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The purpose of the survey study was to examine the perception of Global Citizen by: (1) Rover, who had undergone 21 days of Scouts Leadership Training, (2) Rover, who has not undergone 21 days of Scouts Leadership Training, (3) Nazhoen Scouts who have undergone 21 days of Scouts Leadership Training, and (4) to examine whether the perceptions of Global Citizen are determined by the number of years in the Scouting. The questionnaires were administered using google form to (n=209) (Male=87, Female=122, (1) =90, (2) =74, (3) =45 (4) = (0-5 Years=48, 5-10 Years=91 ,10-15 Years=70).Reysen and Katzarska-Miller (2013) Global Citizen Scale questionnaire within the total Cronbach’s alpha reliability coefficient of (α=.92) and nine subscales viz Normative Environment(0.86), Global Awareness(0.74), Global Citizenship Identification(0.81), Intergroup Empathy(0.65), Valuing Diversity(0.79), Social Justice(0.81), Environmental Sustainability(0.79), Intergroup helping(0.80), and Responsibility to Act(0.83) were used to examine the perceptions of Global Citizen. The results of the survey study revealed that out of the nine subscales of the Global Citizen Scale of Reysen and Katzarska-Miller (2013), Normative Environment, Global awareness, Global Citizenship Identification, and Intergroup Empathy have been perceived as Somewhat Agree (5.00-5.99): Valuing Diversity, Social Justice, Environmental Sustainability, Intergroup Helping, and Responsibility to Act have been perceived as Agree (6.00-6.99). The overall perception on the Global Citizen is established at x ̅=6.09 and σ=0.90. The correlation and regression line between the number of years being in the Scouting indicated very strong and positive associations between the variables.

The endangered Bengal tiger (Panthera tigris tigris) is a keystone species playing an essential role in ecology as well as in the social and spiritual lives of the Himalayan people. The latest estimate of the Bengal tiger population in Bhutan accounts for 103 individuals. Infectious organisms, including zoonotic parasites causing high burden in human health, have received little attention as a cause of mortality in tigers. Taeniosis/cysticercosis, caused by the cestode Taenia solium, is considered one of the major neglected tropical diseases in Southeast Asia. We present here a case of neurocysticercosis in a Bengal tiger showing advanced neurological disease outside Thimphu, the capital city of Bhutan. After palliative care, the animal died, and necropsy revealed multiple small cysts in the brain. Here we show the presence of two genetic variants of T. solium in the parasite material collected based on PCR and sequencing of the complete cox1 and cytB genes. The sequences form a discrete branch within the Asia plus Madagascar cluster of the parasite. On other hand, tests for feline morbillivirus, feline calicivirus, canine distemper virus, Nipah, rabies, Japanese encephalitis, feline leukaemia and feline immunodeficiency virus were negative. In contrast, PCR for feline herpesvirus was positive and a latex agglutination test revealed an elevated antibody titer against Toxoplasma gondii (titer 1:256). The molecular examination of taeniid eggs isolated from the tiger faeces produced sequences for which the highest homology in GenBank is between 92% and 94% with T. regis and T. hydatigena. This fatal case of T. solium neurocysticercosis, a disease previously unrecorded in tigers or other non-domestic felids, demonstrates an anthropogenically driven transmission of a deadly pathogen which could become a serious threat to the tiger population., Graphical abstract Image 1, Highlights • This is the first report of a fatal infection with Taenia solium in a Bengal tiger. • There is a need for research into infectious disease threats to tigers in Bhutan. • The importance of a ‘One Health’ approach is demonstrated and recommended. • Non-domestic felids.

The burden of overweight and obesity in children and adolescents has increased, especially in developing countries, posing a significant health challenge. Data on factors influencing overweight amo...

