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Background Trauma and related injuries are one of the top ten causes of disability in the world. With the lack of proper baseline data, this study was conducted to improve the understanding of types, modes and outcomes related to trauma visiting the emergency department of national referral hospital in Bhutan. Methods An observational study of all the trauma cases admitted to the Emergency Department over a one year period detailing the mechanism of injury, types of injuries sustained and patient outcomes was carried out. Case record form was used for data collection and Epidata analysis was done for descriptive analysis. Results A total of 820 participants were included during the study period. The sample consisted of 71.6% males and 28.4% females. The median age was 32 years with more than half of the patients (51.4%) belonging to the age range from 26 to 60 years. The top three occupations that experienced trauma were farmers (23.2%), followed by office workers (20.7%) and students (16.9%). Pre-hospital transport was primarily by ambulance (66%) followed by private vehicle (33%). Accidental injury accounted for 91.9% of the injured patients, followed by interpersonal assault (4.8%) and self-harm 3.3%. Fall injuries accounted for 46.2% of the trauma among the study participants, followed by occupational injury (19.1%) and motor vehicle collision injury (19.0%). Extremity injuries were the most common anatomical site comprising of nearly half of all trauma. Majority were admitted to the orthopedic ward 68.2% (n = 391) followed by the surgical ward (n = 91 15.8%). Around sixty five percent (64.9%) were admitted to general ward, 28% of the patients were discharged from ER, 5% were admitted to the ICU and ED mortality was 1.3%. Conclusion This study provides a clinical trauma profile at the national referral hospital in Bhutan where injury-related presentations are common. It highlights the importance of emergency department in managing and evaluation of trauma cases. It also shows the need of further studies to better understand the country’s trauma distribution and development of a robust trauma surveillance system to better provide effective prehospital care and standardized timely hospital care.

Background:The Postgraduate Medical Education globally has transited from traditional cognitive based to more competency-based learning. Bhutan’s only medical university, Khesar Gyalpo University of Medical Sciences of Bhutan (KGUMSB) introduced Competency Based curriculum (CBC) through implementation of workplace-based assessment (WPBA) in June 2018. The proposed competency-based curriculum (CBC) was aimed at developing appropriate competencies in the learners through workplace-based assessment. A programmatic evaluation of the trainees and trainer’s perception on implementation of workplace-based assessment for three years at KGUMSB was conducted in July-Sept 2021. Methods: The evaluation was conducted in July-Sept, 2021. The mixed methods design was utilized such as survey, review of student portfolios and focus group discussion. A total of 62 participants (46 residents in clinical training and 16 faculty members) participated in this evaluation. Results: After three years of implementation of WPBA, it was perceived as a good system of assessing learners with a high level of acceptability among both the students and faculty members. The practice of providing immediate feedback was well appreciated by students. Conclusions: These findings support that WPBA is a good assessment system in postgraduate education. However, it was also evident that issues such as perceived time constraints, overburdened students and lack of faculty capacity were possible obstacles to proper implementation of WPBA.

Evaluation of four varieties of mango was carried out at Agriculture Research and Development Centre, Samtenling during 2016-2018 to characterise the varieties with basic morphological traits and to assess their performance under sub-tropical agro-ecological zone. The varieties evaluated were Chinwang, Irwin, Duncan and Tommy Atkin with Amrapali as a check. Description of morphological traits is based on IBPGR mango descriptors. For performance evaluation, yield data and fruit quality analysis were recorded. Significant differences were observed in the quality analysis of fruits from all the varieties tested against the check variety. Maximum fruit weight was recorded in Chinwang variety with the mean weight of 893 gram and minimum was recorded in Amrapali (194 gram). The TSS result from all the four varieties did not show any significant difference (P value 0.0998) with the mean TSS of 13.2. Average yield per tree was also recorded in Chinwang (81kg/ tree) followed by Tommy Atkin (79 kg/tree), Duncan (69 kg/tree) and Irwin (33 kg/tree and lowest yield in the check variety Amrapali (19 kg/tree). Although all varieties were short stature in growth habit, Chinwang was found to be taller (5.2 m) than other varieties (Amrapali (4.7 m), Duncan (4 m), Irwin (3.9 m) and Tommy Atkin (4.0 m)). All four varieties have the potential for further promotion. However, continued multi-location evaluation will determine their performance under different climate and soil conditions.

