Explore the vast range of titles available.

Bovine tuberculosis (bTB) is a chronic disease of cattle and the leading cause of zoonotic tuberculosis. In Bhutan, there is no dedicated program for bTB despite the country being situated in the bTB enzootic region, where a large section of population relies on cattle and raw milk and, dairy products are widely consumed.To contribute to the design of future education, surveillance, mitigation, and control programs, we investigated the knowledge, attitudes, and practices relevant to bTB among dairy farmers. We surveyed 264 farmers in Thimphu, Paro, and Haa Dzongkhags. These farmers contribute to supplying the eight milk outlets in the capital, Thimphu. We found that only 11 farmers (4.2%; confidence interval 95%: 2.1% - 7.3%) were aware that bTB existed, and only five of them (1.9%; CI 95%: 0.6% – 4.3%) were aware that bTB is a zoonosis. Risk perception and practice followed a gradient of variation from Thimphu to Haa, but overall, we found a correlation between bTB risk perception for animals and humans. Farmers and traders, along with the consumption of meat and sick animals, were perceived as occupations and activities involving the highest risk of zoonotic infection. Contact with animals entering the herd and with neighbouring cattle were perceived as the highest risk for animal infection. Most farmers in Haa consume raw milk and dairy products they produced by themselves, whereas farmers in Paro and Thimphu prefer powdered milk. Using generalised low-rank models and k-means clustering, we found that dzongkhag of residence and attitudes toward zoonotic infection prevention explained most variability in the data. The severe knowledge deficits about bTB are particularly concerning given the zoonosis is present in Bhutan, is prevalent in neighbouring countries, and negatively affects cattle health and well-being, diminishing fertility, milk, and overall productivity, ultimately impacting farmers’ livelihoods and undermining Bhutan’s nutritional and economic reliance on this sector. Urgent short and mid-term activities should be prioritised to identify bTB high-risk areas, educate farmers, and mitigate bTB impacts.

Livestock farming plays an important role in supporting the livelihood of resource-poor subsistence farmers in Bhutan. However, ticks and tick-borne diseases (TBDs) are one of the major constraints to livestock farming due to their negative effect on health and production. To date, no study has been conducted in Bhutan to assess farmers’ knowledge, attitude, and practices (KAP) about ticks and TBDs in cattle, although such information is essential in ensuring the development and adoption of effective prevention and control measures. Therefore, a KAP survey was conducted among 246 cattle owners in the Samkhar sub-district of eastern Bhutan in June 2019, using a structured questionnaire. Based on our scoring criteria, 52% [95%CI: 45.5–58.4] had adequate knowledge about ticks as potential vectors of diseases. Logistic regression analysis showed that the individuals who practiced a stall-feeding system of cattle rearing were 2.8 times [OR = 2.8 (95%CI: 1.66–4.78)] more likely to have adequate knowledge than others. Sixty-eight percent [95%CI: 62.5–74.4] had a favorable attitude toward tick prevention and control programs. Men were 1.95 times [OR = 1.95 (95%CI: 1.09–3.55)] more likely to have a favorable attitude than women, and the individuals who practiced a stall-feeding system were 2.59 times [OR = 2.59 95%CI: 1.45–4.78)] more likely to have a favorable attitude than others, after adjusting for the effect of other variables in the model. Overall, only 38% [95%CI 32.5–45] of the respondents reported tick infestation as one of the most important animal health problems, but 100% reported using acaricides to control ticks in cattle. Despite a high level of acaricide usage, the level of knowledge was low among the farmers interviewed. Findings from this study underline the importance of considering identified knowledge gaps and initiating education efforts to improve the adoption of effective tick prevention and control measures among farmers.

We conducted serosurveillance for Crimean-Congo hemorrhagic fever virus (CCHFV) among goats in southern Bhutan. Testing serum samples from 472 goats for CCHFV-specific IgG using an indirect fluorescent antibody test and ELISA, we found CCHFV antibody-positive goats along the analyzed border region with India, indicating widespread distribution of CCHFV in this area.

Bhutan is a tropical country where snakebite is supposedly common, but official data are scanty and unmethodical. Deaths from snakebites were reported from areas where snakebites are common. Four‐year (2018–2021) data of snakebite from 45 Bhutanese hospitals were collected and analysed to describe the burden and map by districts. A total of 371 snakebites were recorded from 45 hospitals during the 4 years. Most cases were seen in the southern and central parts of the country. There was a definite rise in the number of cases in the warmer months, starting from March and peaking between June and August. About 240 (65%) of the bites occurred in males, and the highest number of snakebites occurred during farming (n = 100, 27%), bush walking (n = 42, 11.3%), herding (n = 15, 4%) and trekking (n = 1, 0.2%). The most common anatomical bite site was the leg (n = 167, 45.01%), followed by the hand (n = 81, 21.8%), finger (n = 56, 15.09%), toes (n = 11, 2.96%), thigh region (n = 6, 1.6%), head and face (n = 3, 0.8%), chest and shoulder (n = 3, 0.8%) and abdomen (n = 1, 0.3%). Most snakes were unidentified (n = 266, 71.7%). Those identified were vipers (n = 74, 19.9%), rat snakes (n = 12, 3.2%), kraits (n = 7, 1.88%), cobras (n = 6, 1.61%), river snakes (n = 5, 1.34%) and wolf snakes (n = 1, 0.26%). Forty‐three (11.6%) of the bite victims had resorted to non‐medical home treatment. Even with an obvious underreporting, snakebite is a significant public health problem, and Bhutan should embrace more public health and clinical activities to prevent morbidities and mortalities from snakebite. This study reports 371 cases of snakebites in 4 years (2018–2021) from 45 Bhutanese hospitals. Snakebite is a neglected public health problem with no consistent recording and reporting system, no national treatment guidelines and no public health program activities in Bhutan.

