Introduction: Urine reflects the body’s functional status playing a central role in the diagnosis of disease conditions. This study aimed to compare six of the nine features of urine at physiological and lukewarm states after artificial heating – colour, odour, steam, bubbles, sediment, and frothiness. Method: This comparative study utilized the Bhutan Analysis System for Urine Properties (BASUP) chart. The study was conducted from July 2021 to January 2022 at the Eastern Regional Referral Hospital, Wangdicholing District Hospital, and the National Traditional Medicine Hospital. The properties of urine were evaluated soon after collection at physiological state. After the urine specimen had cooled down to room temperature, it was heated to body temperature following a standard procedure for reassessment of its properties. Results: A total of 91 specimens from 35 men and 56 women were analysed. There were no significant differences observed in the colour, odour, steam, bubbles, sediment, or frothiness between physiological and artificially heated specimens. However, there were differences in the colours of དམར་ཤས་ ཆེ་བ། (Marshechewa) with p = 0.023 and སེར་ཤས་ ཆེ་བ། (Sershechewa) with p = 0.015. Conclusion: The study found no significant differences in the majority of the properties of urine in specimens at physiological state and after artificial heating. However, further studies are required to evaluate the physicochemical properties and the differences in the Marshechewa and Sershechewa colours noted.

Objectives: Bhutan is experiencing a dual burden of undernutrition and overnutrition among adolescents. Understanding dietary behavior is vital to designing evidence-based interventions to improve adolescent nutrition and prevent non-communicable diseases in adults. The aim of this study was to assess the pattern of dietary behavior and associated sociodemographic, behavioral, and metabolic risk factors among school going adolescents in Bhutan. Methods: The Bhutan Global School-based Student Health Survey 2016 studied students in grades 7 to 11 (N = 7576), sampled from 50 schools, randomly selected based on probability proportional to enrollment size, using a standardized self-administered questionnaire. Consumption of adequate fruits and vegetables (each at least twice daily, or a combination of at least five times daily), high-protein food at least twice weekly) in the past 30 d, no fast food in the past week, and no carbonated/sweetened drinks in the past 30 d were studied. Weighted prevalence of dietary behaviors and adjusted prevalence ratio (95% confidence interval) for factors associated with them were calculated. Results: Of 5809 students from 13 to 17 y of age comprising 3255 (56%) girls and 3184 (54.8%) day students, 1166 (20.1%) were underweight, 1655 (28.5%) were tobacco users, and 1349 (23.2%) were alcohol users. Adequate fruit and vegetable intake, high protein consumption, not consuming fast foods and carbonated beverages were reported by 29.6%, 31.8%, 9.6%, and 14.9%, respectively. Being a day student, sex, and not reporting health risk behaviors were significantly associated with any healthy dietary behavior. Conclusion: Healthy eating behavior was low among Bhutanese adolescents. Policies influencing availability, affordability, and acceptability of healthy diets through peer-led, school-and community-based interventions are required to promote adolescent health and prevent non-communicable diseases. (c) 2021 Elsevier Inc. All rights reserved.

Soil Transmitted Helminth (STH) infections affect over 1.5 billion people worldwide. Although prevalent in all age groups, school aged children are a high-risk groups for STH infections. In Bhutan, epidemiological data on STH were collected from western Bhutan in 2003, which found a prevalence of 16.5%. However, little evidence is available on the prevalence of infection at national level. Therefore, this study was conducted with the aim to assess the prevalence and intensity of STH infections, and identify significant correlates of STH among students. A school-based survey was conducted in three regions of Bhutan. Two-stage cluster sampling was adopted to select a sample of 1500 students from 24 schools, in equal proportion from three regions of the country. A total of 1456 (97%) students were interviewed and their stool sample examined for the presence of parasites. Mini-FLOTAC technique was used to detect the parasite eggs/ova. The prevalence of any STH infection was 1.4%, with 0.8% Ascaris lumbricoides, 0.5% Trichuris trichiura and 0.2% hookworms. The eastern region had the highest prevalence at 2.3%. Except for one student who had moderate intensity of A. lumbricoides, the rest had light infection. Any STH presence was significantly associated with father's occupation, father's education level, type of house and the flooring of the house in which students reported to live. No significant associations were observed between water, sanitation and hygiene (WASH) variables measured and presence of any STH infection. The prevalence of STH was found to be very low with primarily light intensity in this study. Nonetheless, it was also found that the sanitation situation is not ideal in the country, with several students reporting constant or partial open defecation leading to environmental contamination. Based on this prevalence and in line with the WHO guideline, it is recommended that deworming be reduced to once a year in combination with concerted health education on proper hygiene and sanitation practice.

