Aims: To investigate the association of various maternal factors and associated medical condition... more Aims: To investigate the association of various maternal factors and associated medical conditions during pregnancy with low birth weight (LBW) at term in neonates. Methods: An unmatched case control study was done involving 150 cases (mothers who delivered singleton baby at term weighing less than 2500g) and 150 controls (mothers who delivered singleton baby at term weighing ≥2500g) in Jigme Dorji Wangchuck National Referral Hospital from 2018 to 2019. Consecutive and systematic sampling methods were used to select case and control respectively. Student unpaired t-test was used to test the differences between the control and case means for various factors. Odds ratios were used to assess the role of various factors on low birth weight Results: This study found maternal height, weight gain during pregnancy, time of first antenatal visit and hypertension during pregnancy as the independent predictors of low birth weight. Conclusions: Targeted interventions such as improving maternal ...
Obstetric care relies on the application of evidence based knowledge in practice, in often stress... more Obstetric care relies on the application of evidence based knowledge in practice, in often stressful and rapidly changing situations. Bhutan is a small Buddhist Kingdom located in the Himalayas, with a population of under 700,000. Although there has been an emphasis on supporting primary care, Obstetric outcomes have a great deal of room for improvement. Primary health units are located across the country staffed by a mixture of doctors, nurses and paramedical personnel. However road transport is difficult and slow, air evacuation is not generally available and much of the population lives more than an hours walk from a road head. In these circumstances, rural health professionals are both the primary caregivers and first responders to obstetric problems. The aim of this project was to support the development of skills and expertise to deal with emergencies, prevent them if possible and identify pregnant women at high risk so that they could be transferred into hospital early in their pregnancy if necessary. A set of Obstetric protocols for treatment and diagnosis were developed via a consensus process and hosted on a web server. In terms of geographical challenges, Bhutan has many similarities to rural New Zealand as well as Pacific nations, and lessons learned here may be applicable more widely.
International Journal of Healthcare Information Systems and Informatics, 2008
The global burden of disease falls most heavily on people in developing countries. Few resources ... more The global burden of disease falls most heavily on people in developing countries. Few resources for healthcare, geographical and infrastructure issues, lack of trained staff, language and cultural diversity and political instability all affect the ability of health providers to support effective and efficient healthcare. Health information systems are a key aspect of improving healthcare, but existing systems are often expensive and unsuitable. Open source software appears to be a promising avenue for quickly and cheaply introducing health information systems that are appropriate for developing nations. This article describes some aspects of open source e-health software that are particularly relevant to developing nations, issues and problems that may arise and suggests some future areas for research and action. Suggestions for critical success factors are included. Much of the discussion will be related to a case study of a training and e-health project, currently running in the ...
Background The third Sustainable Development Goal for 2030 development agenda aims to reduce mate... more Background The third Sustainable Development Goal for 2030 development agenda aims to reduce maternal and newborn deaths. Pregnant women’s understanding of danger signs is an important factor in seeking timely care during emergencies. We assessed knowledge of obstetric danger signs using both recall and understanding of appropriate action required during obstetric emergencies. Methods This was a cross-sectional study among pregnant women attending antenatal clinic at Bhutan’s largest hospital in Thimphu. Recall was assessed against seven obstetric danger signs outlined in the Mother and Child Health Handbook (7 points). Understanding of danger signs was tested using 13 multiple choice questions (13 points). Knowledge was scored out of 20 points and reported as ‘good’ (≥80%), ‘satisfactory’ (60–79%) and ‘poor’ (
Bhutan has opened up to modernization in 1961s and since then good progress has been made in soci... more Bhutan has opened up to modernization in 1961s and since then good progress has been made in social sectors. Providing free health service and education has the top priority from the beginning to this day. With humble starting from almost bare grounds, the situation of maternal health has improved. Until the start of the Safe Motherhood program in 1994, health programs were not streamlined. The maternal mortality ratio (MMR) was 380 per 100000 livebirths in 1994. A lot of efforts with different programs have been implemented by the reproductive health program of Ministry of Health to improve maternal health. Main challenge has been with health human resource from the very beginning and it still stands to this day as number one challenge. With the inputs of various programs to improve maternal health and development in non-health sectors, the MMR has come down to 89 per 100000 livebirths in 2017.
