Knowledge and Attitudes towards Suicide among Nurses of National Referral Hospital in Bhutan

Objective: To explore Bhutanese nurse’s knowledge about and attitudes towards suicide, to determine the association between nurse’s characteristics and their knowledge about and attitudes towards suicide, and to test the relationship between knowledge about and attitudes towards suicide. Method: A descriptive study with the correlational method was conducted in 216 nurses working in various units and departments of the National Referral hospital in Thimphu city of Bhutan. Data collection was performed in March, 2017 using structured questionnaires, i.e. nurses’ characteristics, suicidal knowledge questionnaire and suicidal attitude questionnaire. The internal consistency reliability of the knowledge questionnaire was acceptable (Kuder-Richardson 20 coefficient = 0.70), whereas that of the attitude questionnaire was high (Cronbach’s alpha coefficient = 0.80). Descriptive statistics, Pearson’s product moment and point biserial correlation were used for data analyses. Results: Knowledge about (mean = 14.31; SD = 2.88) and attitudes towards (mean = 53.86; SD = 6.36) suicide among nurses were in moderate levels. Nurse’s characteristics including age, level of education, years of experience, and nurses’ history of attempted or contemplated suicide were significantly associated with knowledge about suicide. Nurse’s gender, years of experience, past caring experience, and previous training and education were significantly associated with nurse’s attitudes towards suicide. There was also a significant positive correlation between nurse’s knowledge about and attitudes towards suicide (r = 0.25, P < 0.01). Conclusion: The study results can be used as baseline data to develop effective nursing care and interventions pertinent to suicide. Training and education are needed for nurses to improve their knowledge about and attitudes towards suicide. Keywords: suicide, knowledge, attitude, nurses, Bhuta

Aversive reaction between disulfiram and betel quid among inpatients with alcohol use disorder in Bhutan: A preliminary study

Betel Quid (BQ) is commonly used in the Asia-Pacific region. Disulfiram is prescribed for people with alcohol use disorders (PwAUDs) after the completion of detoxification as an alternative to rehabilitation. This prospective observational study reports the aversive reactions and common symptoms of Disulfiram and BQ in PwAUDs. Participants included PwAUDs admitted to the psychiatric ward at the Jigme Dorji Wangchuck National Referral Hospital for detoxification, who were on Disulfiram and using BQ at the same time. Aversive reactions between Disulfiram and BQ were observed for 100 patients over a year. Twenty participants showed aversive reactions between BQ and Disulfiram. Common symptoms included sweating, diarrhea, dizziness, tremors, palpitations, shortness of breath, nausea and vomiting, and headache. Since PwAUDs in Bhutan are inducted on Disulfiram after detoxification, and most use BQ simultaneously, this study will help inform health care providers to educate people about the aversive reactions of Disulfiram and BQ

Addressing cervical cancer prevention in Bhutan: A study on the use of loop electrosurgical excision procedures at the primary health care level

Abstract Background Cervical cancer is the top and fourth leading cause of death among women in Bhutan and worldwide, respectively. The cervical cancer elimination flagship program initiated by the Ministry of Health aims to achieve the 90–70–90 goals by 2030. To achieve this, detection and treatment of pre‐cancerous lesions of the cervix through colposcopy and loop electrosurgical excision procedure (LEEP) are being carried out through the outreach health camps. Methods This descriptive study aimed to assess the safety and tolerability of LEEP under local anesthesia and assess the margin status of high‐grade lesion (HGL). We analyzed 193 records of clients who underwent LEEP at Wangdue Phodrang Hospital from 26 September to 5 October 2022. The sociodemographic profile, intraoperative pain, complications, and histopathological reports were described using structured pro forma. Results The mean age of clients was 40.9 ± 8.5 years (range 25–66 years). There were 3.1% who had intraoperative and 2.6% who had postoperative bleeding. There were 18.6% who had foul‐smelling vaginal discharge, and 8.3% had moderate‐to‐severe intraoperative pain. Histopathological assessment revealed 29.5% with chronic cervicitis, 34.2% with HGL, and 1.6% with microinvasive cervical carcinoma. The margin positivity for HGL was 36.4%. Conclusion Given the safety profile of LEEP under local anesthesia in our setting, the scope of providing a complete cervical cancer screening and treatment package at the primary health care level looks promising. Based on the higher rate of overtreatment and margin positivity, we recommend the practical implementation of standard colposcopy guidelines

Compliance to current national medicines law for proper storage and dispensing of medicines at community pharmacies in Bhutan

Introduction: Compliance of community pharmacies with the national medicines law for proper storage and dispensing of medicines is crucial for ensuring the quality and safety of medicines. Community pharmacies in Bhutan are of two types: retail pharmacies and wholesale pharmacies. Objective: This study was aimed to assess the compliance of community pharmacies with the Medicines Act of the Kingdom of Bhutan 2003 and Bhutan Medicines Rules and Regulation 2012. Methods: This is a retrospective cross-sectional study from the inspection reports of community pharmacies inspected from January 2015 to December 2017. Descriptive statistics in frequency and percentage was used to report the results. Results: The overall compliance level for the regulatory provisions under critical and minor categories was 90.4% followed by 86.74% for major category. Around 32.99% of community pharmacies were found without standard operating procedures for storing and dispensing of medicines while 100% of community pharmacies had technical authorization from the Drug Regulatory Authority. Conclusion: Although the compliance level of community pharmacies in Bhutan for storing and dispensing of medicines was found to be above 80%, there are several areas that need to be corrected to ensure full compliance. This study will serve as a baseline for policymakers, managers, and researchers in developing designs for future interventions

Awareness and practice of medical waste management among healthcare providers in National Referral Hospital.

IntroductionThe management and treatment of Medical Waste (MW) are of great concern owing to its potential hazard to human health and the environment, particularly in developing countries. In Bhutan, although guidelines exist on the prevention and management of wastes, the implementation is still hampered by technological, economic, social difficulties and inadequate training of staff responsible for handling these waste. The study aimed at assessing the awareness and practice of medical waste management among health care providers and support staff at the National Referral Hospital and its compliance with the existing National guidelines and policies.Materials and methodsAn observational cross-sectional study was conducted from March to April 2019. Three research instruments were developed and used; (i) Demographic questionnaire, (ii) Awareness questions, and (iii) the Observational checklist. The data was coded and double entered into Epi data version 3.1 and SPSS version 18 was used for analysis. Descriptive statistics were used to present the findings of the study.ResultsThe majority of the respondents were female (54.1%) with a mean age of 32.2 (±7.67) years, most of whom have not received any waste management related training/education (56.8%). About 74.4% are aware of medical waste management and 98.2% are aware on the importance of using proper personal protective equipment. Only 37.6% knew about the maximum time limit for medical waste to be kept in hospital premises is 48 hours. About 61.3% of the observed units/wards/departments correctly segregated the waste in accordance to the national guidelines. However, half of the Hospital wastes are not being correctly transported based on correct segregation process with 58% of waste not segregated into infectious and general wastes.ConclusionThe awareness and practice of medical waste management among healthcare workers is often limited with inadequate sensitization and lack of proper implementation of the existing National guidelines at the study site. Therefore, timely and effective monitoring is required with regular training for healthcare workers and support staff. Furthermore, strengthening the waste management system at National Referral Hospital would provide beneficial impact in enhancing safety measures of patients