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Background Zoonotic diseases pose an increasing threat to human, animal and environmental health, and identifying the zoonoses of greatest public health concern is key to address them effectively. Despite high ongoing risks from zoonotic diseases, Bhutan has never conducted a zoonotic disease prioritization exercise. Therefore, the present study aimed to prioritize the top 10 zoonotic diseases in Bhutan and develop action plans to support targeted resource allocation, coordinated surveillance, and strategic planning through the One Health framework. Methods The current study used a literature review of peer-reviewed publications and grey literature, expert knowledge, followed by a workshop to prioritize zoonoses in Bhutan. The workshop was convened in April 2024, and 42 participants from 20 different organizations from human, animal, wildlife, environmental, and food safety sectors participated in the workshop. Zoonotic disease prioritization was conducted using a mixed-method approach that combined an expert consensus approach with the U.S. Centers for Disease Control and Prevention One Health Zoonotic Disease Prioritization (OHZDP) tool. Results The initial literature review listed 55 zoonotic diseases for prioritization in the country. The workshop prioritized the top 10 zoonotic diseases viz., Rabies; Influenza A H5N1; Leptospirosis; Brucellosis; Escherichia coli infections; Dengue; Scrub Typhus; Bovine tuberculosis; Anthrax; and Salmonellosis. Joint action areas for the top five zoonotic diseases were developed to effectively address each disease through the One Health approach in the country. Conclusion The prioritized zoonoses in Bhutan should be used for strengthening One Health coordination. Key recommendations from the OHZDP workshop emphasized strengthening disease surveillance, building laboratory diagnostic capacity, enhancing intersectoral collaboration, and developing a harmonized, interoperable system for information sharing and reporting. These measures aim to improve real-time data exchange, facilitate joint outbreak investigations, and support evidence-based decision-making for the prevention and control of zoonotic diseases.

Mountainous regions are affected the most by climate change across the world. The livelihood of highlanders primarily depends on livestock farming and natural resources. In Bhutan, yak farming and sale of Cordyceps sinensis (caterpillar fungus)remain the main source of income for most highlanders. We conducted a study to understand the impact of climate change on the community livelihoods in Bhutan. A cross-sectional survey was conducted and interviewed 132 household heads, two focus group discussions of 20 respondents (10 in each group), and key informant interviews (n = 5) in two highland communities (i.e., Laya and Lunana) of Gasa district in northern Bhutan between August 2019 and February 2020. The study revealed that the caterpillar fungus (78.8%) is the major source of income for highland communities which overtook the yak farming practices since its legalization in 2004. More than 80% of households have abandoned yak farming due to its poor economic return because of the decreased utility of yak for meat purposes and other socio-cultural related practices. The majority of the respondents (91%) expressed concern that climate change is posing a threat to the growth and subsequent harvest of caterpillar fungus. The highland people reported emergence of insects/vectors in their community and mosquitoes were the most frequently reported (85%) insect. A small proportion of respondents (1.5%) were concerned about the grazing habitat of the yaks due to the change in the botanical composition of the rangeland. Given that there is a decrease in caterpillar fungus, which is the main source of income for highland communities, this study calls for a climate-resilient community-based economic opportunity for the sustainable livelihood of highland communities. Furthermore, we recommend a detailed study of the negative impacts due to climate change on freshwater resources, the distribution of vectors and vector-borne diseases, and rangeland ecology in the highland.

Abstract Background The National Action Plan on Antimicrobial Resistance in Bhutan promotes the rational use of antibiotics. It is important to establish baseline data on the use of antibiotics and the quality indicators of antibiotic prescriptions to identify where improvement efforts may need to be focused. Objectives To describe the prevalence and patterns of antibiotic prescription and establish baseline data regarding quality indicators of antibiotic prescriptions in four major hospitals in Bhutan. Methods This was a point prevalence survey of antibiotic use among inpatients in June 2022 conducted using the Australian National Antibiotic Prescribing Survey (NAPS). Results There were 314 patients (41.5%) receiving at least one antibiotic on the audit day. Among prescriptions reviewed, 278 (88.5%) had indications for use documented, 102 (32.5%) had a review or stop date documented and 120 (38.2%) had microbiology samples collected prior to antibiotics. Ceftriaxone (68; 21.7%), cefazolin (41; 13.1%) and metronidazole (32; 10.2%), were the common antibiotics prescribed. The most common indications for use were surgical prophylaxis (42; 13.4%), community-acquired pneumonia (39; 12.4%) and sepsis (26; 8.3%). There were 125 prescriptions (39.8%) that were compliant with national/therapeutic antibiotic guidelines and 169 (53.8%) where antibiotic prescriptions were appropriate. Conclusions This study identified key areas for targeted interventions in antimicrobial stewardship programmes in Bhutan. The prevalence of antibiotic use, indications for use, and drug choices were similar to data from other countries. Documentation plans for durations of use, prolonged surgical prophylaxis and concordance of choices with guideline recommendations present opportunities for improvement.