Rates and indications of caesarean section deliveries in Bhutan 2015-2019: a national review

BACKGROUND: Bhutan has made much efforts to provide timely access to health services during pregnancy and increase institutional deliveries. However, as specialist obstetric services became available in seven hospitals in the country, there has been a steady increase in the rates of caesarean deliveries. This article describes the national rates and indications of caesarean section deliveries in Bhutan. METHODS: This is a review of hospital records and a qualitative analysis of peer-reviewed articles on caesarean deliveries in Bhutan. Data on the volume of all deliveries that happened in the country from 2015 to 2019 were retrieved from the Annual Health Bulletins published by the Ministry of Health. The volume of deliveries and caesarean deliveries were extracted from the Annual Report of the National Referral Hospital 2015-2019 and the data were collected from hospital records of six other obstetric centres. A national rate of caesarean section was calculated as a proportion out of the total institutional deliveries at all hospitals combined. At the hospital level, the proportion of caesarean deliveries are presented as a proportion out of total institutional deliveries conducted in that hospital. RESULTS: For the period 2015-2019, the average national rate of caesarean section was 20.1% with a statistically significant increase from 18.1 to 21.5%. The average rate at the six obstetric centres was 29.9% with Phuentsholing Hospital (37.2%), Eastern Regional Referral Hospital (34.2%) and Samtse General Hospital (32.0%) reporting rates higher than that of the National Referral Hospital (28.1%). Except for the Eastern Regional Referral and Trashigang Hospitals, the other three centres showed significant increase in the proportion of caesarean deliveries during the study period. The proportion of emergency caesarean section at National Referral Hospital, Central Regional Referral Hospital and the Phuentsholing General Hospital was 58.8%. The National Referral Hospital (71.6%) and Phuentsholing General Hospital reported higher proportions of emergency caesarean sections (64.4%) while the Central Regional Referral Hospital reported higher proportions of elective sections (59.5%). The common indications were 'past caesarean section' (27.5%), foetal distress and non-reassuring cardiotocograph (14.3%), failed progress of labour (13.2%), cephalo-pelvic disproportion or shoulder dystocia (12.0%), and malpresentation including breech (8.8%). CONCLUSION: Bhutan's caesarean section rates are high and on the rise despite a shortage of obstetricians. This trend may be counterproductive to Bhutan's efforts towards 2030 Sustainable Development Goal agendas and calls for a review of obstetric standards and practices to reduce primary caesarean sections

Implementation of National Action Plans on Noncommunicable Diseases, Bhutan, Cambodia, Indonesia, Philippines, Sri Lanka, Thailand and Viet Nam

By 2016, Member States of the World Health Organization (WHO) had developed and implemented national action plans on noncommunicable diseases in line with the Global action plan for the prevention and control of noncommunicable diseases (2013–2020). In 2018, we assessed the implementation status of the recommended best-buy noncommunicable diseases interventions in seven Asian countries: Bhutan, Cambodia, Indonesia, Philippines, Sri Lanka, Thailand and Viet Nam. We gathered data from a range of published reports and directly from health ministries. We included interventions that addressed the use of tobacco and alcohol, inadequate physical activity and high salt intake, as well as health-systems responses, and we identified gaps and proposed solutions. In 2018, progress was uneven across countries. Implementation gaps were largely due to inadequate funding; limited institutional capacity (despite designated noncommunicable diseases units); inadequate action across different sectors within and outside the health system; and a lack of standardized monitoring and evaluation mechanisms to inform policies. To address implementation gaps, governments need to invest more in effective interventions such as the WHO-recommended best-buy interventions, improve action across different sectors, and enhance capacity in monitoring and evaluation and in research. Learning from the Framework Convention on Tobacco Control, the WHO and international partners should develop a standardized, comprehensive monitoring tool on alcohol, salt and unhealthy food consumption, physical activity and health-systems response

FAIRifying STEM Data Ecosystem to Enhance Data Reuse

In the science, technology, engineering, and mathematics (STEM) community, academic and research workflows and work practices are increasingly mediated and informed by data. However, making digital materials and resources findable, accessible, interoperable, and reusable (FAIR) for teaching, learning, and research is an under-researched area. Thus, it is vital to examine the current data practices of STEM students and faculties and acquaint them with the FAIR data concept. FAIR Data Principles is a set of guidelines that underscore metadata, vocabularies, licences, and standards to enhance data reuse. A study was conducted among students and faculties in the STEM community of the Royal University of Bhutan (RUB) to unpack their current data practices and explore areas for improvement using the FAIR Data Principles. The STEM students and faculties of the RUB share and reuse digital materials and resources for teaching, learning, and research. Nevertheless, their data practice is not as widespread or desired in the literature on optimum data reuse. Moreover, the compliance of current data practices to the tenets of FAIR Data Principles is not satisfactory. A pragmatic solution is complementing data practices with policies and infrastructural systems that underscore FAIR Data Principles. A sensitisation programme such as seminars and hands-on exercises on data FAIRification is crucial to familiarise people with the essentialness of FAIR data, and doing so will provide a platform to develop their repertoire for FAIRifying data and encourage systematic sharing and reuse of data. An in-depth account of the FAIRifying STEM data ecosystem in the study contributes to the growing knowledge base on adopting FAIR Data Principles in other areas of data-informed work and life

