Introduction: Peripheral intravenous catheter insertion is a clinical procedure commonly performed by nurses for pediatric patients in Bhutan. This study describes peripheral intravenous catheter first attempt success and factors associated with such insertions. Methods: A cross-sectional survey was conducted from October 2016 to March 2017, comprised of a national sample of the Bhutan pediatric patient population (0-12 years). We collected data on peripheral intravenous catheter first time insertion success rate of admitted pediatric patients, to identify predictors of a successful first time attempt. Clustered log binomial generalized linear models were used to obtain the prevalence of first time attempt success and predictors of success. Results: The prevalence rate of successful first time attempt adjusted for clustering was 64% (95% confidence interval: 51%-80%). Predictors of a successful first time attempt were older patient age, lighter skin color, the vein being visible with a tourniquet, and the left hand being used for insertion. A transilluminator was used in 52 patients, and the peripheral intravenous catheter was eventually successfully placed in 82% of the patients. Discussion: Our first time successful cannulation rate is substantially lower than that found in similar studies in other countries. Considering the impact a peripheral intravenous catheter has on patients' clinical outcomes and cost implications, reducing the number of failed attempts should be of high importance. Better education and simulation, combined with the adoption of vessel locating technology, are required to improve insertion practice in Bhutan. This could lead to greater efficiency of the health facilities in Bhutan.

Introduction: Respectful Maternity Care (RMC) acknowledges that respects for woman’s rights, choices and dignity during labor and childbirth is vital component of health care quality. This cross-sectional descriptive study intended to gain in-depth understanding on knowledge, attitude and practices of nurse midwives working in referral hospitals of Bhutan on RMC. The study also looked into determinants of RMC. Methods: The sample consisted of 83 nurse midwives who were working in birthing and maternity unit of three regional referral hospitals of Bhutan. The sites were chosen purposefully due to their high delivery volume. A survey instrument was piloted in Paro hospital prior to study. Data was collected from July to October 2017. Analysis was mainly descriptive, simple percentages were used to calculate frequency distribution of aspects and determinants of respectful maternity care. Results: Four in five of the respondents knew and practiced woman’s right to information and communication during childbirth process. However, providers were found lacking on some aspects of the knowledge and practices related to respecting choices and rights of the women during childbirth and recounted their experiences of observing events which are described as abusive in maternal health literatures. Inadequate facilities, overworked staffs and limited trainings were found as detrimental factors. Conclusion: Aspects of RMC were not duly practiced. Providers must be made aware of the woman’s right to respectful care which is crucial to improve maternal health services. Individual Health Facility must provide conducive environment to practice RMC. Future studies on RMC from receiver end are recommended.

Introduction: The objectives of this cross sectional study were to determine prevalence, determinants, and outcomes of unplanned pregnancy among women in Nganglam, a town in southeastern Bhutan. It also gauged opinions of women and healthcare providers towards abortion. Methods: A total of 683 women attending health clinics were consecutively interviewed using a semi-structured questionnaire. The core group for analysis was 490 women who indicated their recent pregnancy as planned or unplanned. Percentages, x2 tests, and multivariate logistic regression analyses were used to determine prevalence and differences in unintended pregnancy by demographic characteristics. Results: The prevalence of unplanned pregnancy was 20.2%. Higher education, employed status of partner, higher parity, and non-use of contraceptives significantly increased the odds of unplanned pregnancy. Over half (58.4%) of the women said they knew someone to have crossed Indian borders to avail abortion services. Overall, 23% women supported legal abortion but majority (64%) were ambivalent. Given specific circumstances, both participants and health care providers supported some scenarios (life of mother, severe anomaly in fetus, rape and incest, maternal mental health) and opposed some circumstances as reasons for abortion (desired number of children met, contraception failure, not wanting to marry,poverty). Conclusions: One in five women in our setting in Bhutan experienced unplanned pregnancy. Programs to  romote family planning are required among populations most at risk for unplanned pregnancy. Awareness programs are required to encourage use of effective contraceptive methods among Bhutanese women.