Background Suicide is one of the leading causes of death and Disability Adjusted Life Years (DALYs) worldwide. The economic, emotional and human cost of suicidal behaviour to individuals, families, communities and society makes it a serious public health issue. We aim to determine the prevalence and factors associated with self-reported suicidal behaviour (suicidal ideation and attempt) among school going adolescents (13–17 years). Methods This is a secondary analysis of a nationally representative data for Bhutan namely Global School Based Student Health Survey in 2016 which reports on various dimensions of adolescent health including suicidal behaviour. The survey employed a multistage sampling method to recruit participants aged 13–17 years ( n = 5809) from 50 schools (25 each in rural and urban area). The survey used an anonymous self-administered pre-tested 84-item questionnaire. Weighted analysis was done. Adjusted prevalence ratios (aPRs) and adjusted Odds Ratios (aORs) have been presented with 95% confidence intervals (95% CI). Results A total of 667 (11.6%) adolescents reported considering a suicide attempt whereas 656 (11.3%) reported attempting suicide in the past 12 months. Among those reporting suicidal ideation, 388 (58.6%) reported attempting a suicide and 274 (41.4%) had ideation alone, whereas, 247 (38.9%) reported attempting a suicide without previous ideation. Female sex, food insecurity, physical attack, sexual violence, bullying, feeling of loneliness, low parental engagement, reported worry about lack of sleep, urge to use drugs/alcohol, smokeless tobacco use, drug abuse and parental smoking were the factors associated with suicidal attempt. All these factors except smokeless tobacco use and parental smoking were associated with suicidal ideation. Having helpful/close friends was found to be protective against suicide ideation. Conclusion Suicidal behaviour among school going adolescents in Bhutan is high and alarming, especially among girls. Bullying, sexual violence, feeling of loneliness and drug abuse were some of the key risk factors identified. It is important to identify these risk factors early and effectively tackle them in order to prevent suicides. It requires a multi-faceted intervention with the support of the children, community, teachers and parents.

Social media are interactive computer-mediated technologies that facilitate the creation and sharing of information, ideas, interests, and other forms of expression via virtual communities and networks [1]. They are also an important platform from which to promote health issues, for example, to facilitate the exchange of information and experiences among medical personnel and patients or among patients themselves, and to share health education messages. This opportunity is largely used by medical personnel, especially those in countries with good access to the internet [2]. We summarize here an experience in Bhutan, the country that introduced a school deworming programme in 1988, but records about frequency, drug administration, and coverage of the intervention are not available for the first 10 years; since 1998, a dose of albendazole was administered every six months to students through the school-based approach and preschool children are dewormed during their visit to health center; coverage is estimated between 80% and 95%. In 2004, a survey was conducted and the Soil Transmitted Helminth (STH) prevalence was evaluated at 24% [3]. In January 2012, Mr. Kencho Namgyal, former WASH Officer with UNICEF Bhutan Country Office, initiated the Facebook group “Health Nutrition and WinS (WASH in Schools)– Bhutan” [4] as an informal platform to exchange knowledge among personnel involved in school health activities, such as school health coordinators, teachers, school principals, administrators, civil servants, employees of nongovernmental organizations, international intergovernmental organizations, and United Nations agencies. This Facebook group focuses on different aspects of school health, hygiene, and sanitation, including safe use of toilets, access to safe drinking-water, handwashing practices, personal hygiene (including menstrual hygiene), disease prevention (including periodical deworming, Weekly Iron Folic acid supplementation, Vitamin A supplementation, and oral health), waste management in schools, and food hygiene. The intent of the group was to allow the sharing of ideas about best practices, challenges, and innovation at school and national levels and to ensure that children practice key hygiene behavior. The group has been highly successful: presently, more than 3,000 members are part of the group and, for example, in September 2018 alone, 50 posts were uploaded, mainly by teachers, containing more than 320 photos and videos showing WASH and health interventions in schools (frequently showing deworming campaigns), and in occasion of the 2018 Global Handwashing Day (15 October), over 60 posts were uploaded by different members of the group that received in total over 1,000 ‘likes’.

Background: A suspected peripheral neuropathy outbreak was reported from Dechentsemo Central School, Thinleygang, Punakha, following which the investigation team was immediately dispatched in the field.Objective: The aim of investigation was to ascertain the cause and risk factor for the outbreak in order to implement control measures.Methods: A case control study was devised for the investigation to study about the past exposure or deficiencies in order to find out the suspected cause and risk factors. A semi-quantitative food frequency questionnaire was administered to both cases and controls to collect information on the type of food they have consumed. The information garnered was analyzed using Chi-Square or Fischer Exact test for categorical variables and Man-Whitney U-test for quantitative variables. Results: All 17 cases were females with mean age of 13 years (SD 2.7 years). The average daily amount of thiamine intake was 0.6 mg/day for case and 0.8 mg/day for controls against the recommended daily allowance (RDA) of 1.2 mg/day. Case and control patients differed significantly with respect to fat intake (p-value = 0.02), more strongly with folate and iron intake (p-value 0.01).Conclusion: The outbreak of peripheral neuropathy in Dechentsemo Central School appears to be linked to reduced dietary intake rich in vitamin B1 coupled with low intake of folate and iron in their diet.