Natural saltlicks are used by mammal species mainly to supplement mineral deficiency playing critical role in animal ecology. There is information gap on the use of natural saltlicks by mammals in Bhutan. Nine natural saltlicks from Jomotsangkha Wildlife Sanctuary were purposively selected to fill this gap of information. The study aimed to assess mineral composition and ecological behaviour of mammals at natural saltlicks. Nine composite soil samples were randomly collected and nine camera traps were set up at nine saltlicks for a duration of 56 days from 2 January to 28 February, 2019. Data management and analysis were carried out using camerabase and R software. Potassium, phosphorus and sodium elements were found in the saltlicks. Camera traps yielded 419 independent events of 12 species under 10 families. Herbivores were most common (n = 390) and non-herbivores the least (n = 12). Wild dog was also captured licking salts (n = 1) which is least reported across the world. Mineral composition (r = 0.70, p < .05) and anthropogenic activities (r = 0.60, p < .05) were key factors affecting the visitation rate and ecological behaviour of mammal species. Disturbed saltlicks from Samdrupcholing Range revealed fewer individuals of mammals (n = 71) with disturbed ecological behaviour while undisturbed saltlicks from Jomotsangkha Range revealed higher individuals of mammals (n = 340) with undisturbed ecological behaviour. Therefore, anthropogenic activities at disturbed saltlicks call for planned monitoring.

We report first country record of Boiga quincunciata (Wall, 1908) (Squamata: Colubridae) from Bhutan. This addition increases the ophidian fauna of Bhutan to 70 species and adds the seventh species of snake within the genus Boiga.

Non-pharmacological measures, such as hand hygiene and face mask use, continue to play an important role in the fight against the COVID-19 pandemic. However, there is a paucity of studies on the adherence to these measures among students in Bhutan. Therefore, we aimed to investigate hand hygiene and face mask-wearing behaviours, as well as their associated factors, among the students of Mongar Higher Secondary School, Bhutan. We conducted a cross-sectional study amongst the students of Mongar Higher Secondary School in Bhutan. The students self-answered the questionnaire on web-based Google Forms. Multivariable logistic regression for good hand washing and face mask use was conducted in order to identify statistically significant socio-demographic covariates. The correlation between hand hygiene and mask use was investigated using Pearson’s correlation coefficient. A total of 533 students completed the survey questionnaire, 52.9% (282) of whom were female students. Facebook (44.3%, 236) and TV (35.5%, 189) were the two most popular sources of information on COVID-19 prevention and control. Good (scores of ≥80% of total scores) hand hygiene and face mask use were reported in 33.6% (179) and 22.1% (118) of students. In multivariable logistic regression, male students presented 79% (adjusted odds ratio [AOR] = 1.79, 95% confidence interval [CI] = 1.23–2.613) odds of engaging in good hand hygiene, compared to female students. Compared to grade 9, those in grade 10 were 60% (AOR = 0.4, 95% CI 0.158–0.998) less likely to engage in good hand hygiene. Boarding students presented 68% (AOR = 1.68, 95% CI 1.001, 2.813) higher odds of wearing a face mask compared to day students. There was a significant positive correlation between good hand hygiene and face mask use (r = 0.3671, p-value < 0.001). Good hand hygiene and face mask use were reported in less than one-third of the study participants. It is recommended to continue educating students on good hand hygiene and face mask use through popular information sources.

Little is known regarding the biology and status of Near Threatened Asiatic golden cat, Catopumma teminckii Vigors and Horsfield and Vulnerable Clouded leopard, Neofelis nebulosa Griffith, in Bhutan. A systematic camera trap survey was conducted in Jomotsangkha Wildlife Sanctuary from December 2018 to February 2019 to assess the abundance, activity patterns and conservation threats of these species. Distributions of both the species were recorded in the elevation range of 216-1690 m asl. Asiatic golden cat was nocturnal (66.60% of the pictures; n = 2) and least abundant (RAI = 0.17) whereas the Clouded leopard was diurnal (75.00%; n = 8) and second least abundant (RAI = 0.68) among its sympatric species. Daily activities of these species showed an overlapping pattern with its sympatric species in which high degree of overlap was seen between Clouded leopard and Marbled cat (Δ = 0.77). The habitat under study was moderately disturbed by deforestation (46.45%). Thus, these findings call for regular monitoring of their threatened habitats.

