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Mathematics is underscored as a compulsory subject in schools of Bhutan but it has little impact on students by constantly showing poor achievement in mathematics. This study seeks to explore the relationship between grade six students’ attitude towards mathematics and their achievement in mathematics. All the grade six students of Khoma Lower Secondary and Dungkhar Primary School were taken as samples for the study. A total of 50 students (26 female and 24 male) students were selected as samples following the convenience sampling technique. The study adopted a descriptive correlational survey design with pure quantitative techniques. The data were gathered using Attitude toward Mathematics Inventory (ATMI) developed by Tapia and Marsh (2004) [1]. These data were organized and analyzed using Statistical Package for the Social Sciences (22.0 version). The results revealed that there was no significant difference between female students’ attitude towards mathematics and male students’ attitude towards mathematics (t (138) =-1.154, p> 0.05)). However, it was also found that there was a very strong positive and significant relationship between the students who scored high in mathematics and their attitude towards mathematics (r = 0.634, p< 0.001) indicating that students with a higher level of attitude towards mathematics tend to have better achievement in mathematics. As a result, educators must analyse students' attitudes toward mathematics and provide necessary support in order to encourage the development of a positive attitude toward mathematics.

Leishmaniasis is a neglected tropical disease with an annual estimated 700,000 to 1 million new cases globally. The diseases affect the rural community and people living in poverty. It is transmitted by female phlebotomine sand-fly; a tiny 2–3 mm long insect vector. Along with the regional countries, Bhutan has embarked on the elimination goal. However, several challenges lies ahead on its path to elimination. There is no elimination strategy and actions. The reporting, surveillance system, control and prevention mechanisms are inadequate. Further, there is lack of knowledge among the health care providers that impedes elimination goals. Therefore, if Bhutan is serious about its elimination goal, all the gaps and current challenges needs to be addressed appropriately. Keywords: Bhutan; Elimination; Leishmaniasis.

This article describes an atypical case of post-kala-azar dermal leishmaniasis associated with complications due to delayed diagnosis and poor case management. The grave consequences of the prolonged disease process that continued for over 2 decades with eventual healing included facial disfigurement, visual impairment, and mental distress both to the patient and the family. The persistent infection within the skin over a lengthy period with likely increased risk of infection spread in the community highlights its potential negative impact on the ongoing leishmaniasis elimination program in the Indian subcontinent. Bhutan is a member of the leishmaniasis elimination network in Asia, and the government continues to invest in maintenance of the national healthcare system. The case study reveals the gaps in the healthcare system with hardships faced by a patient to access quality healthcare and poor patient outcome used as proxy indicators. It also points to the need to enhance access to healthcare to ensure early diagnosis and effective treatment for leishmaniasis patients including those who live in remote areas, in order to achieve the planned disease elimination targets. It also points towards the key challenges faced by a resource poor nation such as Bhutan in achieving universal health coverage and reaching the set goals for disease elimination. The findings underscore the need for a careful review of the national health care system and to address the deficiencies.

The present paper records, for the first time, the Anopheles fauna of Bhutan, determined from surveys conducted from 2007 to early 2018. Adult mosquitoes were collected mainly on cattle bait and occasionally in human landing catches. Collections of immature stages were performed in various aquatic habitats. Larvae were preserved or reared to adults. Identification was based on morphological characters using available keys. A total of 30 species were identified, including nine species of subgenus Anopheles and 21 species of subgenus Cellia. Distribution and collection data are provided with notes on the locations and habitats of the species. Anopheles pseudowillmori is suspected to be a vector of malarial parasites in the plains and hilly forested areas of the country because it is widely distributed and the most common species collected in human landing catches. Notes also include observed morphological variation observed in An. baileyi and An. lindesayi, which differ from the type forms. Corrections are made for previous reports of Anopheles in Bhutan. The need for further surveys and molecular identification of members of species complexes and morphological variants is emphasized.

Bhutan experienced its largest and first nation-wide dengue epidemic in 2019. The cases in 2019 were greater than the total number of cases in all the previous years. This study aimed to characterize the spatiotemporal patterns and effective reproduction number of this explosive epidemic. Weekly notified dengue cases were extracted from the National Early Warning, Alert, Response and Surveillance (NEWARS) database to describe the spatial and temporal patterns of the epidemic. The time-varying, temperature-adjusted cohort effective reproduction number was estimated over the course of the epidemic. The dengue epidemic occurred between 29 April and 8 December 2019 over 32 weeks, and included 5935 cases. During the epidemic, dengue expanded from six to 44 subdistricts. The effective reproduction number was &lt, 3 for most of the epidemic period, except for a &asymp, 1 month period of explosive growth, coinciding with the monsoon season and school vacations, when the effective reproduction number peaked &gt, 30 and after which the effective reproduction number declined steadily. Interventions were only initiated 6 weeks after the end of the period of explosive growth. This finding highlights the need to reinforce the national preparedness plan for outbreak response, and to enable the early detection of cases and timely response.

This paper reports the results of a molecular and morphological study of Anopheles baileyi in Bhutan and Thailand. Phylogenetic analyses of ribosomal (ITS2) and mitochondrial DNA (COI) sequences revealed the presence of four genetically distinct clades, three in Bhutan (Clades I, II and III) and one in Thailand (Clade IV). Most of the larvae in the Bhutanese clades differed from those in the Thai clade in having seta 4-C branched, whereas it is single in the latter. The adults of each clade showed variation of wing markings and overlapping characters. The combination of characteristics of thoracic setae 1,2-P and abdominal seta 3-I was found to be useful for distinguishing the larvae. Pupae were inseparable. We provisionally recognize mosquitoes of Clades I, II, III and IV as members of a sibling species complex, the Baileyi Complex, denoted as species A, B, C and D, respectively. Species A is most likely the type form of An. baileyi s.s. because it was found adjacent to the type locality (Yatung, Tibet), and the others are unrecognized species.

In 2018, Bhutan reported 54 cases of malaria, of which six were indigenous, 14 introduced and 34 imported. Considering the continuous reduction in the number of indigenous cases, Bhutan plans to eliminate malaria by 2025 under the Bhutan Malaria Elimination Strategy. The study was conducted to assess the presence of asymptomatic plasmodial infection in both, Bhutanese population living in malaria-risk areas and in migrant workers to guide the elimination strategies. A cross-sectional study was conducted from April to May 2016 in 750 Bhutanese people and 473 migrant workers. Plasmodium falciparum and Plasmodium vivax infections were investigated by using a rapid diagnostic test (RDT) and the polymerase chain reaction (PCR). Prevalence of asymptomatic plasmodial infection based on PCR was 0.27% (95% CI: 0.05–1.07%) among Bhutanese people with a mean age of 43 years old. The proportions of males and females were 45% and 55%, respectively. Among migrant workers, the prevalence of asymptomatic plasmodial infection was 0.42% (95% CI: 0.07–1.69%) with a mean age of 30 years old. The majority of migrant workers were from the neighboring Indian State of West Bengal (57.51%), followed by Assam (12.26%). RDT in both study groups did not detect any plasmodial infection. The presence of a low prevalence of asymptomatic plasmodial infection indicates that the current elimination strategies and interventions are effective.