FAIRifying STEM Data Ecosystem to Enhance Data Reuse

In the science, technology, engineering, and mathematics (STEM) community, academic and research workflows and work practices are increasingly mediated and informed by data. However, making digital materials and resources findable, accessible, interoperable, and reusable (FAIR) for teaching, learning, and research is an under-researched area. Thus, it is vital to examine the current data practices of STEM students and faculties and acquaint them with the FAIR data concept. FAIR Data Principles is a set of guidelines that underscore metadata, vocabularies, licences, and standards to enhance data reuse. A study was conducted among students and faculties in the STEM community of the Royal University of Bhutan (RUB) to unpack their current data practices and explore areas for improvement using the FAIR Data Principles. The STEM students and faculties of the RUB share and reuse digital materials and resources for teaching, learning, and research. Nevertheless, their data practice is not as widespread or desired in the literature on optimum data reuse. Moreover, the compliance of current data practices to the tenets of FAIR Data Principles is not satisfactory. A pragmatic solution is complementing data practices with policies and infrastructural systems that underscore FAIR Data Principles. A sensitisation programme such as seminars and hands-on exercises on data FAIRification is crucial to familiarise people with the essentialness of FAIR data, and doing so will provide a platform to develop their repertoire for FAIRifying data and encourage systematic sharing and reuse of data. An in-depth account of the FAIRifying STEM data ecosystem in the study contributes to the growing knowledge base on adopting FAIR Data Principles in other areas of data-informed work and life

Profile and outcome of patients with Warfarin Toxicity admitted in a tertiary care hospital in Bhutan: a cross-sectional study investigators and institutions

Abstract Objective To study the profile, clinical presentation and outcome of hospital stay among patients admitted with warfarin toxicity at the Jigme Dorji Wangchuck National Referral Hospital, Bhutan. This was a cross-sectional study with a review of hospital records of patients admitted between 01 and 2018 and 30 June 2020. Results There were 22 admissions due to warfarin toxicity. The mean age of patients was 55.9 (± SD 20.2) years, the median duration of warfarin therapy was 30 months (IQR 4.8, 69 months). The indications for warfarin were atrial fibrillation (9, 40.9%), mechanical heart valves (6, 27.3%), deep vein thrombosis (6, 27.3%) and pulmonary thromboembolism (1, 4.5%). The mean of dosage of warfarin was 4.3 (± 2.6) mg and the cumulative dosage in the week prior to admission was 30.9 (± 18.6) mg. The mean of INR at presentation was 7.7 (± 4.3) with the maximum noted at 20. The patients presented with gastrointestinal bleeding, muscle haematomas, epistaxis and oral cavity bleeding. There was no mortality related to warfarin toxicity. The reasons for warfarin toxicity included patient dosing error and drug interactions. Warfarin therapy requires appropriate patient education, adequate facilities for follow-up and avoidance of warfarin wherever possible in clinical settings

Annotated Checklist and Conservation Status of Mammal Species in Sarpang District, Bhutan

Bhutan has a total geographical area of 38,394 Km² located in between the Indo-Malayan and Palearctic region, out of which 51.44% (19750.75 km²) of its total geographical area has been designated as the protected area. However, none of the districts have a structured baseline checklist of mammal species documented till date. Therefore, Sarpang Forest Division under the Department of Forests and Park Services had carried out five rigorous camera trap surveys including a nationwide tiger survey that covers representable areas of the district from 2014 till 2020. The survey shows that district has 36 mammal species that belong to 18 families under seven orders. Felidae and Cervidae families has the highest species abundance (n = 17%), while, Canidae, Herpestidae, Leporidae, Manidae, Melinae, Muridae, Mustelidae, Tupaiidae, Proboscidae, Pteromyidae, Suidae and Ursidae were the lowest (n = 3%). Above all, Sarpang homed 29.90% of total mammal species of Bhutan, out of which 3% of mammal species were categorized under Critically Endangered, 14% Endangered, 14% Vulnerable, 22% Near Threatened, and 47% Least Concern as per IUCN Red List. However, only 20 mammal species are listed under CITES and nine in Schedule I of Forest and Nature Conservation Act of Bhutan, 1995. Therefore, landscape-based planning such as the Division-based Conservation & Management plan; periodic monitoring of wildlife species using camera traps, and validation of Schedule I species are suggested for long-term conservation and management of globally threatened species inside the landscape of Sarpang district in Bhutan

Knowledge, Attitude, and Practice of Infection Control and Waste Management among Traditional Medicine Practitioners in Bhutan, 2019: A Nationwide Cross-Sectional Survey

Background. In Bhutan, Traditional Medicine (TM) is a part of the government-sponsored free healthcare system and Traditional Medicine Units (TMUs) are colocated with allopathic hospitals. Prevention of healthcare-associated infections and patient safety must apply to all institutionalized healthcare settings including TMUs. This study assessed the knowledge, attitude, and practice of TM practitioners in Bhutan in the field of infection control and waste management practices. Methods. This was a descriptive study among TM practitioners selected through simple random sampling. Data were collected using a structured pro forma and entered in EpiData 3.1 and analyzed in STATA 13.1. Results. There were 132 respondents (response rate 98%). The majority (64%) knew the seven steps of handwashing but their knowledge of WHO’s Five Moments for Handwashing was poor, especially handwashing after aseptic procedures (17%) and handwashing after touching patient surroundings (5%). Handwashing before palpation of the pulse (37%) and using gloves while dispensing medicines (9%) were poor; but the proportions of handwashing before performing moxibustion (96%), correct disposal of sharps (84%), and disinfection of cupping sets (78%) were high. The majority of participants hold a positive attitude towards the adoption of infection control and waste management practices for the benefit of patients. Only 23% had received preservice and 44% had received in-service training on infection control. Conclusions. The knowledge and practices of infection control and waste management are optimal only in select domains of practice. The practitioners hold a positive attitude towards the adoption of infection control and waste management standards