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.

Tree ring science is a new discipline in Bhutan but has contributed substantially to our understanding of climate history and informed sustainable forest management practices in the country. This paper describes dendroecological contributions to the second aspect for Blue Pine using three case studies. i) The effects of livestock grazing impact on Blue Pine radial growth were quantified. Radial growth increment was tendentially higher after three years of livestock exclosure, as compared to continued grazing. However, differences remained statistically not significant, likely due to the brevity of the treatment period. ii) Radial growth rates of Blue Pine were characterized across a 400 m elevation gradient. Cumulative radial growth over 40 years differed by a factor of more than three between the low and the high end of the gradient. However, below 2300 m, radial growth showed a continuous decline from 1990, likely as a results of drought due to climate change. iii) Effects of three levels of prescribed thinning of pole stage (DBH 30–50 cm) Blue Pine in central Bhutan showed distinct response to thinning. Heavy thinning lead to a thinning shock in the year after harvest and did not lead to significantly higher radial growth as compared to moderate thinning, which is thus recommended for the species. A positive thinning effect remained for seven years post operation. The case studies were incorporated into national guidelines on sustainable forest management in Bhutan and prove the demand for tree ring based research to inform policy and practice.

Major progress has been made in improving the health of vulnerable populations, especially children and pregnant women in low and middle income countries after the launch of the Millennium Development Goals in 2000. While fewer children die, many now face the prospect of years lived with disability (YLD) from chronic non-communicable diseases (NCDs). The estimate for the total YLD for children under-5 years of age for South-East Asia was 2,780,104 in 2015. To improve the health outcomes for children globally, the World Health Organization’s Department of Public Health, Environment and Social Determinants of Health has designated a number of collaborating centres, each with differing areas of expertise. The collaborating centres have formed a network to address children’s environmental health (CEH) issues at the local, national, regional and international levels. However, many gaps in knowledge exist. To further this aim, the 1st Regional Workshop of South-East Asian Children’s Environmental Health was held at the Chulabhorn Research Institute, Bangkok, on 18th November 2016. The workshop was attended by three of WHO Collaborating Centres with representatives of five regional countries of Bhutan, India, Myanmar, Thailand and Vietnam. Workshops such as this one are designed to bring together researchers and policy makers from regionals areas to identify and close gaps in knowledge.

Aconite is widely used in both Chinese and Ayurvedic medications and therefore often used within the Himalayan Kingdom of Bhutan. Despite its use in traditional medicine, because of its narrow therapeutic index, significant cardiotoxic and neurotoxic events are documented due to both intentional and unintentional ingestion. In this case series we present 2 cases of bradycardia, hypotension and reversible conduction defects caused by prescribed aconite-based Bhutanese traditional medicines, for different therapeutic goals, who suffered cardiac dysrhythmias.

Introduction: The purpose of this quasi-experimental research was to study the effectiveness of a behavioral change program in reducing house index of mosquito in Village Baan-Wangpong, Lomsak district in Phetcabun province, Thailand. Methods: The sample size of experimental and control group was 42 representatives of household in each group. Representatives of each sampled household were tested for knowledge, perception and behavioral practice in prevention of dengue fever before and after the program intervention. The program included training on dengue fever prevention by health personnel, demonstration of making mosquito repellents from local product, organising an awareness contest, broadcasting health messages through media and surveying households for mosquitoes’ larvae. Results: The study found that most households in village Baan-Wangpong had low knowledge (60.4%), perceived risk (60.4%), perceived severity (64.6%) and behavioral practice (77.1%) in the prevention of dengue fever prior to the program, with comparability in intervention versus control. The results showed that after the program intervention, the experimental group had a significantly higher level of knowledge (p=0.001), perceived risk (p=0.042), perceived severity (p=0.002) and behavior (p=0.028) in preventing dengue fever than before the program intervention and higher than the control group post-intervention. The experimental group’s house index was also significantly (p=0.001) lower than before the program and lower than the control group post-intervention. Conclusions: This study suggests that a proactive program about knowledge, perceptions and behaviors on prevention of dengue fever with support from public health personnel and community participation, can positively change health behavior, resulting in reducing the house index of mosquito larva.