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By 2016, Member States of the World Health Organization (WHO) had developed and implemented national action plans on noncommunicable diseases in line with the In 2018, we assessed the implementation status of the recommended best-buy noncommunicable diseases interventions in seven Asian countries: Bhutan, Cambodia, Indonesia, Philippines, Sri Lanka, Thailand and Viet Nam. We gathered data from a range of published reports and directly from health ministries. We included interventions that addressed the use of tobacco and alcohol, inadequate physical activity and high salt intake, as well as health-systems responses, and we identified gaps and proposed solutions. In 2018, progress was uneven across countries. Implementation gaps were largely due to inadequate funding; limited institutional capacity (despite designated noncommunicable diseases units); inadequate action across different sectors within and outside the health system; and a lack of standardized monitoring and evaluation mechanisms to inform policies. To address implementation gaps, governments need to invest more in effective interventions such as the WHO-recommended best-buy interventions, improve action across different sectors, and enhance capacity in monitoring and evaluation and in research. Learning from the Framework Convention on Tobacco Control, the WHO and international partners should develop a standardized, comprehensive monitoring tool on alcohol, salt and unhealthy food consumption, physical activity and health-systems response.

In response to a lack of cost-effective data on screening and early treatment of diabetes and hypertension in resource-limited settings, a model-based economic evaluation was performed on the World Health Organization (WHO)’s Package of Essential Non-communicable (PEN) disease interventions for primary health care in Bhutan. Both local and international data were applied in the model in order to derive lifetime costs and outcomes resulting from the early treatment of diabetes and hypertension. The results indicate that the current screening option (where people who are overweight, obese or aged 40 years or older who visit primary care facilities are screened for diabetes and hypertension) represents good value for money compared to ‘no screening’. The study findings also indicate that expanding opportunistic screening (70% coverage of the target population) to universal screening (where 100% of the target population are screened), is likely to be even more cost-effective. From the sensitivity analysis, the value of the screening options remains the same when disease prevalence varies. Therefore, applying this model to other healthcare settings is warranted, since disease prevalence is one of the major factors in affecting the cost-effectiveness results of screening programs. En réponse au manque de données probantes sur le coût/efficacité des dépistages et des traitements précoces du diabète et de l’hypertension dans un contexte de ressources limitées, une évaluation économique a été menée sur un ensemble d’interventions essentielles pour la prise en charge des maladies non transmissibles par l’Organisation mondiale de la Santé (OMS) au niveau des soins de santé primaires au Bhoutan. Nous avons appliqué des données locales et internationales au modèle afin d’en ressortir les coûts de durée de vie et les résultats des traitements précoces du diabète et de l’hypertension. Les résultats montrent que les options actuelles de dépistage (pour lesquelles les individus en surpoids, obèses ou âgés de quarante ans et plus s’étant rendus dans un établissement de soins primaires ont subi des tests de dépistage pour le diabète et l’hypertension) représentent un bon rapport qualité prix par rapport à aucun dépistage. Les résultats de l’étude montrent aussi que passer du dépistage opportuniste (70% de la population cible couverte) au dépistage universel (où 100% de la population ciblée est dépistée) est vraisemblablement plus rentable. A partir d’une analyse sensitive, la valeur des options de dépistage reste la même quand la prévalence de la maladie varie. C’est pourquoi, appliquer ce modèle à d’autres situations sanitaires est justifié puisque la prévalence de la maladie est un des facteurs principaux affectant la rentabilité des résultats des programmes de dépistage. 在资源有限的情况下，缺少对糖尿病和高血压筛查和早期治 疗的成本效用数据，世界卫生组织（WHO）在不丹针对基础 医疗的基础非传染疾病（PEN）干预方案开展了一个以模型 为基础经济评估。这个模型采用了本地和国际的数据，从中 能够提取出对糖尿病和高血压早期治疗的终生支出和效果。 研究结果显示现在的筛查选项（对到基础医疗机构的超重、 肥胖和 40 岁及以上的人进行筛查）相比于不筛查是更经济 的。研究结果还显示扩大机会的筛查（目标人群的 70%）可 能更经济。通过敏感度分析，当疾病患病率变化时，筛选选 项的价值保持不变。因为疾病患病率是影响筛查项目成本效 用结果的主要因素，所以将这个模型应用于其他医疗机构情 境也是适当的。 En reacción a la falta de información de costo-efectividad sobre los chequeos y tratamiento temprano de diabetes e hipertensión en lugares de bajos recursos, una evaluación económica modelada fue llevada a cabo sobre el Paquete de Intervenciones Esenciales para Enfermedades No Transmisibles de la Organización Mundial de la Salud (OMS) para atención de salud primaria en Bután. Datos locales e internacionales fueron aplicados en el modelo para derivar costos durante la vida y resultados del tratamiento temprano de diabetes e hipertensión. Los resultados indican que la opción de chequeo actual (en el cual a las personas que visitan centros de atención primaria que tienen sobrepeso, son obesas o son mayores de 40 años se les hacen chequeos de diabetes e hipertensión) representan buen valor por dinero comparado con la opción de no hacer chequeos. Los hallazgos del estudio también indican que la expansión de revisiones oportunistas (cobertura del 70% de la población objetivo), a chequeos universales (cuando se le hacen chequeos al 100% de la población objetivo), es probablemente aún más costo-efectiva. Del análisis de sensibilidad, el valor de las opciones de chequeo se mantiene igual cuando la prevalencia de la enfermedad varía. Por lo tanto, aplicar este modelo a otros contextos en el marco de la salud es justificado, ya que la prevalencia de la enfermedad es uno de los factores importantes que afectan el resultado de costo-efectividad de los programas de chequeo.

