The Bhutanese Leading the way.
The Ministry of Health (MoH) from 14th November to 7th December 2024 conducted Non-Communicable Disease (NCD) screening in 20 dzongkhags covering 216,096 individuals.
The screening aimed to identify individuals at risk for conditions, such as heart disease, diabetes, and hypertension, facilitating early intervention and effective management. The NCD survey in 20 districts, focused on key health indicators, like raised blood pressure, elevated blood sugar, cardiovascular disease risk, overweight or obesity, and the number of individuals referred for further investigation.
Individuals with elevated blood pressure and blood sugar levels are not a final diagnosis. They are advised to visit the nearest health facility for a confirmatory diagnosis; however, their chances of a positive diagnosis are higher.
A total of 10.8% (23,340) of individuals have raised blood sugar, Punakha (21.7%), Gasa (21.3%), and Tsirang (19.2%) have the highest percentages of people with raised blood sugar relative to their total screenings.
This is alarming because the separate survey of National Health Survey (NHS) 2019 found diabetes in 1.9% which jumped to 5.8% in 2023. The above NCD screening data for 2024 though yet to be confirmed, and taking a fasting sugar blood level of 110 instead of 126, still shows that diabetes and pre-diabetes is on a major upward trend.
An alarmingly high 41.7% (90,115) of the NCD screened population is overweight or obese, highlighting a significant public health concern. Samtse (9,681) and Thimphu Thromde (6,931) reported the highest rates of overweight and obesity.
As per the NHS, there was a significant rise in the prevalence of overweight from 26.7 % in 2014 to 33.8% in 2019. However, a gradual decline in the prevalence of overweight was noted from 33.8% in 2019 to 33.3% in 2023.
Its rise in 2024 through the NCD screening shows that obesity is on the rise.
A total of 23.8% (51,399) of individuals in the NCD screening were found to have raised blood pressure, with the highest number of cases recorded in Samtse (6,481), Thimphu Thromde (3,120), and Punakha (3,043).
As per the NHS, prevalence of raised blood pressure among people decreased from 35.7% in 2014 to 28% in 2019. However, the prevalence of raised blood pressure slightly increased to 30.1% in 2023
Only 1% (2,067) of the screened population has a cardiovascular disease (CVD) risk greater than 20%, indicating that the percentage of individuals with a CVD risk above 20% remains relatively low.
A total of 16.4% (35,371) of the screened individuals were referred for further investigation, highlighting that a significant number of people require follow-up care for non-communicable diseases.
All individuals with raised blood pressure are advised to visit the nearest health facility for confirmation of their diagnosis one week after screening. Additionally, those with raised blood glucose levels are recommended to visit a hospital for confirmation of diabetes.
A MoH official said the screening shows that NCDs are going up in Bhutan. The official said that NCDs are often related, and if someone develops diabetes, they have a high chance of getting blood pressure and vice versa.
For both NCDs, the causes are similar with obesity, unhealthy diet and lack of exercise.
The official said that many Bhutanese assume they won’t get diabetes as they don’t have a sweet tooth or refrain from putting sugar in their tea, however, he said Bhutanese are increasingly susceptible to diabetes due to high rice consumption with the norm being three times in a day. Rice, and especially white, and even red rice have a high glycemic index spiking the sugar level in the blood.
What makes it worse is that most Bhutanese do not mix up their meals with a lot of salad and vegetables, and so they aim to get satiated by rice only.
Drinking alcohol, which contains high calories, can lead to weight gain. Regular heavy drinking also lowers the body sensitivity to insulin.
The high prevalence of drinking Suja and eating salty Bhutanese dishes also increases the risk for BP.
If Diabetes is not controlled then it can impact the eyes, kidneys and other organs.
BP patients who do not control their pressure can go on to develop stroke or heart attack which can result in sudden death.
“In Bhutan, there is a common saying that a person was fine just until yesterday, and today, he or she passed away. The culprit often is stroke,” said the official.
In order to prevent NCDs, the official said that people should exercise 30 minutes a day and avoid unhealthy diets and high salt or sugar products.
Once a person is diagnosed with diabetes or hypertension, all 20 districts have a dashboard into which these people are entered and they are followed up on a monthly basis to check for BP, sugar, etc., and after three months a general organ function test is done.
The official said that in response to the above findings and rising prevalence of NCDs and its burden, MoH is coming up with a ‘Multi Sectoral Action Plan on Prevention and Control of NCDs’ in 2025 which will run till 2030.
The 13th Five-Year-Plan has budgeted Nu 130 mn for this effort across agencies.
The action plan has four major strategic areas. One is advocacy, policies enforcement and strategic leadership and partnership. Second is health promotion and risk reduction. Third is health system strengthening, early detection and management, and the fourth is surveillance, monitoring and evaluation.