This study examined the bio-demographic, socioeconomic, environmental, and health-related determinants of infant mortality in the Kingdom of Bhutan. The nationally representative dataset of the 2012 National Health Survey (NHS), Ministry of Health of Bhutan, was used. Cox proportional hazards regression from survival analysis, accounting for the complex study design of the NHS, was performed using a stepwise approach to identify the determinants associated with infant mortality. The weighted infant mortality rate from November 2009 to October 2011 was 34 per 1,000 live births. Children born to uneducated mothers (aHR=2.27; 95%CI=1.16-4.47) and mothers who experienced domestic violence during pregnancy (aHR=4.24; 95%CI=1.45-12.41) were more likely to die before reaching their first birthday. Those infants born in households that used solid fuel were 2.16 times (95%CI=1.21-3.85) more likely to die than their counterparts. Relative to those born in the central region, children born in western (aHR=6.13; 95%CI=2.84-13.20) and the eastern (aHR=5.13; 95%CI=2.81-9.35) regions had a greater risk of dying. The results showed that education, domestic violence experience, solid fuel use, and region of residence are the key determinants of infant mortality in Bhutan. Policies that facilitate education and empowerment of women, prevent domestic violence, reduce solid fuel use, and equitable regional socioeconomic development policies may help accelerate the reduction of child mortality.

Purpose This paper aims to outline the history of libraries in Bhutan, to describe the current state of library development and to recommend priority areas for library enhancement. Design/methodology/approach The authors have worked extensively as library professionals in Bhutan and share factual details derived from their personal experience. They review the published literature, particularly the fieldwork of two scholars who studied Bhutan’s libraries and library workers. The authors use their own experience to interpret those findings and make suggestions for future development. Findings The paper briefly traces the evolution of print culture and the history of libraries, exploring monastic, school, college, public and national libraries. The paper examines government policies regarding education and libraries and discusses the acknowledgment of the value of libraries and the lack of actual support. Originality/value There is limited study of the history of reading culture or libraries in Bhutan. The authors document their first-hand experiences and efforts to implement systems for library resource sharing and professional development. The authors hope that this record will serve to illuminate past effort, to describe the unique information environment in Bhutan and to guide future decision-making. The authors recommend many future avenues for study, including reading habits, information-seeking behavior and attitudes toward libraries and librarians.

Red panda Ailurus fulgens is a threatened mammalian species endemic to the eastern Himalayas. In Bhutan, the red panda is distributed across the country’s temperate forests, covering 19 of the 20 districts within an elevation range of 1500–4300 m, with potential habitat of 10,971.2 km2, which is 28.57% of the total country area. The country’s Forests and Nature Conservation Act 1995 strictly protects the species by listing the red panda under Schedule I and cultural values build reverence and protection to the species by local communities. Yet, conservation actions and research are limited and anthropogenic threats are on the rise which makes the red panda vulnerable in its natural habitat. Mitigating the threats, enhancing awareness education and building scientific knowledge on the red panda through research will help strengthen the conservation of the red panda in Bhutan.

The necessity of rangers and other frontline staff for ensuring the protection and effective management of protected areas is well documented. The Spatial Monitoring and Reporting Tool (SMART) was developed as a law enforcement monitoring tool with the aim of assisting management in the allocation of resources and strategic deployment of ranger patrols. The ability of SMART to contribute to improved protection depends heavily on effective application through an adaptive management framework. Royal Manas National Park (RMNP), Bhutan, presents an opportunity to review the use of a protected area law enforcement monitoring tool for improving the detection and reduction of illegal activities within a protected area through effective ranger patrols. Results from the analysis of 5 years of monitoring data collected by rangers indicates a marked improvement in patrol effort in RMNP and suggests that the effective deployment of law enforcement monitoring tools, when used as part of an adaptive management framework, can improve the detectability of poaching related threats, potentially resulting in an overall reduction of poaching threats through enabling the informed and targeted allocation of staff and resources.

Background In 2017, measles elimination was verified in Bhutan, and the country appears to have sufficiently high vaccination coverage to achieve rubella elimination. However, a measles and rubella serosurvey was conducted to find if any hidden immunity gaps existed that could threaten Bhutan’s elimination status. Methods A nationwide, three-stage, cluster seroprevalence survey was conducted among individuals aged 1–4, 5–17, and >20 years in 2017. Demographic information and children’s vaccination history were collected, and a blood specimen was drawn. Serum was tested for measles and rubella immunoglobulin G (IgG). Frequencies, weighted proportions, and prevalence ratios for measles and rubella seropositivity were calculated by demographic and vaccination history, taking into account the study design. Results Of the 1325 individuals tested, 1045 (81%, 95% CI 78%–85%) were measles IgG seropositive, and 1290 (97%, 95% CI 95%–99%) were rubella IgG seropositive. Rubella IgG seropositivity was high in all three age strata, but only 47% of those aged 5–17 years were measles IgG seropositive. Additionally, only 41% of those aged 5–17 years who had documented receipt of two doses of measles– or measles-rubella–containing vaccine were seropositive for measles IgG, but almost all these children were rubella IgG seropositive. Conclusions An unexpected measles immunity gap was identified among children 5–17 years of age. It is unclear why this immunity gap exists; however, it could have led to a large outbreak and threatened sustaining of measles elimination in Bhutan. Based on this finding, a mass vaccination campaign was conducted to close the immunity gap.