Introduction: A fetal death or stillbirth is a baby born weighing >500 grams and with no signs... more Introduction: A fetal death or stillbirth is a baby born weighing >500 grams and with no signs of life at or after 28 weeks of gestation. Methods: This was a cross-sectional survey to estimate the rate of stillbirths and a case series study to describe all stillbirths occurring at Bhutan’s national referral centre, Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), from June 2006 to July 2008. Ethical approval was granted by the Ministry of Health. All pregnant women who had stillbirths with fetuses weighing >500 grams were included. Antenatal and socio-demographic details and examination of the newborn were abstracted from records. Results: There were 96 stillbirths among 5,417 births at JDWNRH, for a rate of 17.72 per 1,000 births. The mean age of women with stillbirths was 26.5 years (range 15 to 44 years). The majority of stillbirths occurred in women aged between 20 to 34 years and in primipara. The majority (87.5%) of the women had at least one antenatal visit, 6...
Introduction: The birth weight of every new born is a key predictor of its immediate outcome and ... more Introduction: The birth weight of every new born is a key predictor of its immediate outcome and indirect indicator for later development. There were no studies done in Bhutan to look at the average term birth weight. This study was under taken to estimate the average term birth weight of new born in Jigme Dorji Wangchuck National Referral Hospital in Thimphu and to study its correlation with maternal factors and sex of the new born. Methods: This was a retrospective study with data collected from the birthing center record for those delivered between January 2011 to December 2014. A total of 13,647 singleton babies were included. Other variables studied maternal age, parity, education level, family income, antenatal booking visits, sex of baby and maternal ethnic origins. Data were analysed for correlations. Results: From the 13,647 singleton cases, the overall average term birth weight for new born was 3,177± 435 g with boys (mean weight 3,228± 435g) being heavier than girls (mean...
Introduction: Prevention of mother-to-child transmission activities form important part of HIV/AI... more Introduction: Prevention of mother-to-child transmission activities form important part of HIV/AIDS prevention program of any community or country. Methods: Information from the PMTCT Programme from the Ministry of Health and other published literature on HIV in Bhutan were reviewed. Results: The first case of mother to child transmission was reported in Bhutan in 2001. However, the retrospective study shows that one of the earliest mothers-to- child transmissions could have taken place back in 1997. Strategies for the prevention of mother-to-child transmission (PMTCT) of HIV in Bhutan have endured substantial advancement based on global scientific evidence. It is a concern as there is a slow rise in the number of HIV cases. The main modeof transmission is unsafe heterosexual practice in Bhutan. Before the planned PMTCT program, 3 children were infected. After launch of proper PMTCT program, we had all the components of effective strategies in PMCT program which have evolved with be...
Aims To examine the prevalence of gestational diabetes in third-trimester pregnant women as well ... more Aims To examine the prevalence of gestational diabetes in third-trimester pregnant women as well as to assess their insulin secretion and insulin resistance (IR). Methods Third-trimester pregnant women (n = 262) attending antenatal care at local clinics in the central region of the Limpopo Province underwent a 2-h oral glucose tolerance test (OGTT) with blood collected at 0, 30 and 120 min. Glucose and insulin were measured. Results The prevalence of gestational impaired glucose tolerance (GIGT) and gestational diabetes mellitus (GDM) was 8.8% (7.3% GIGT; 1.5% GDM). Women with GIGT/GDM were significantly older and had more children compared with women with a normal response to the OGTT. Homeostasis model assessment (HOMA)-IR and fasting insulin were lower in the GIGT/GDM group compared with the normal group, as were measures of insulin secretion (HOMA B-cell function and insulinogenic index). Furthermore, women with body mass index (BMI) ≥ 30.0 kg /m 2 were significantly older and had higher parity, systolic and diastolic blood pressure measurements than those with BMI 25.0-29.9 kg /m 2 and BMI < 25.0 kg /m 2. However, increased BMI was not associated with an increased risk of GIGT/GDM. Conclusion The present study shows that there is a high prevalence of GIGT/ GDM, with most women having IGT. The GIGT/GDM present in these women is characterized by increased insulin sensitivity accompanied by reduced pancreatic B-cell function. Additionally, heavier women appear to have increased first phase insulin secretion, suggesting the presence of insulin resistance.