By 2016, Member States of the World Health Organization (WHO) had developed and implemented national action plans on noncommunicable diseases in line with the Global action plan for the prevention and control of noncommunicable diseases (2013-2020). In 2018, we assessed the implementation status of the recommended best-buy noncommunicable diseases interventions in seven Asian countries: Bhutan, Cambodia, Indonesia, Philippines, Sri Lanka, Thailand and Viet Nam. We gathered data from a range of published reports and directly from health ministries. We included interventions that addressed the use of tobacco and alcohol, inadequate physical activity and high salt intake, as well as health-systems responses, and we identified gaps and proposed solutions. In 2018, progress was uneven across countries. Implementation gaps were largely due to inadequate funding; limited institutional capacity (despite designated noncommunicable diseases units); inadequate action across different sectors within and outside the health system; and a lack of standardized monitoring and evaluation mechanisms to inform policies. To address implementation gaps, governments need to invest more in effective interventions such as the WHO-recommended best-buy interventions, improve action across different sectors, and enhance capacity in monitoring and evaluation and in research. Learning from the Framework Convention on Tobacco Control, the WHO and international partners should develop a standardized, comprehensive monitoring tool on alcohol, salt and unhealthy food consumption, physical activity and health-systems response.

Maize-legume intercropping is a sustainable strategy to improve maize production for smallholder farmers. Maize is a staple food crop in Bhutan and integration of legumes with maize has been considered as an alternative option towards enhancing maize production in the country. Here, we conducted two studies in eastern Bhutan: first study (2021) to identify suitable legumes for intercropping with maize and second study (2022) to evaluate the effects of different maize-soybean intercropping patterns on grain yield, land use efficiency, and economic benefits. The maize-soybean intercropping system showed better productivity and economic viability than the kidney bean and groundnut systems in both the sites. Row intercropping and strip intercropping with 2 rows of maize alternating with 2 rows of soybean (2 M:2S) spaced 0.3 × 0.3 m showed stable and consistently higher grain yield at Lingmethang and Wengkhar (LING = 6.05 t ha−1; WENG = 8.37 t ha−1). The land equivalent ratio (LING = 1.78; WENG = 1.73) and net return (0.16 million Nu. ha−1 for LING and 0.21 million Nu. ha−1 for WENG) were notably higher for these intercropping methods. Our results suggest that the integration of legumes between conventional maize planting density, row intercropping and strip intercropping (2 M:2S) spaced at 0.3 × 0.3 m would be beneficial for achieving higher productivity for smallholder farmers in eastern Bhutan.

Bovine tuberculosis (bTB) is a chronic zoonotic disease affecting cattle of all age groups including wild animals. It poses a significant threat to public health and high economic losses to dairy farmers. While the disease has been eradicated from most of the developed countries through extensive surveillance, testing and culling strategy, it is endemic in Africa, Asia, and the Middle East countries. Currently, there is limited research regarding the prevalence of bTB in cattle in Bhutan. This study aimed to determine the seroprevalence of bTB in cattle in six districts of eastern Bhutan. A two-stage probability proportional to size (PPS) sampling strategy was used to determine the number of animals from which serum samples needed to be collected in each district and sub-district. All farms and cattle for sampling were randomly selected from the data in the annual livestock census of 2020. The samples were tested using bTB ELISA test kit. The seroprevalence and their 95% confidence intervals were calculated. Logistic regression models were constructed to assess the influence of various individual animal and environmental risk factors (breed, age, sex, source of animal, body condition scores of animals, respiratory system status) associated with sero-positivity in animals. The study revealed an apparent seroprevalence of 2.57% (25/971 cattle; 95% CI:1.58–3.57), with an estimated true seroprevalence of 0.91% (95% CI: 0.0–2.81). However, none of the variables were found to be significantly associated with bTB seroprevalence in cattle. We recommend, further sampling and employment of confirmatory testing to fully ascertain the extent of bTB in the cattle herds in eastern Bhutan for prevention and control.

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.