Background Dog bites are the main source of rabies infection and death in humans, contributing up to 99% of all cases. We conducted a contact-tracing study to evaluate the health seeking and treatment compliance behaviors of people following potential exposure to rabies in rabies endemic south Bhutan. Methods Using information from the rabies post exposure prophylaxis (PEP) register, animal-exposed victims who had visited five hospitals in south Bhutan between January and March 2017 were traced and further data were collected from them using a structured questionnaire. A snowballing technique was used to identify victims who did not seek PEP.The survey was conducted between April and June 2017. Logistic regression was performed to assess factors associated with PEP-seeking and compliance behavior by the victims. Results Amongst 630 who reported to hospitals, 70% (444) of people could be traced and additional 8% (39) who did not seek PEP was identified through contact tracing. Therefore, a total of 483 people were interviewed. Seventy one percent (344/483) of exposure were due to animal bites of which 80% (365/455) were considered to be provoked incidents. Common reasons for not seeking health care included assumptions that risks of infection were minor if bitten by an owned or vaccinated dog. The victims who are male (OR: 0.36; 95% CI: 0.16–0.77) and educated (OR: 0.41; 95% CI: 0.17–0.96) were less likely to seek PEP, while those that experienced unprovoked bite (OR: 5.10; 95% CI: 1.20–21.77) were more likely to seek PEP in the hospitals. Overall, 82% of the victims sought PEP from the hospitals within 24 h after exposure. Eighty three percent completed the PEP course prescribed by the physician. The respondents living in urban areas (OR: 2.67; 95% CI: 1.34–5.30) were more likely to complete the prescribed PEP course than rural dwellers. Conclusions There is high risk of rabies infection in southern Bhutan. It is critical to bridge knowledge gaps and dispel existing myths which will help to improve PEP seeking and compliance behavior of people exposed to rabies infection from animals. A risk-based advocacy program is necessary to prevent dog-mediated human rabies deaths. Electronic supplementary material The online version of this article (10.1186/s12889-019-6559-x) contains supplementary material, which is available to authorized users.

1. Globally, the conversion of natural forest into agricultural land and human settlement has altered avian diversity and structure often leading to functional and/or phylogenetic homogenisation. While the effects of land-use change on avian functional diversity (FD) and phylogenetic diversity (PD) is well studied in the tropics, it is poorly understood and scarcely studied in the Himalayas let alone in eastern Himalayan bird communities. 2. Using data from replicated transect surveys, we investigated the effects of landuse change (agriculture, settlement and forest) on the community diversity and structure of 336 bird species while accounting for imperfect detection across 679-point count locations along an elevational gradient in the eastern Himalayan biodiversity hotspot of Bhutan. 3. The main findings of our study are (a) bird community occupancy along the elevational gradient is negatively associated with human land use (agriculture and settlement), (b) bird assemblages at higher elevations were functionally and phylogenetically clustered and (c) agriculture and settlement harboured disproportionately higher FD and PD whereas forest had phylogenetically diverse communities within functionally convergent traits. 4. Synthesis and applications. Our findings suggest that high functional diversity in agriculture and settlement offers an opportunity for a broad range of ecosystem services such as pollination, insect-and rodent-pest control. Agricultural practices that protect and improve bird-friendly habitats (particularly for insectivores) should be promoted. To facilitate coexistence, educational programmes on the importance of the functional roles of birds should be implemented to raise farmers' awareness of the importance of farmland biodiversity. Management interventions should seek to integrate bird conservation and farm production.Safeguarding edge habitats and forests abutting human settlements would be key to promoting phylogenetically diverse assemblages and ecological functions in Himalayan working landscapes.

Introduction: The burden of haematological malignancies in developing countries is on the rise. This burden may be further aggravated in Bhutan due to the aging population and rapid modernization of the nation. Despite this, there is a paucity of information about the incidence and pattern of leukemia in the Bhutanese population. In this retrospective study, we aim to investigate the incidence and pattern of leukemia in Bhutan using a database of leukemia diagnosed at Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan from January 2008 to December 2015. Methods: The diagnoses and classification of leukemias were based on the morphology of blood cells on peripheral blood and bone marrow smears. The data was analyzed with descriptive statistics. The age-standardized incidence rate per 100,000 populations and its 95% confidence interval was calculated to assess the statistical significance. Results: In total 118 patients were diagnosed with leukemia over the period of eight years. Leukemia was found to be more frequent in male (51.69%) compared to female (48.30%) with a male to female ratio of 1.1:1. Acute leukemia accounted for 66.95% of all leukemia case diagnosed, whereas chronic leukemia accounted for only 33.05% of the cases. The average, annual, age-standardized incidence rate of leukemia per 100,000 population was 2.30 (95% CI: 1.87-2.73). Conclusions: The incidence and pattern of leukemia in the Bhutanese population is similar to other published literature. Leukemia is not uncommon in the Bhutanese population, thus additional studies on risk factors for leukemia in the Bhutanese population is necessary.