Aims: To investigate the association of various maternal factors and associated medical condition... more Aims: To investigate the association of various maternal factors and associated medical conditions during pregnancy with low birth weight (LBW) at term in neonates. Methods: An unmatched case control study was done involving 150 cases (mothers who delivered singleton baby at term weighing less than 2500g) and 150 controls (mothers who delivered singleton baby at term weighing ≥2500g) in Jigme Dorji Wangchuck National Referral Hospital from 2018 to 2019. Consecutive and systematic sampling methods were used to select case and control respectively. Student unpaired t-test was used to test the differences between the control and case means for various factors. Odds ratios were used to assess the role of various factors on low birth weight Results: This study found maternal height, weight gain during pregnancy, time of first antenatal visit and hypertension during pregnancy as the independent predictors of low birth weight. Conclusions: Targeted interventions such as improving maternal ...
Background Bhutan has made much efforts to provide timely access to health services during pregna... more 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 global burden of disease falls most heavily on people in developing countries. Few resources ... more The global burden of disease falls most heavily on people in developing countries. Few resources for healthcare, geographical and infrastructure issues, lack of trained staff, language and cultural diversity and political instability all affect the ability of health providers to support effective and efficient healthcare. Health information systems are a key aspect of improving healthcare, but existing systems are often expensive and unsuitable. Open source software appears to be a promising avenue for quickly and cheaply introducing health information systems that are appropriate for developing nations. This article describes some aspects of open source e-health software that are particularly relevant to developing nations, issues and problems that may arise and suggests some future areas for research and action. Suggestions for critical success factors are included. Much of the discussion will be related to a case study of a training and e-health project, currently running in the Himalayan kingdom of Bhutan.
Aims: To investigate the association of various maternal factors and associated medical condition... more Aims: To investigate the association of various maternal factors and associated medical conditions during pregnancy with low birth weight (LBW) at term in neonates. Methods: An unmatched case control study was done involving 150 cases (mothers who delivered singleton baby at term weighing less than 2500g) and 150 controls (mothers who delivered singleton baby at term weighing ≥2500g) in Jigme Dorji Wangchuck National Referral Hospital from 2018 to 2019. Consecutive and systematic sampling methods were used to select case and control respectively. Student unpaired t-test was used to test the differences between the control and case means for various factors. Odds ratios were used to assess the role of various factors on low birth weight Results: This study found maternal height, weight gain during pregnancy, time of first antenatal visit and hypertension during pregnancy as the independent predictors of low birth weight. Conclusions: Targeted interventions such as improving maternal ...
Obstetric care relies on the application of evidence based knowledge in practice, in often stress... more Obstetric care relies on the application of evidence based knowledge in practice, in often stressful and rapidly changing situations. Bhutan is a small Buddhist Kingdom located in the Himalayas, with a population of under 700,000. Although there has been an emphasis on supporting primary care, Obstetric outcomes have a great deal of room for improvement. Primary health units are located across the country staffed by a mixture of doctors, nurses and paramedical personnel. However road transport is difficult and slow, air evacuation is not generally available and much of the population lives more than an hours walk from a road head. In these circumstances, rural health professionals are both the primary caregivers and first responders to obstetric problems. The aim of this project was to support the development of skills and expertise to deal with emergencies, prevent them if possible and identify pregnant women at high risk so that they could be transferred into hospital early in their pregnancy if necessary. A set of Obstetric protocols for treatment and diagnosis were developed via a consensus process and hosted on a web server. In terms of geographical challenges, Bhutan has many similarities to rural New Zealand as well as Pacific nations, and lessons learned here may be applicable more widely.