Introduction: The rapid socio-economic development in Bhutan has brought changes in individual lifestyles resulting in increased risk behavior of the urban population, particularly the Drayang girls. This study investigated the underlying factors influencing the sexual risk behaviour of Drayang girls and their vulnerability to HIV and Sexually Transmitted Infection (STI). The Drayangs are dance bars in Bhutan where the women perform Bhutanese songs/dances on the stage to entertain the bar patrons and making them pay for their performance. Methods: This is a cross-sectional descriptive study conducted from May-July 2015 in three urban districts (Thimphu, Paro, and Phuentsholing) of Bhutan. The convenient non-random sampling method was used to recruit the respondents. We have collected the data using structured questionnaires including the taking of blood samples for HIV, Hepatitis B, and Syphilis testing. Results: Of the 245 Drayang girls recruited for this study, 28.2% have engaged in transactional sex and 71.8% in non-transactional sex within last month. Condom use during transactional sex was 36.2% and non-transactional sex was 21.6%. The prevalence of HIV was 0.82%, hepatitis B 6.9%, and syphilis 2.8%. The factors such as marital status (divorced and unmarried), living arrangements, current living cities, and alcohol consumption were significantly (p

Bhutan aims to achieve 100% institutional delivery coverage. While evidence indicates improved institutional delivery coverage over the years, coverage in some of the districts is only 49%. This study was aimed at exploring barriers to institutional delivery in three low-coverage districts. In-depth qualitative interviews and six focus group discussions were conducted in December 2015. The analysis was done as per the Braun and Clarke’s 6-phase guide to doing thematic analysis. This study sheds light on 15 barriers for institutional deliveries, which include hesitancy to seek health care when the pregnancy is out of wedlock, the restriction of alcohol consumption at health centers, fear of hypothermia in cold places, pastoralism, health care providers shortage, lack of maternity waiting home and food, distance, difficult terrain, lack of transportation services, and financial constraints. Some of these barriers could be unique to Bhutan. The coverage could be improved considerably if the recommendations in this article are implemented.

Supplemental material, InstitutionalDeliveyQualitativeStudy_IDIandFGDguides_V02 for Barriers to Institutional Delivery Services in Districts With the Lowest Institutional Delivery Coverage in Bhutan by Mongal Singh Gurung, Sonam Wangdi, Pema Lethro, Tashi Tshomo, Tashi Dema and Dorji Pelzom in Asia Pacific Journal of Public Health

Threat assessment is critical to species conservation and management planning, because prior identification and assessment of key threats to conservation planning can assist in developing appropriate interventions or strategies. Comprehensive threat assessments are currently lacking for many threatened primates. In this paper, we classify and rank all direct threats to the endangered golden langur (Trachypithecus geei) in Bhutan in order to provide a practical guide to future conservation of the species. Information on threats was based on interviews with local people, discussion with field forestry staff, and social media interaction. We classified threats to golden langur habitats and populations, and ranked them using Miradi™, an analytical software for the adaptive management of conservation projects. We identified five habitat threats: (1) hydropower development, (2) road development, (3) housing development, (4) resource extraction, and (5) agricultural expansion. We also identified seven population threats: (1) electrocution, (2) road kill, (3) road injury, (4) dog kill, (5) retaliatory killing, (6) illegal pet keeping, and (7) hybridization with capped langurs. We rated the overall threat to golden langurs in Bhutan as ‘medium’. Hydropower, road, and housing development constituted ‘high’ impact, while agricultural expansion, resource extraction, electrocution, and road kill had ‘medium’ impact; the remaining threats had ‘low’ impact. To immediately mitigate threats to golden langurs, we recommend: (a) installing speed limit signage and speed breakers with strict enforcement of speed limits; (b) installing insulated electric cables and fencing around power transformers; and (c) reducing and restraining domestic dog populations.

