reducing malaria incidence. The national guidelines recommend chloroquine (CQ) and primaquine (PQ) for radical cure of uncomplicated Plasmodium vivax, but the local efficacy has not been assessed. The impact of cases imported from India on the genetic make-up of the local vivax populations is currently unknown.Patients over 4\ua0years of age with uncomplicated P. vivax mono-infection were enrolled into a clinical efficacy study and molecular survey. Study participants received a standard dose of CQ (25\ua0mg/kg over 3\ua0days) followed by weekly review until day 28. On day 28 a 14-day regimen of PQ (0.25\ua0mg/kg/day) was commenced under direct observation. After day 42, patients were followed up monthly for a year. The primary and secondary endpoints were risk of treatment failure at day 28 and at 1\ua0year. Parasite genotyping was undertaken at nine tandem repeat markers, and standard population genetic metrics were applied to examine population diversity and structure in infections thought to be acquired inside or outside of Bhutan.A total of 24 patients were enrolled in the clinical study between April 2013 and October 2015. Eight patients (33.3\ua0%) were lost to follow-up in the first 6\ua0months and another eight patients lost between 6 and 12\ua0months. No (0/24) treatment failures occurred by day 28 and no (0/8) parasitaemia was detected following PQ treatment. Some 95.8\ua0% (23/24) of patients were aparasitaemic by day 2. There were no haemolytic or serious events. Genotyping was undertaken on parasites from 12 autochthonous cases and 16 suspected imported cases. Diversity was high (H E 0.87 and 0.90) in both populations. There was no notable differentiation between the autochthonous and imported populations.CQ and PQ remains effective for radical cure of P. vivax in Bhutan. The genetic analyses indicate that imported infections are sustaining the local vivax population, with concomitant risk of introducing drug-resistant strains