International Journal of Healthcare Information Systems and Informatics, 2008
The global burden of disease falls most heavily on people in developing countries. Few resources ... more The global burden of disease falls most heavily on people in developing countries. Few resources for healthcare, geographical and infrastructure issues, lack of trained staff, language and cultural diversity and political instability all affect the ability of health providers to support effective and efficient healthcare. Health information systems are a key aspect of improving healthcare, but existing systems are often expensive and unsuitable. Open source software appears to be a promising avenue for quickly and cheaply introducing health information systems that are appropriate for developing nations. This article describes some aspects of open source e-health software that are particularly relevant to developing nations, issues and problems that may arise and suggests some future areas for research and action. Suggestions for critical success factors are included. Much of the discussion will be related to a case study of a training and e-health project, currently running in the ...
Background The third Sustainable Development Goal for 2030 development agenda aims to reduce mate... more Background The third Sustainable Development Goal for 2030 development agenda aims to reduce maternal and newborn deaths. Pregnant women’s understanding of danger signs is an important factor in seeking timely care during emergencies. We assessed knowledge of obstetric danger signs using both recall and understanding of appropriate action required during obstetric emergencies. Methods This was a cross-sectional study among pregnant women attending antenatal clinic at Bhutan’s largest hospital in Thimphu. Recall was assessed against seven obstetric danger signs outlined in the Mother and Child Health Handbook (7 points). Understanding of danger signs was tested using 13 multiple choice questions (13 points). Knowledge was scored out of 20 points and reported as ‘good’ (≥80%), ‘satisfactory’ (60–79%) and ‘poor’ (
Bhutan has opened up to modernization in 1961s and since then good progress has been made in soci... more Bhutan has opened up to modernization in 1961s and since then good progress has been made in social sectors. Providing free health service and education has the top priority from the beginning to this day. With humble starting from almost bare grounds, the situation of maternal health has improved. Until the start of the Safe Motherhood program in 1994, health programs were not streamlined. The maternal mortality ratio (MMR) was 380 per 100000 livebirths in 1994. A lot of efforts with different programs have been implemented by the reproductive health program of Ministry of Health to improve maternal health. Main challenge has been with health human resource from the very beginning and it still stands to this day as number one challenge. With the inputs of various programs to improve maternal health and development in non-health sectors, the MMR has come down to 89 per 100000 livebirths in 2017.
Introduction: A fetal death or stillbirth is a baby born weighing >500 grams and with no signs... more Introduction: A fetal death or stillbirth is a baby born weighing >500 grams and with no signs of life at or after 28 weeks of gestation. Methods: This was a cross-sectional survey to estimate the rate of stillbirths and a case series study to describe all stillbirths occurring at Bhutan’s national referral centre, Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), from June 2006 to July 2008. Ethical approval was granted by the Ministry of Health. All pregnant women who had stillbirths with fetuses weighing >500 grams were included. Antenatal and socio-demographic details and examination of the newborn were abstracted from records. Results: There were 96 stillbirths among 5,417 births at JDWNRH, for a rate of 17.72 per 1,000 births. The mean age of women with stillbirths was 26.5 years (range 15 to 44 years). The majority of stillbirths occurred in women aged between 20 to 34 years and in primipara. The majority (87.5%) of the women had at least one antenatal visit, 6...
Introduction: The birth weight of every new born is a key predictor of its immediate outcome and ... more Introduction: The birth weight of every new born is a key predictor of its immediate outcome and indirect indicator for later development. There were no studies done in Bhutan to look at the average term birth weight. This study was under taken to estimate the average term birth weight of new born in Jigme Dorji Wangchuck National Referral Hospital in Thimphu and to study its correlation with maternal factors and sex of the new born. Methods: This was a retrospective study with data collected from the birthing center record for those delivered between January 2011 to December 2014. A total of 13,647 singleton babies were included. Other variables studied maternal age, parity, education level, family income, antenatal booking visits, sex of baby and maternal ethnic origins. Data were analysed for correlations. Results: From the 13,647 singleton cases, the overall average term birth weight for new born was 3,177± 435 g with boys (mean weight 3,228± 435g) being heavier than girls (mean...
