NCDs a growing problem in Bhutan says 2015 National Health report

Ministry of Health’s Annual Health Bulletin 2015 states that the emerging habits of smoking, drinking alcohol, physical inactivity as well as salty diet and poor nutrition are the major causes of the increasing Non-Communicable Diseases (NCDs). The most prevalent NCDs in Bhutan, among others, are diabetes, cancers, chronic obstructive pulmonary diseases and cardiovascular diseases.

In 2013, liver diseases consumed 129 lives and recorded highest deaths in NCDs category. Cancer took 99 lives. Diabetes comes the third at 30, followed by hypertension (20), ischemic heart disease (9), mental disorders (1) and transport and work related injuries (26).

Diabetes mellitus has been increasing from 2,606 cases in 2009 to 5,890 cases in 2013. Mortality due to diabetes has also been steadily increasing and the rate of self-reported prevalence of diabetes among population aged 15-75 is 1.4% at present.

Obesity is a risk factor for many life-threatening diseases including diabetes, heart diseases, osteoarthritis, breast and colon cancer, ulcers and gallstones. Report finds out that in 2014, 27% of men and 40% of women were either overweight or obese.

Bhutan 2011 Physical Activity Guideline recommends children and adolescent between five to 18 years to engage in physical activity of a minimum of 60 minutes a day. For adults between 19 to 64, 30 minutes of moderate intensity five days a week is suggested. For older adults above 65 to 30 minutes a day.

A survey 2014 also found out that 48.8% of the total respondents did not engage in vigorous activity.

Lack of nutrition is also one of the causes of the NCDs. In 2010, one in eight children under five were moderately underweight, 3.2% were severely underweight and 33.6% of children were moderately or severely stunted. In addition, prevalence of anemia as high at 16.1% in men, 40.7% in women and 69.7% in children as a consequence of poor nutrition. Only 30.1% of Bhutanese population ate recommended intake of fruits and vegetables per day in 2014. The Ministry recommends adults to take at least five portions of fruits and vegetables.

The transport and work related injuries top the cause of specific disease burden in the country. According to the report, an increase in number of transport and work related cases rose to 29,303 in 2013 up from 12,861 in 2009. The number of injuries related to vehicles almost doubled from 247 in 2005 to 426 in 2014.

Regarding people with disabilities, the prevalence of self-reported hearing impairment was the highest of all impairments in 2014 with 2,789 cases, while the physical impairment was the lowest. By dzongkhag, Haa and Samtse had the highest (29%) report of hearing impairments and Pemagatshel reported the lowest (9%).

Communicable diseases in relation to water borne, sanitation, and hygiene driven were mostly common cold, skin infection, diarrhea, conjunctivitis, respiratory and nose disease.

Tuberculosis prevalence and incidence is estimated at 196 and 169 per 100,000 populations respectively in 2014. However, emergence of Multi-Drug Resistance TB (MDRTB) remains to be of a serious concern. The MDRTB is estimated at 5 percent among new cases and 35 percent among treatment cases.

In 2014, an outbreak of Scrub Typhus cases was reported in Southern Bhutan. Leptospirosis cases were reported from Samdrup Jongkhar, Mongar and Jigme Dorji Wangchuk National Referral Hospital. An outbreak of H1N1 was also reported in Punakha. Two suspected cases of Japanese encephalitis were also reported from Punakha and Trongsa dzongkhags.

Ministry states that many of the millennium development goals were fulfilled. However, the malaria cases declined from 474 in 2009 to 15 last year. No deaths were reported since 2013. Ministry is positive that Bhutan can achieve elimination of malaria by 2018.

Ministry also plans to achieve 100% birth attendance by 2015 through deployment of health workforce. As of now, childbirths attended by skilled personnel reached 74.6% from 23.6% in 2000. Bhutan health system has successfully maintained the immunization coverage above 90% since 2010.

At present life expectancy at birth in Bhutan is at 68 years, which was dramatically improved from 36.1 years in 1950s. The Ministry highlights that country’s health system is still facing challenges due to emerging and re-emerging of communicable diseases and NCDs. The shortage of heath workforce and escalation of health expenditures were also mentioned among others.

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