Malaria control in Bhutan: case study of a country embarking on elimination

<p>Abstract</p> <p>Background</p> <p>Bhutan has achieved a major reduction in malaria incidence amid multiple challenges. This case study seeks to characterize the Bhutan malaria control programme over the last 10 years.</p> <p>Methods</p> <p>A review of the malaria epidemiology, control strategies, and elimination strategies employed in Bhutan was carried out through a literature review of peer-reviewed and grey national and international literature with the addition of reviewing the surveillance and vector control records of the Bhutan Vector-Borne Disease Control Programme (VDCP). Data triangulation was used to identify trends in epidemiology and key strategies and interventions through analysis of the VDCP surveillance and programme records and the literature review. Enabling and challenging factors were identified through analysis of socio-economic and health indicators, corroborated through a review of national and international reports and peer-review articles.</p> <p>Findings</p> <p>Confirmed malaria cases in Bhutan declined by 98.7% from 1994 to 2010. The majority of indigenous cases were due to <it>Plasmodium vivax </it>(59.9%) and adult males are most at-risk of malaria. Imported cases, or those in foreign nationals, varied over the years, reaching 21.8% of all confirmed cases in 2006.</p> <p>Strategies implemented by the VDCP are likely to be related to the decline in cases over the last 10 years. Access to malaria diagnosis in treatment was expanded throughout the country and evidence-based case management, including the introduction of artemisinin-based combination therapy (ACT) for <it>P. falciparum</it>, increasing coverage of high risk areas with Indoor Residual Spraying, insecticide-treated bed nets, and long-lasting insecticidal nets are likely to have contributed to the decline alongside enabling factors such as economic development and increasing access to health services.</p> <p>Conclusion</p> <p>Bhutan has made significant strides towards elimination and has adopted a goal of national elimination. A major challenge in the future will be prevention and management of imported malaria infections from neighbouring Indian states. Bhutan plans to implement screening at border points to prevent importation of malaria and to targeted prevention and surveillance efforts towards at-risk Bhutanese and migrant workers in construction sites.</p

Endemic transmission of visceral leishmaniasis in Bhutan

Visceral leishmaniasis was first reported in Bhutan in 2006. We conducted studies of the parasite, possible vectors and reservoirs, and leishmanin skin test and risk factor surveys in three villages. Nineteen cases were reported from seven districts. Parasite typing yielded two novel microsatellite sequences, both related to Indian L. donovani. In one case village, 40 (18.5%) of 216 participants had positive leishmanin skin test results, compared with 3 (4.2%) of 72 in the other case village and 0 of 108 in the control village. Positive results were strongly associated with the village and increasing age. None of the tested dogs were infected. Eighteen sand flies were collected, 13 Phlebotomus species and 5 Sergentomyia species; polymerase chain reaction for leishmanial DNA was negative. This assessment suggests that endemic visceral leishmaniasis transmission has occurred in diverse locations in Bhutan. Surveillance, case investigations, and further parasite, vector, and reservoir studies are needed. The potential protective impact of bed nets should be evaluated.This assessment was made thanks to the support that the Spanish Agency for International Cooperation for Development (AECID) provides to WHO for the control of visceral leishmaniasis. We are grateful to Rinzin Namgay from the Ministry of Health, Bhutan and the staff from Karuna House canine shelter in Trashigang, Bhutan, for their support during the field study

Understanding Human-Canid Conflict and Coexistence: Socioeconomic Correlates Underlying Local Attitude and Support Toward the Endangered Dhole (Cuon alpinus) in Bhutan

Understanding human–canid conflict and coexistence must focus on documenting human–canid interactions and identifying the underlying drivers of reciprocal human attitude which enables appropriate strategies to minimize conflict and forge coexistence. The dhole (Cuon alpinus), Asia's most widely distributed wild canid, is highly threatened by human persecution and anthropogenic activities. Despite its "endangered" status, its ecological role as an apex predator, negative interactions with humans, and dhole-specific attitude studies are limited, thus hindering the development of a comprehensive dhole-conservation strategy. Here, we investigate the influence of socioeconomic factors of age, gender, income, residency inside/outside a protected area (PA), and other variables (cultural beliefs, livestock loss, and quantity of livestock loss) on the attitudes of local people and support for dhole conservation in the Himalayan Kingdom of Bhutan. We conducted a semi-structured questionnaire survey of 1,444 households located within the PA and non-PA from four representative regions in the country. Using R programming, we ran Pearson's chi-square test of independence to test the overall difference in the attitude and support for dhole conservation, followed by recursive partitioning through a conditional inference regression tree to identify its significant covariates with the highest explanatory power. Majority (79.1%) of respondents (χ2 = 488.6; df = 1; p χ2 = 412.7; df = 2; p

INVESTIGATION OF SUSPECTED PERIPHERAL NEUROPATHY OUTBREAK IN DECHENTSEMO CENTRAL SCHOOL, THINLEYGANG, PUNAKHA

Background: A suspected peripheral neuropathy outbreak was reported from Dechentsemo Central School, Thinleygang, Punakha, following which the investigation team was immediately dispatched in the field. Objective: The aim of investigation was to ascertain the cause and risk factor for the outbreak in order to implement control measures. Methods: A case control study was devised for the investigation to study about the past exposure or deficiencies in order to find out the suspected cause and risk factors. A semi-quantitative food frequency questionnaire was administered to both cases and controls to collect information on the type of food they have consumed. The information garnered was analyzed using Chi-Square or Fischer Exact test for categorical variables and Man-Whitney U-test for quantitative variables. Results: All 17 cases were females with mean age of 13 years (SD 2.7 years). The average daily amount of thiamine intake was 0.6 mg/day for case and 0.8 mg/day for controls against the recommended daily allowance (RDA) of 1.2 mg/day. Case and control patients differed significantly with respect to fat intake (p-value = 0.02), more strongly with folate and iron intake (p-value < 0.01). Conclusion: The outbreak of peripheral neuropathy in Dechentsemo Central School appears to be linked to reduced dietary intake rich in vitamin B1 coupled with low intake of folate and iron in their diet