Introduction: Prevention of mother-to-child transmission activities form important part of HIV/AI... more Introduction: Prevention of mother-to-child transmission activities form important part of HIV/AIDS prevention program of any community or country. Methods: Information from the PMTCT Programme from the Ministry of Health and other published literature on HIV in Bhutan were reviewed. Results: The first case of mother to child transmission was reported in Bhutan in 2001. However, the retrospective study shows that one of the earliest mothers-to- child transmissions could have taken place back in 1997. Strategies for the prevention of mother-to-child transmission (PMTCT) of HIV in Bhutan have endured substantial advancement based on global scientific evidence. It is a concern as there is a slow rise in the number of HIV cases. The main modeof transmission is unsafe heterosexual practice in Bhutan. Before the planned PMTCT program, 3 children were infected. After launch of proper PMTCT program, we had all the components of effective strategies in PMCT program which have evolved with be...
Aims To examine the prevalence of gestational diabetes in third-trimester pregnant women as well ... more Aims To examine the prevalence of gestational diabetes in third-trimester pregnant women as well as to assess their insulin secretion and insulin resistance (IR). Methods Third-trimester pregnant women (n = 262) attending antenatal care at local clinics in the central region of the Limpopo Province underwent a 2-h oral glucose tolerance test (OGTT) with blood collected at 0, 30 and 120 min. Glucose and insulin were measured. Results The prevalence of gestational impaired glucose tolerance (GIGT) and gestational diabetes mellitus (GDM) was 8.8% (7.3% GIGT; 1.5% GDM). Women with GIGT/GDM were significantly older and had more children compared with women with a normal response to the OGTT. Homeostasis model assessment (HOMA)-IR and fasting insulin were lower in the GIGT/GDM group compared with the normal group, as were measures of insulin secretion (HOMA B-cell function and insulinogenic index). Furthermore, women with body mass index (BMI) ≥ 30.0 kg /m 2 were significantly older and had higher parity, systolic and diastolic blood pressure measurements than those with BMI 25.0-29.9 kg /m 2 and BMI < 25.0 kg /m 2. However, increased BMI was not associated with an increased risk of GIGT/GDM. Conclusion The present study shows that there is a high prevalence of GIGT/ GDM, with most women having IGT. The GIGT/GDM present in these women is characterized by increased insulin sensitivity accompanied by reduced pancreatic B-cell function. Additionally, heavier women appear to have increased first phase insulin secretion, suggesting the presence of insulin resistance.
Aims: To investigate the association of various maternal factors and associated medical condition... more Aims: To investigate the association of various maternal factors and associated medical conditions during pregnancy with low birth weight (LBW) at term in neonates. Methods: An unmatched case control study was done involving 150 cases (mothers who delivered singleton baby at term weighing less than 2500g) and 150 controls (mothers who delivered singleton baby at term weighing ≥2500g) in Jigme Dorji Wangchuck National Referral Hospital from 2018 to 2019. Consecutive and systematic sampling methods were used to select case and control respectively. Student unpaired t-test was used to test the differences between the control and case means for various factors. Odds ratios were used to assess the role of various factors on low birth weight Results: This study found maternal height, weight gain during pregnancy, time of first antenatal visit and hypertension during pregnancy as the independent predictors of low birth weight. Conclusions: Targeted interventions such as improving maternal ...
Background Bhutan has made much efforts to provide timely access to health services during pregna... more 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 global burden of disease falls most heavily on people in developing countries. Few resources ... more The global burden of disease falls most heavily on people in developing countries. Few resources for healthcare, geographical and infrastructure issues, lack of trained staff, language and cultural diversity and political instability all affect the ability of health providers to support effective and efficient healthcare. Health information systems are a key aspect of improving healthcare, but existing systems are often expensive and unsuitable. Open source software appears to be a promising avenue for quickly and cheaply introducing health information systems that are appropriate for developing nations. This article describes some aspects of open source e-health software that are particularly relevant to developing nations, issues and problems that may arise and suggests some future areas for research and action. Suggestions for critical success factors are included. Much of the discussion will be related to a case study of a training and e-health project, currently running in the Himalayan kingdom of Bhutan.
Uploads
Papers by Phurb Dorji