Village health workers (VHWs) are the first contact extending vital health services to unreached and underserved communities in Bhutan. VHWs truly embody the principles of primary health care and are effective catalysts in promoting community health. This study identifies and confirms factors motivating VHWs to remain in the health care system. This is a quantitative study with a cross-sectional survey design. Two-stage cluster sampling was used with VHWs from 12 districts representing 3 regions of Bhutan. Data were collected using pretested semistructured questionnaires. Confirmatory factor analysis was used for data analysis. Findings reveal a 4-factor model of motivations among VHWs that includes social, personal, job related, and organizational factors. Among these, the social factor most significantly motivates VHWs to remain in the health care system. VHW motivation can be further fostered by providing a holistic combination of financial and nonfinancial incentives that recognize intrinsic needs and empower innate altruism.
Introduction: The World Health Organization (WHO) has estimated around 1.4 million deaths and 10% of the disease burden in children under 5 years of age is due to non-exclusive breastfeeding in the first 6 months of life. As per the WHO, exclusive breastfeeding is considered the best nourishment for children in first six months. However, majority of the mothers fail to practice exclusive breastfeeding due to inadequate or lack of knowledge which poses a challenge. Thus, this study intends to assess knowledge, attitude and practices among breastfeeding mothers in Trongsa. Methods: A cross-sectional study was used. Data was collected from 205 breast feeding mothers in Trongsa District using the pre-tested structured questionnaire. Results: Majority (98%) of the mothers had an adequate knowledge on exclusive breastfeeding starting from early initiation, the feeding of colostrum and providing complementary feeding. Health staff and the national television were the main source of information for the mothers on exclusive breastfeeding. However, in terms of practice, 20% of them did not exclusively breastfeed and had given additional feeds along with breast milk with the assumption of insufficient mother’s milk. Similarly, 13.2% of them had squeezed and thrown away the colostrum. Conclusions: Despite mothers having good knowledge on exclusive breastfeeding, it was not practiced and followed. This study’s findings indicate a gap between the knowledge and the actual practice of exclusive breastfeeding among breastfeeding mothers in Trongsa.
Introduction. The detailed risk assessment of the diagnosed HIV cases in Bhutan is an opportunity to carry out the risk analysis to generate evidence of wherein, under what context, and in which population groups most new infections are occurring. The evidence collected will help to test the current assumption of Bhutan experiencing diffused and generalized HIV epidemic. Methods. This is a cross-sectional study using a quantitative method to assess the risk behavior of the diagnosed HIV cases from 1993 to 2019. The study also included secondary data analysis of those cases already captured by the routine case-based surveillance from 2020 to 2021. The data collection was done from 1 to 30 January 2022 in all the twenty districts of Bhutan. Descriptive statistical analysis was used to analyze the characteristics of the study population, and relationships were established using the Chi-square Test. We have sought ethics approval and obtained participants’ informed consent. Results. The risk attribution analysis showed that 81.94% of HIV infection among the reported HIV cases in Bhutan has occurred through high-risk heterosexuals and 8.88% through mother-to-child transmission, and parenteral transmission accounts for 1.58% and then 1.35% through homosexual. Of the 81.94% high-risk heterosexuals, 41.08% acquired through sex workers and clients of sex workers, 27.99% from HIV-infected persons, 12.64% from sex work, and 0.23% from injecting drug use. Conclusions. This study has shed some light on a gradual epidemic shift from the current perceived diffused and generalized to the concentrated epidemic among subpopulation groups like female sex workers and their clients.
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