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Dorji T, Wangmo S, Dargay S, Dorji N, Dorjey Y, Pradhan B, Pema D, Dema C, Choden J, Dorji T, Mynak ML, Pempa, Jamphel K. Population-level cancer screening and cancer care in Bhutan, 2020-2023: a review. Lancet Reg Health Southeast Asia 2024; 24:100370. [PMID: 38444883 PMCID: PMC10910341 DOI: 10.1016/j.lansea.2024.100370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/25/2024] [Accepted: 02/05/2024] [Indexed: 03/07/2024]
Abstract
Screening of cancers is an important intervention in reducing the incidence and mortality related to cancers. Bhutan is one small country that is witnessing an increasing incidence and mortality related to cancers. The government implemented a time-bound population-level screening for gastric, cervical and breast cancers from 2020 to 2023 with an overall coverage of 91.2% of the eligible population. Among 370,225 individuals screened for H pylori, 32.4% tested positive; among 53,182 who underwent upper gastrointestinal endoscopy and biopsy, 255 (0.07%) had gastric cancer. Among 10,749 tested for HPV DNA, 9.3% were positive; among 9887 evaluated with colposcopy and biopsy, 154 (0.13%) had cervical cancer. For breast cancer screening, 72,283 underwent clinical breast examination, 845 mammography and cancer was detected in 73 (0.10%) individuals. In this article, we review how Bhutan implemented a population-level cancer screening programme with on boarding of multiple stakeholders and the participation of people across all districts.
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Affiliation(s)
- Thinley Dorji
- Department of Internal Medicine, Central Regional Referral Hospital, Gelephu, Bhutan
| | - Sangay Wangmo
- Department of Surgery, Central Regional Referral Hospital, Gelephu, Bhutan
| | - Sonam Dargay
- Department of Surgery, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Namkha Dorji
- Department of Obstetrics and Gynaecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Yeshey Dorjey
- Department of Obstetrics and Gynaecology, Phuentsholing General Hospital, Phuentsholing, Bhutan
| | - Birendra Pradhan
- Department of Pathology and Laboratory Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Dechen Pema
- Department of Radiodiagnosis and Imaging, Central Regional Referral Hospital, Gelephu, Bhutan
| | - Choney Dema
- National Medical Services, Ministry of Health, Thimphu, Bhutan
| | - Jamyang Choden
- Department of Health Services, Ministry of Health, Thimphu, Bhutan
| | | | | | - Pempa
- Department of Health Services, Ministry of Health, Thimphu, Bhutan
| | - Kinga Jamphel
- Department of Health Services, Ministry of Health, Thimphu, Bhutan
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Tenzin T, Karki R, Duba T, Jamphel K, Dhendup S, Subba DK, Dorji G, Miller PG, Connor J, Barker D, O'Brien KS, Kypri K. Prevalence of drink-driving in Thimphu, Bhutan: Targeted surveillance at sentinel sites. Drug Alcohol Rev 2020; 40:454-458. [PMID: 33289214 DOI: 10.1111/dar.13224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/30/2020] [Accepted: 11/01/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS Bhutan has a high incidence of alcohol-related disease. With economic development, motorised transport is proliferating, increasing the potential for traffic injury. We investigated drink-driving in the country's largest urban environment. METHODS Working with police, we set up checkpoints at major thoroughfares in Thimphu, on Tuesday, Friday and Saturday nights, from May to July 2017. Police directed cars to testing bays where drivers were breathalysed and interviewed. RESULTS All 1596 drivers stopped by police were breathalysed, and 212 (13%) tested positive. Blood alcohol of >0.02 g/dL (which we defined as 'probable impairment') was detected in 178 drivers (11%), while 67 (4.2%) exceeded the legal limit of 0.08 g/dL. Probable impairment was more common in men, older drivers, on Tuesdays (versus Fridays or Saturdays) and later at night. CONCLUSION Drink-driving is very common at night-time in Bhutan. Routine roadside random breath-testing, and media campaigns emphasising the risk of apprehension and consequent serious financial and social penalties, should be considered to deter drink-driving.
