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Background: Influenza burden estimates help provide evidence to support influenza prevention and control programs. In this study, we estimated influenza-associated respiratory hospitalization rates in Bhutan, a country considering influenza vaccine introduction., Methods: Using real-time reverse transcription-polymerase chain reaction laboratory results from severe acute respiratory infection (SARI) surveillance, we estimated the proportion of respiratory hospitalizations attributable to influenza each month among patients aged <5, 5-49, and ≥50 years in six Bhutanese districts for 2015 and 2016. We divided the sum of the monthly influenza-attributed hospitalizations by the total of the six district populations to generate age-specific rates for each year., Results: In 2015, 10% of SARI patients tested positive for influenza (64/659) and 18% tested positive (129/736) in 2016. The incidence of influenza-associated hospitalizations among all age groups was 50/100 000 persons (95% confidence interval [CI]: 45-55) in 2015 and 118/100 000 persons (95% CI: 110-127) in 2016. The highest rates were among children <5 years: 182/100 000 (95% CI: 153-210) in 2015 and 532/100 000 (95% CI: 473-591) in 2016. The second highest influenza-associated hospitalization rates were among adults ≥50 years: 110/100 000 (95% CI: 91-130) in 2015 and 193/100 000 (95% CI: 165-221) in 2016., Conclusions: Influenza viruses were associated with a substantial burden of severe illness requiring hospitalization especially among children and older adults. These findings can be used to understand the potential impact of seasonal influenza vaccination in these age groups., (© 2018 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.)

Objective: To assess the economic impact of epilepsy in Bhutan, a lower-middle-income country with a universal health care system, but with limited access to neurological care., Methods: A cross-sectional survey was conducted of patients with epilepsy at the Jigme Dorji Wangchuk National Referral Hospital from January to August 2016. Data were collected on clinical features, cost of care, impact of epilepsy on school or work and household economic status of participants and matched comparisons (a sibling or neighbour from a household without epilepsy)., Results: A total of 172 individuals were included in the study (130 adults and 42 children). One-third of adults and 20 (48%) children had seizures at least once per month. Mean direct out-of-pocket cost for epilepsy care was 6054 Bhutanese Ngultrum (BTN; 91 USD) per year, of which transportation formed the greatest portion (53%). Direct costs of epilepsy were an average of 3.2% of annual household income. Adults missed 6.8 (standard deviation [SD]: 9.0) days of work or school per year on average, and children missed 18.6 (SD: 34.7) days of school. Among adults, 23 (18%) abandoned employment or school because of epilepsy; seven children (18%) stopped school because of epilepsy. Households with a person with epilepsy had a lower monthly per-person income (6434 BTN) than comparison households without epilepsy (8892 BTN; P = 0.027)., Conclusions: In Bhutan, despite universal health care services, households of people with epilepsy face a significant economic burden. With many adults and children unable to attend school or work, epilepsy causes a major disruption to individuals' livelihoods., (© 2018 John Wiley & Sons Ltd.)

A review of the surgical admission, operating room records, and emergency room consultations for the 2006 was undertaken with the objective of assessing the injury burden at the Jigme Dorji Wangchuck National Referral Hospital in Thimphu. The study revealed that trauma accounted for 20% of all surgical admissions in 2006, out of which the Orthopedic department bore the major chunk of trauma admissions at 61%. Trauma was responsible for more than 5000 disability-adjusted life years lost (DALYs) in 2006. On an average, 2 out of 3 orthopedic procedures were performed for trauma-related conditions. It is hoped that this study will stimulate the local practitioners and policy makers to initiate further studies to build up standardized database on injury burden in Bhutan to facilitate evidence-based decisions by the stakeholders., (Copyright © 2011 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.)