Prevalence and risk factors of pulmonary tuberculosis among people living with diabetes mellitus at the National Referral Hospital, Thimphu, Bhutan

Abstract

Introduction: Diabetes mellitus (DM) is increasing the risk of pulmonary tuberculosis (PTB) with concern over the convergence of these two diseases. Although screening for PTB among people with DM has been recommended by WHO, it has not been implemented in Bhutan yet. Objective: The aim of this study was to determine the prevalence and risk factors of PTB among people living with DM at the National Referral Hospital (NRH), Thimphu, Bhutan. Methods: This was a cross-sectional study conducted from 1st June – 9th October 2018. All 343 consenting DM patients were screened for PTB using the WHO recommended questionnaire and those with TB positive symptoms were tested for active PTB using sputum smear microscopy and Gene-Xpert. A descriptive statistical analysis was performed using SPSS 21. Results: The prevalence of PTB among people living with DM was 0.87% (95% CI: 0.20-2.50).The mean age was 54.95 (± 13.2 years) and all were DM type II. The median duration of diabetes was 4 years (range of 0.1-40 years), an average level of HbA1c 7.47 (± 2.6), and median duration on DM medication was 4 years (range of 0.1-40 years) with the majority (88.9%) on oral hypoglycemic drugs. Good glycemic control (HbA1c< 7) was achieved by 39.4% of individuals. PTB risk factors included PTB positive symptoms (7.0%), prior PTB history (5.5%) and recent contact with PTB patient (5.0%). Additional known PTB risk factors were smoking (7.6%), alcohol use (4.1%) and low body mass index (1.5%). Conclusions: Although the prevalence PTB was low, health education, proper case management and risk based screening for PTB among DM is recommended.

The future of yak farming and herding culture in Bhutan: A case of the Brokpa herders of Merak and Sakteng

“…SWS (2019) land use analysis indicates that Merak has about 3748.603 hectares of rangeland and Sakteng has about 4747.367 hectares; this land is allotted to the communities on lease in accordance with the Land Act of Bhutan 2007 (National Land Commission, 2007). However, because of climate variability, unpalatable plant species have encroached on the rangelands, and some portions of rangeland have been destroyed because of road construction and extension since 2015 (SWS, 2019; Wangchuk, 2013; Wangchuk, Dhammasaccakarn, and Tepsing, 2013). Additionally, the rangelands are continuously being degraded because of overgrazing and poor management practices (SWS, 2019).…”

“…The Brokpa (Wylie transliteration: ‘Brog pa) of Merak and Sakteng of eastern Bhutan are seminomadic. In Brokpa families, herders called Nag rdze (Wylie transliteration)—pronounced as na ze —in Brokpa dialect practice a traditional seasonal migratory cycle, while nonherder family members remain in permanent settlements elsewhere (Wangchuk, 2013; Wangchuk, Dhammasaccakarn, and Tepsing, 2013; Wangchuk et al, “The Yaks,” 2013). Generally, the number of herders depends on the herd size; however, a typical Brokpa family will have at least one male herder with culturally embedded experiences in managing the herds in the region's rugged terrains and harsh climatic conditions.…”

“…Another distinctive cultural aspect of the Brokpa is their costumes, which are woven predominantly from yak hair (Wangchuk, Dhammasaccakarn, and Tepsing, 2013). According to Wangchuk (2013), the tribes of Tawang, in the Indian state of Arunachal Pradesh, wear similar costumes. Over the years, the Brokpa were observed wearing imported clothes; however, they wear traditional costumes during ceremonies and when visiting government offices (Wangchuk, 2013; Wangchuk, Dhammasaccakarn, and Tepsing et al, 2013).…”

“…According to Wangchuk (2013), the tribes of Tawang, in the Indian state of Arunachal Pradesh, wear similar costumes. Over the years, the Brokpa were observed wearing imported clothes; however, they wear traditional costumes during ceremonies and when visiting government offices (Wangchuk, 2013; Wangchuk, Dhammasaccakarn, and Tepsing et al, 2013). Such a behavioral shift, particularly among the younger generations, who are less inclined to wear traditional yak‐hair clothing, is an indication of increasing rejection of yak farming and its associated cultural practices (Wangchuk, 2013).…”

“…Due in part to the ecological factors that diminish the socioeconomic viability of yak farming, countries centered on this economic activity have seen declines in the number of youths wishing to engage in it as well as in traditional herding culture (Dorji et al, 2020; Joshi et al, 2020; Wangchuk and Wangdi, 2015; Wangdi, 2016). If younger generations discontinue yak farming, the associated cultural practices, which principally informs the Brokpa's distinctive identity, would disappear along with it (Wangchuk, 2013; Wangchuk, Dhammasaccakarn, and Tepsing, 2013; Wangchuk, Dhammasaccakarn, Tepsing, and Sakolnakarn, 2013). In the Brokpa communities of Merak and Sakteng, yaks are not just a source of livelihood but are fundamental to the centuries of cultural history that contribute to their shared sense of identity.…”