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Affiliation(s)
- Tashi Tenzin
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
- Khesar Gyalpo Medical University of Medical Sciences of Bhutan, Thimphu, Bhutan
| | - Roma Karki
- Ministry of Health, Royal Government of Bhutan, Thimphu, Bhutan
| | - Tashi Duba
- Ministry of Health, Royal Government of Bhutan, Thimphu, Bhutan
| | - Kinga Jamphel
- Drug Regulatory Authority of Bhutan, Thimphu, Bhutan
| | - Sonam Dhendup
- Ministry of Health, Royal Government of Bhutan, Thimphu, Bhutan
| | - Dil Kumar Subba
- Ministry of Health, Royal Government of Bhutan, Thimphu, Bhutan
| | - Gampo Dorji
- World Health Organization, South East Asia Regional Office, New Delhi, India
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Peter G Miller
- School of Psychology, Deakin University, Geelong, Australia
| | - Jennie Connor
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Daniel Barker
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Kerry S O'Brien
- School of Social Sciences, Monash University, Melbourne, Australia
| | - Kypros Kypri
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
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Chejor P, Jamphel K, Tsheten, Letho Z, Guru, Tshering U. Compliance to current national medicines law for proper storage and dispensing of medicines at community pharmacies in Bhutan. Medicine Access @ Point of Care 2018. [DOI: 10.1177/2399202618816900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Pelden Chejor
- Drug Regulatory Authority, Royal Government of Bhutan, Thimphu, Bhutan
| | - Kinga Jamphel
- Drug Regulatory Authority, Royal Government of Bhutan, Thimphu, Bhutan
| | - Tsheten
- Royal Center for Disease Control, Ministry of Health, Royal Government of Bhutan, Thimphu, Bhutan
| | - Zimba Letho
- Jigme Dorji Wangchuck National Referral Hospital, Royal Government of Bhutan, Thimphu, Bhutan
| | - Guru
- Drug Regulatory Authority, Royal Government of Bhutan, Thimphu, Bhutan
| | - Ugyen Tshering
- Drug Regulatory Authority, Royal Government of Bhutan, Thimphu, Bhutan
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Lethro P, Jamphel K, Joshi V, Mongar C, Tshering L, Tshomo T. Stillbirth rate in Bhutan: a retrospective facility-based study. ACTA ACUST UNITED AC 2018. [DOI: 10.47811/bhj.66] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction: Stillbirth is an important public health concern; yet there is no reliable stillbirth rate for Bhutan. Hence the aim of this study was to estimate the stillbirth rate for Bhutan.
Methods: A retrospective study was carried out for live and stillbirths recorded in delivery registers of all 253 health facilities across the country for a period of one year commencing 1st January till 31st December 2015.
Results: There were a total of 11,126 live births and 108 stillbirths documented in delivery registers. The stillbirth rate from this data set was 10 per 1000 live births.
Conclusions: The stillbirth rate for Bhutan from this study is 10 per 1000 live births lower than 16 per 1000 live births estimated in Lancet Series 2015. In order to find the true burden of stillbirths in the country, a surveillance may be instituted which can facilitate the prevention efforts while at the same time enable to strengthen information system.
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Dorji G, Choki S, Jamphel K, Wangdi Y, Chogyel T, Dorji C, Nirola DK. Policy and governance to address depression and suicide in Bhutan: The national suicide-prevention strategy. WHO South East Asia J Public Health 2018; 6:39-44. [PMID: 28597858 DOI: 10.4103/2224-3151.206163] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Suicide and mental disorders are a growing public health issue in Bhutan, due in part to a rapidly transitioning society. The burden of suicide has been recognized by the Royal Government of Bhutan and, as a result, it introduced the country's first ever national suicide-prevention plan in 2015. The 3-year action plan takes a holistic approach to making suicide-prevention services a top social priority, through strengthening suicide-prevention policies, promoting socially protective measures, mitigating risk factors and reaching out to individuals who are at risk of suicide or affected by incidents of suicide. This article documents Bhutan's policy and governance for addressing depression and suicide within the context of its national suicide-prevention strategy, examines progress and highlights lessons for future directions in suicide prevention. Since the endorsement of the 3-year action plan by the prime minister's cabinet, the implementation of suicide-prevention measures has been accelerated through a high-level national steering committee. Activities include suicide-prevention actions by sectors such as health, education, monastic communities and police; building capacity of gatekeepers; and improving the suicide information system to inform policies and decision-making. Suicide-prevention activities have become the responsibility of local governments, paving the way for suicide prevention as an integral mandate across sectors and at grass-root levels in the Kingdom of Bhutan.
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Affiliation(s)
- Gampo Dorji
- World Health Organization Regional Office for South-East Asia, New Delhi, India; University of Newcastle, Australia
| | - Sonam Choki
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Kinga Jamphel
- Department of Public Health, Ministry of Health, Royal Government of Bhutan, Thimphu, Bhutan
| | - Yeshi Wangdi
- Department of Public Health, Ministry of Health, Royal Government of Bhutan, Thimphu, Bhutan
| | - Tandin Chogyel
- Department of Traditional Medicine Services, Ministry of Health, Royal Government of Bhutan, Thimphu, Bhutan
| | - Chencho Dorji
- Department of Psychiatry, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Damber Kumar Nirola
- Jigme Dorji Wangchuck National Referral Hospital; Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
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