Social, Cultural and Economic determinants of HIV/AIDS: A community case report of Bhutan

Background: Bhutan has a low-level HIV epidemic, with sporadic cases across the whole population. Our society is witnessing momentous social and cultural changes coinciding with the arc of the HIV pandemic. Therefore, this paper systematically assesses socio cultural determinants of HIV in Bhutan for appropriate responses to end the AIDS epidemic by 2030. Methods: We reviewed the literature relevant to HIV in Bhutan using appropriate search engines. We adapted Dahlgren and Whitehead’s model of social health determinants in the population as a conceptual framework. Results: Young age played the salient role between rapid sociocultural changes and HIV in Bhutan. Most teens are sexually active, has relaxed sexual norms, low condom use, and has multiple sexual partners. Gender identity and sexual orientation are increasingly fluid among transgender and gay/bisexual men. Worksites with migrants and entertainment venues are nexuses for sexual networking resulting in transactional/sex work. Conclusion: Our findings suggest a high potential for a shift from diffuse cases of HIV to more concentrated HIV epidemic. HIV responses need to be tailored specifically for key populations instead of the current generalized approach. We recommend community-based HIV Self Testing and social support to overcome the structural barriers to enhance case diagnosis.&nbsp

Health and Gross National Happiness: review of current status in Bhutan

Worldwide, contemporary measures of the success of health development programs have been mostly in terms of the reduction of mortality and morbidity as well as increasing longevity. While these goals have yielded much-needed health improvements, the subjective outcomes of these improvements, as experienced by individuals and the communities, have not been considered. Bhutan, under the overarching policy of Gross National Happiness, has provided due consideration to these subjective indicators. Here, we report on the current status of health and happiness in Bhutan as revealed by conventional objective indicators and subjective Gross National Happiness indicators. The current literature on health in Bhutan in relation to the Gross National Happiness Survey conducted by the Centre of Bhutan Studies has been reviewed. Bhutan has made great strides within a short period of modernization, as shown by both objective and subjective indicators. Tremendous challenges lie ahead to achieve the ultimate goal of health and happiness, and how Bhutan articulates its path to modernization may be a lesson for the rest of the world

Factors influencing COVID-19 testing: a qualitative study in Bhutan

The COVID-19 pandemic has reaffirmed an all-knowing truth—that health is central in the 2030 Sustainable Development Agenda. To fully control the infection in a community, accurate testing of suspected cases along with effective tracing and appropriate treatment (3Ts) is still crucial to slowing transmission of COVID-19 virus This study explored factors that influenced COVID-19 testing in Bhutan. The lessons learned from this study could serve as a roadmap to strengthen the current respond to COVID-19 and for future outbreaks, particularly in low- and middle-income countries. The study employed an exploratory qualitative design. Data collection methods included interviews with key informants with a purposively selected sample of 20 participants. The interview findings were augmented by reviewing both published literature and unpublished documents.For the analysis of qualitative interviews, a hybrid approach of inductive and deductive coding and theme development was conducted to analyze findings. A tailored version of the WHO Health System Framework incorporating the Essential Public Health Function was used to guide data interpretation. Political will through the influence and leadership of the King of Bhutan played a crucial role in raising attention to the problem, and provision of adequate financial and technical relief to ensure that all people irrespective of their socioeconomic status do not pay to get tested of COVID-19. A compassionate leadership, Whole of Society approach is backed by the scientific community, functional health systems and community-based approaches, use of information technology for awareness creation and improved surveillance system, and fast-tracked COVID-19 testing service delivery. Bhutans success relied greatly on multi-sectoral and systematic approach during policy design, implementation and monitoring, and active collaborative efforts involving consultation and engagements with a broad range of local (community members), national and global actors for accelerated COVID-19 testing. These efforts were made possible through improved health governance and leadership at all levels of the society

Community-directed educational intervention for malaria elimination in Bhutan: quasi-experimental study in malaria endemic areas of Sarpang district

BACKGROUND: As per the World Malaria Report 2011, there was a 17% reduction in morbidity and 26% reduction in mortality in 2010, compared to 2000. In Bhutan, there were only 194 malaria cases in 2011 as compared to 5,935 cases in 2000. As the country moves towards an elimination phase, educating the community and empowering them on malaria prevention and control is imperative. Hence, this study was conducted to elucidate the effectiveness of the community-directed educational intervention on malaria prevention and control in malaria-endemic areas of Sarpang district, Bhutan. METHODS: This quasi-experimental study design was conducted using both qualitative and quantitative data collection methods. In-depth interviews and focus group discussions were carried out in addition to household survey using a structured questionnaire conducted before and after the intervention. Intervention was conducted using community action groups, who were provided with training and which then developed action plans for implementation of interventions within their communities. RESULTS: The study resulted in a significant improvement in knowledge and attitude in intervention as compared to control during the post-intervention survey (p < 0.001). The practice score was higher in the control group both during pre- and post-intervention, however, the mean ( ±sd) score of practice in intervention group increased from 6.84 ± 1.26 in pre-intervention to 8.35 ± 1.14 in post-intervention (p < 0.001), where as it decreased from 9.19 ± 1.78 to 9.10 ± 1.98 in the control group (p = 0. 68). When comparing pre- and post- in the intervention group, there was significant improvement during post-intervention in knowledge, attitude and practice (p < 0.001). CONCLUSIONS: The findings from this study corroborate that community-directed interventions can be utilized as an effective means for improving knowledge, attitude and practice in the malaria-endemic areas of Bhutan. Further studies are needed to see the long-term effect and sustainability of such interventions

Insights into the relationship between hydraulic safety, hydraulic efficiency and tree structural complexity from terrestrial laser scanning and fractal analysis

The potential of trees to adapt to drier and hotter climates will determine the future state of forests in the wake of a changing climate. Attributes connected to the hydraulic network are likely to determine a tree’s ability to endure drought. However, how a tree’s architectural attributes related to drought tolerance remains understudied. To fill this gap, we compared the structural complexity of 71 trees of 18 species obtained from terrestrial laser scanning (TLS) with key hydraulic thresholds. We used three measures of xylem safety, i.e., the water potential at 12%, 50%, and 88% loss of hydraulic conductance (P12, P50, P88) and specific hydraulic conductivity (Ks) to assess the trees’ drought tolerance. TLS data were used to generate 3D attributes of each tree and to construct quantitative structure models (QSMs) to characterize the branching patterns. Fractal analysis (box-dimension approach) was used to evaluate the overall structural complexity of the trees (Db) by integrating horizontal and vertical extent as well as internal branching patterns. Our findings revealed a significant relationship between the structural complexity (Db) and the three measures of xylem safety along with Ks. Tree species with low structural complexity developed embolism-resistant xylem at the cost of hydraulic efficiency. Our findings also revealed that the Db had a stronger and more significant relationship with branch hydraulic safety and efficiency compared to other structural attributes examined. We conclude that Db seems to be a robust descriptor of tree architecture that relates to important branch hydraulic properties of a tree

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

Diversity and Origin of Dengue Virus Serotypes 1, 2, and 3, Bhutan

To determine the serotype and genotype of dengue virus (DENV) in Bhutan, we conducted phylogenetic analyses of complete envelope gene sequences. DENV-2 (Cosmopolitan genotype) predominated in 2004, and DENV-3 (genotype III) predominated in 2005–2006; these viruses were imported from India. Primary dengue infections outnumbered secondary infections, suggesting recent emergence