Rabies is one of the most important zoonotic diseases that mostly affect children. We conducted a rabies education among 129 secondary school children (intervention group = 94 students, control group = 35 students) in two schools in southeast Bhutan and evaluated the effectiveness of the lesson by comparing the knowledge, perception and safety behaviour score about rabies before and after education. We also assessed the knowledge retention capacity of the students at three months post intervention. Our findings indicated that short rabies lesson significantly (P<0.001) improved the mean knowledge score from 19.98(±2.72) to 26.96(±2.24) in the intervention group. Similarly, mean scores for perception and safety behaviour improved significantly (P<0.001) from 10.77 (±1.89) to 13.95 (±1.36) and 9.809 (±1.85) to 12.97 (±1.54), respectively. Although the scores have reduced significantly (P<0.001) at three months post intervention, most of the rabies information was largely retained by the students. In control group, significant increase in mean scores were also observed for perception from 10.17 (±2.38) to 11.2 (±2.44) and safety behaviour from 9.14(±1.44) to 10.74 (±1.95) after 3 months of education. The finding demonstrate that a short rabies lesson is effective in improving knowledge, perceptions and understanding of dog bites safety behaviour among the school children. However, there is a need for a frequent awareness program, at least quarterly or half yearly. Rabies education should focus on critical points such as dog bites being the main source of rabies and the importance washing a dog/animal bite wound with soap and water, and visiting the hospital for medical advice following animal bites.

Background This study aimed to assess the extent of knowledge and understanding of rabies disease in rural and urban communities of Pakistan. It also identified malpractices after suspected dog bite that might pose a risk for humans contracting rabies. Methods A cross-sectional study was conducted ( n  = 1466) on people having different age groups and educational levels in four different geographic regions of Punjab and Khyber Pakhtunkhwa provinces in Pakistan. Knowledge, attitude, and practices of people were assessed using a structured questionnaire. We used a bivariate and multivariate analysis to study the association between rabies related mortalities in near or extended family members and different risk behaviors. Results Our results demonstrate that the majority of the juvenile population (less than 18 years of age) were not aware of the clinical signs of rabies in animals. 75% of the total respondents were not vaccinated against rabies, 60% did not seek a doctor’s advice after a suspected animal bite, and 55% had inadequate health care facilities for rabies patients in local hospitals. Respondents that had pets at home had not vaccinated (38%; p  < 0.05; odds ratio 1.58) themselves against rabies due to lack of knowledge and awareness of pre-exposure prophylaxis for rabies (51%; p  < 0.05; odds ratio 1.25). They also tend to not visit doctor after suspected bite (52%; p <  0.05; odds ratio 1.97), which may had resulted in more deaths (65%; p <  0.05; odds ratio 1.73) of someone in their near or extended family due to rabies. Conclusions Lack of knowledge about the nature of rabies disease and prophylaxis has contributed to increase of rabies related deaths. Inadequate health care facilities and poor attitude of not seeking medical attention after suspected dog bite are the major reasons of rabies related deaths. These findings could help in devising a targeted management strategy and awareness program to control and reduce the incidence of human rabies related deaths in Pakistan.

Rabies remains a disease of significant zoonotic and economic concern in rabies endemic areas of Bhutan. Rabies outbreaks in livestock threaten the livelihoods of subsistence farming communities and pose a potential public health threat. As a part of identifying approaches to prevent rabies in cattle, a Knowledge, Attitude, and Practice (KAP) survey was conducted among cattle owners in selected rural areas of the southern rabies high-risk zone and low-risk zone in eastern Bhutan. Between March and April 2017, 562 cattle owners (281 in the east and 281 in the south) were interviewed using a questionnaire. Eighty-eight percent of the participants had heard of rabies but only 39% of the participants who had heard of rabies had adequate knowledge about rabies. Multivariable logistic regression analysis showed that residing in the south [OR = 9.25 (95% CI: 6.01-14.53)] and having seen a rabies case [OR = 2.46 (95% CI: 1.6-3.82)] were significantly associated with having adequate knowledge about rabies. Based on our scoring criteria, 65% of the total participants who had heard of rabies had a favorable attitude towards rabies control and prevention programs. The participants residing in the east were two times more likely to have a favourable attitude than their counterparts in the south [OR = 2.08 (95% CI: 1.43-3.05)]. More than 70% of the participants reported engaging in farm activities such as examining the oral cavity of sick cattle and assisting cattle during parturition. Only 25% of the participants reported using personal protective equipment while undertaking these activities. Despite a high level of rabies awareness, we observed that there is a lack of comprehensive knowledge about rabies regarding susceptible hosts, transmission routes, the health outcome of rabies infection in humans, and appropriate health-seeking behaviours. This study highlights the need to strengthen rabies education programs in rural communities to address the knowledge gaps that have been identified.