Human land-use and climate change drive biodiversity loss, precipitating the extinction crisis. The fragility of the Himalayas makes species in this landscape vulnerable to land-use and climate change. We aim to quantify the response of terrestrial mammal community to land-use and climate scenarios in the Bhutan Himalaya. Using large-scale camera-trap dataset, we examine the effects of anthropic land-use and climate variables on the terrestrial mammal assemblage using Bayesian multi-species occupancy model. Most of the terrestrial mammals in our sample displayed a strong negative relationship with anthropic land-use variables (agriculture, roads and settlement). Further, the occurrence of most species decreased with likely projections for climate variables, illustrating threats to conservation if the current trend in global warming continues. Notably, we found that biodiversity conservation in this landscape can be achieved by protecting extensive forest cover. Our findings emphasize the importance of reconciling land-use management and mammal conservation in the face of climate change and provide vital information which can be used to optimize future conservation and development plans.

The Kangchenjunga Landscape, an important repository of biodiversity, faces several challenges owing to various drivers of change. Human‒wildlife conflict (HWC) is one of such issue that transcends social, economic, environmental, as well as national and international borders among the three participating countries – Bhutan, India, and Nepal – making it a complex, transboundary issue. Based on the existing literature, earth observation data, and geographic information system, we used maximum entropy along with relevant environmental predictor variables to model and map HWC hotspots. The results suggested that about 19 per cent of the area within the landscape is at high risk of human‒wildlife conflict, with an anthropogenic factor ‒ distance to roads ‒ as the top predictor. Some protected areas are at higher risk than others. The Himalayan subtropical pine forest ecoregion is a high HWC zone (~63 per cent), followed by the Terai‒Duars savannah and grasslands ecoregion (~43 per cent). They also revealed that the low- and mid-elevation zones are prone to conflict due to greater forest fragmentation; patchy protected areas are disconnected from each other, and not big enough for large mammals like elephants and tigers. Human-wildlife conflict is observed to vary across different elevation and climate region of the landscape and highly correlated with forest fragmentation of the midhills. Hence, a holistic approach at the landscape level is needed for tackling human‒wildlife conflict. Connecting good habitats by restoring fragmented inter and intra-country areas would be an effective measure to mitigate human‒wildlife conflict.

Introduction: The estimated global maternal deaths in 2013 was 289000. In Bhutan, Maternal Mortality Ratio hasremarkably declined from 770 deaths per 100,000 live births in 1984 to 86 in 2012. However, the maternal mortalityratio still remains high and a high proportion of delivery still take place at homes (26%) despite of adopting 100%institutional delivery policy ever since 2005. This study was carried out to determine the important factors that preventwomen from coming to the health facilities for safe delivery. Methods: A cross-sectional study among the women who delivered in Chukha District in 2013 was carried out after seeking ethical approval from Research Ethics Boardof Health and World Health Organization. Chukha is a district with the second highest number of population in Bhutanwhere 55.7% of the people live in rural villages. Results: Out of 899 eligible listed women, 78.1% participated in thestudy and among the participants 11.5% had delivered at home. The number of home deliveries was higher in ruralareas, 17.3%, as compared to urban places, 6.4%. Women who were delivering for third or more times are 2.42 timesmore likely to give birth at home compared to women who were delivering for the first time. Women residing at placesmore than three hours away from the health facility were 2.58 times more likely to give birth at home compared towomen residing less than three hours away. During their last pregnancy, 99.4% of the participants have sought at leastone ANC. Conclusions: This study suggests that the two most important factors associated with home delivery are thedistance to health facility from their residences and the parity. Keywords: Bhutan; Facility delivery; Home delivery; Place of delivery.

Management of tigers is a response to a global conservation crisis. Range contraction, population decline, habitat fragmentation, prey loss, and poaching cause and aggravate this crisis. There is a debate as to whether conserving source sites or maintaining landscape connectivity is the greater priority. Both approaches rely on understanding environmental and anthropogenic factors. We used a large dataset from a nation-wide camera trapping survey to investigate factors affecting habitat use of tigers across the montane landscape of Bhutan. We tested the effects of environmental and anthropogenic covariates on habitat use while accounting for imperfect detection using a hierarchical occupancy model. Tiger habitat use showed a strong positive association with closeness to protected area, greater distance from human settlement and availability of abundant large prey. Our findings can help to identify the drivers of tiger decline and contribute to the refinement of conservation strategies to combat that decline in this montane conservation landscape. We provide a general approach to tiger conservation by highlighting the importance of understanding the basic ecology of this apex predator, including the relationship between environmental and anthropogenic variables and habitat use. Bhutan, with unusually strong environmental legislation, and a high percentage of its area protected and under contiguous forest cover, set the global standard in large carnivore conservation and is an important component of a wider conservation complex in South Asia.