In Bhutan, dog-mediated rabies has been successfully eliminated from most regions of the country but remains endemic in the Southern region and sporadic incursions are also reported in the East. Elimination of rabies from the southern part of Bhutan is challenged by the porous border with the neighboring states of India which facilitates free and unregulated movement of animals. Around 17 outbreaks of rabies are reported annually in dogs and other domestic animals, posing continuous public health risks and economic losses. Furthermore, due to anthropogenic factors, such as increasing human settlements along highways, increased animal transportation, and the complex and changing human-pet relationship, there is potential to reintroduce rabies from rabies high-risk zone to rabies low-risk zone. This study was undertaken to estimate the risk of rabies re-introduction to the rabies low-risk zone by performing a qualitative risk assessment. The assessment was conducted for three risk pathways (stray dog-pathway, pet dog-pathway and cattle-pathway) under two scenarios: (1) no risk mitigation measures in place and (2) current risk mitigation measures in place. The current control measures include Government led programs, such as mass dog vaccination and dog population management, regulation of the movment of animals through pre-travel check-up and health certification, regular awareness education and rabies surveillance in the rabies endemic areas. The probability of an event occurring was assigned using the data from the available literature. Where gaps in knowledge existed, expert opinion, elicited through modified Delphi method, was used. Under the scenario in which no risk mitigation measures were in place, the risk of rabies re-introduction was estimated to be medium for the stray-dog pathway with a low level of uncertainty, low for pet-dog pathway with a low level of uncertainty, and very low for the cattle-pathway with a medium level of uncertainty. When current risk-mitigation measures were included, the risk of rabies reintroduction was estimated to be very low for the stray-dog pathway with a medium level of uncertainty, low for the pet dog-pathway with a low level of uncertainty, and extremely low for the cattle-pathway with a medium level of uncertainty. The risk of rabies re-introduction through all the pathways was greater than negligible. These findings highlight the importance of maintaining and enhancing current risk mitigation measures to prevent re-introduction of rabies into rabies low-risk zone.

Background Rabies kills approximately 59,000 people each year worldwide. Rapid and accurate diagnosis of rabies is important for instituting rapid containment measures and for advising the exposed people for postexposure treatment. The application of a rapid diagnostic tests in the field can greatly enhance disease surveillance and diagnostic activities, especially in resource poor settings. In this study, a total of 179 brain tissue samples collected from different rabies suspect animal species (113 dogs, 50 cattle, 10 cats, 3 goats, 2 horses, and 1 bear) were selected and tested using both rapid immunochromatographic kit and the reference standard fluorescent antibody test (FAT). We evaluated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of a rapid antigen detection test kit produced by BioNote, Inc. (Hwaseong-si, Korea) relative to a FAT for its fit-for-purpose for confirmation of clinical cases of rabies for early response and enhancing rabies surveillance. Results Among 179 samples examined in this study, there was a concordance in results by the rapid test and FAT in 115 positive samples and 54 negative samples. Test results were discordant in 10 samples which were positive by FAT, but negative (false negative) by rapid kit. The rapid test kit showed a sensitivity of 92% (95% CI: 85.9–95.6) and specificity of 100% (95% CI: 93.4–100) using FAT as the reference standard. The positive and negative predictive values were found to be 100% (95% CI:96.7–100) and 84.4% (95% CI: 73.6–91.3), respectively. Overall, there was 94.4% (95% CI: 90–96.9) test agreement between rapid test and FAT (Kappa value = 0.874) with a positive percent agreement and negative percent agreement of 92 and 100%, respectively. Conclusions Our finding demonstrated that the rapid test kit (BioNote) can be used for rabies surveillance and confirming clinical case of rabies in animals for making rapid decisions particularly controlling rabies outbreaks in resource poor settings.

Rabies is endemic in southern Bhutan and children are the frequent victims of dog bites. We surveyed the knowledge, attitude, and practices on rabies among school children in three schools located in southern Bhutan. A total of 701 students (57.9% female, 42.1% male) with an age range of 12–21 years (mean: 15 years) participated in the survey, of which 98.2% had heard about rabies. Most of the students demonstrated a good level of knowledge (59.7%) and a favorable perception towards rabies (57.7%). Multivariable logistic analysis revealed the relation between knowledge and the awareness campaign (OR:1.5, 95% CI: 1.1–2.1). Similarly, higher grades of students (OR:1.9, 95%CI: 1.3–2.9) and employed mothers of the students (OR: 1.6, 95% CI: 1.0–2.7) were associated with more favorable perceptions. However, some knowledge gaps were identified in this study, such as students not being able to clearly mention the susceptible hosts of rabies, transmission routes, clinical signs, and prevention and control options. Therefore, regular awareness programs on rabies are necessary among school children in Bhutan.