An estimated 2·6 million third trimester stillbirths occurred in 2015 (uncertainty range 2·4-3·0 million). The number of stillbirths has reduced more slowly than has maternal mortality or mortality in children younger than 5 years, which were explicitly targeted in the Millennium Development Goals. The Every Newborn Action Plan has the target of 12 or fewer stillbirths per 1000 births in every country by 2030. 94 mainly high-income countries and upper middle-income countries have already met this target, although with noticeable disparities. At least 56 countries, particularly in Africa and in areas aff ected by confl ict, will have to more than double present progress to reach this target. Most (98%) stillbirths are in low-income and middle-income countries. Improved care at birth is essential to prevent 1·3 million (uncertainty range 1·2-1·6 million) intrapartum stillbirths, end preventable maternal and neonatal deaths, and improve child development. Estimates for stillbirth causation are impeded by various classifi cation systems, but for 18 countries with reliable data, congenital abnormalities account for a median of only 7·4% of stillbirths. Many disorders associated with stillbirths are potentially modifi able and often coexist, such as maternal infections (population attributable fraction: malaria 8·0% and syphilis 7·7%), non-communicable diseases, nutrition and lifestyle factors (each about 10%), and maternal age older than 35 years (6·7%). Prolonged pregnancies contribute to 14·0% of stillbirths. Causal pathways for stillbirth frequently involve impaired placental function, either with fetal growth restriction or preterm labour, or both. Two-thirds of newborns have their births registered. However, less than 5% of neonatal deaths and even fewer stillbirths have death registration. Records and registrations of all births, stillbirths, neonatal, and maternal deaths in a health facility would substantially increase data availability. Improved data alone will not save lives but provide a way to target interventions to reach more than 7000 women every day worldwide who experience the reality of stillbirth.

Background Despite Bhutan's remarkable progress in the area of maternal and child health during the era of the Millennium Development Goals, a large proportion of pregnant women are still delivering at home with no skilled attendant. Limited empirical studies have been carried out to understand the factors associated with delivery at home in Bhutan. Methods This cross-sectional analytical study used secondary data collected in the nationally representative National Health Survey 2012. The survey included a total of 2213 women aged 15–49 years who had a live birth in the 2 years preceding the survey and were selected using multistage stratified cluster sampling. Weighted analysis was done to evaluate determinants for the place of delivery. Unadjusted and adjusted prevalence ratios with 95% confidence intervals (CIs) were calculated to assess the possible association of factors with home delivery. Results Out of 2213 women aged 15–49 years who had a live birth in the 2 years preceding the survey, 73.7% had an institutional delivery. Coverage of institutional delivery ranged from 49.4% in Zhemgang district to 96.1% in Paro district. Women in the poorest wealth quintile were 7.35 times more likely to have a birth at home compared to women in the richest quintile (adjusted prevalence ratio [aPR]: 7.35, 95% CI: 2.59–20.9). The older mothers aged 30–49 years were 0.79 times (aPR: 0.79, 95% CI: 0.70–0.88) less likely to have a home delivery than mothers aged 15–19 years. Women who had fewer than four antenatal care visits were 1.50 times (aPR: 1.50, 95% CI: 1.35–1.66) more likely to give birth at home compared to those who had four or more visits. The mothers giving birth for a third or more time were 1.88 times (aPR: 1.88, 95% CI: 1.60–2.22) more likely to give birth at home compared to those giving birth for the first time. Women living in rural areas were 2.87 times (aPR: 2.87, 95% CI: 1.42–5.77) more likely to deliver at home compared to those living in urban areas and women living in the eastern region of the country were 1.35 times (aPR: 1.35, 95% CI: 1.17–1.55) more likely to have a home delivery compared to those living in the western region. Conclusion Lower socioeconomic status, rural location, eastern location, non- first birth, and having fewer than four antenatal visits were significant factors associated with home delivery. These findings should inform further research and policy to build on Bhutan's progress in promoting institutional delivery as the key strategy towards improving maternal and child health and achieving the relevant targets of Sustainable Development Goal 3.