Introduction The management and treatment of Medical Waste (MW) are of great concern owing to its potential hazard to human health and the environment, particularly in developing countries. In Bhutan, although guidelines exist on the prevention and management of wastes, the implementation is still hampered by technological, economic, social difficulties and inadequate training of staff responsible for handling these waste. The study aimed at assessing the awareness and practice of medical waste management among health care providers and support staff at the National Referral Hospital and its compliance with the existing National guidelines and policies. Materials and methods An observational cross-sectional study was conducted from March to April 2019. Three research instruments were developed and used; (i) Demographic questionnaire, (ii) Awareness questions, and (iii) the Observational checklist. The data was coded and double entered into Epi data version 3.1 and SPSS version 18 was used for analysis. Descriptive statistics were used to present the findings of the study. Results The majority of the respondents were female (54.1%) with a mean age of 32.2 (±7.67) years, most of whom have not received any waste management related training/education (56.8%). About 74.4% are aware of medical waste management and 98.2% are aware on the importance of using proper personal protective equipment. Only 37.6% knew about the maximum time limit for medical waste to be kept in hospital premises is 48 hours. About 61.3% of the observed units/wards/departments correctly segregated the waste in accordance to the national guidelines. However, half of the Hospital wastes are not being correctly transported based on correct segregation process with 58% of waste not segregated into infectious and general wastes. Conclusion The awareness and practice of medical waste management among healthcare workers is often limited with inadequate sensitization and lack of proper implementation of the existing National guidelines at the study site. Therefore, timely and effective monitoring is required with regular training for healthcare workers and support staff. Furthermore, strengthening the waste management system at National Referral Hospital would provide beneficial impact in enhancing safety measures of patients.

Background The third Sustainable Development Goal for 2030 development agenda aims to reduce maternal and newborn deaths. Pregnant women’s understanding of danger signs is an important factor in seeking timely care during emergencies. We assessed knowledge of obstetric danger signs using both recall and understanding of appropriate action required during obstetric emergencies. Methods This was a cross-sectional study among pregnant women attending antenatal clinic at Bhutan’s largest hospital in Thimphu. Recall was assessed against seven obstetric danger signs outlined in the Mother and Child Health Handbook (7 points). Understanding of danger signs was tested using 13 multiple choice questions (13 points). Knowledge was scored out of 20 points and reported as ‘good’ (≥80%), ‘satisfactory’ (60–79%) and ‘poor’ (< 60%). Correlation between participant characteristics and knowledge score as well as number of danger signs recalled was tested using Pearson’s correlation coefficient. Association between knowledge score and participant characteristics was tested using t-tests (and Kruskal-Wallis test) for numeric variables. Socio-demographic and clinical characteristics associated with the level of knowledge ('good’ versus ‘satisfactory’ and ‘poor’ combined) were assessed with odds ratios using a log-binomial regression model. All results with p < 0.05 were considered significant. Results Four hundred and twenty-two women responded to the survey (response rate = 96.0%). Mean (±SD) knowledge score was 12 (±2.5). Twenty women (4.7%) had ‘good’ knowledge, 245 (58.1%) had ‘satisfactory’ knowledge and 157 (37.2%) had ‘poor’ knowledge. The median number of danger signs recalled was 2 (IQR 1, 3) while 68 women (20.3%) could not recall any danger signs. Most women were knowledgeable about pre-labour rupture of membranes (96.0%) while very few women were knowledgeable about spotting during pregnancy (19.9%). Both knowledge score and number of danger signs recalled had significant correlation with the period of gestation. Women with previous surgery on the reproductive tract had higher odds of having ‘good’ level of knowledge. Conclusions Most pregnant women had ‘satisfactory’ knowledge score with poor explicit recall of danger signs. However, women recognized obstetric emergencies and identified the appropriate action warranted.

Background: The carriage of loads on the back in children, >10% of one’s body weight (BW), induces postural change and morbidity related to spinal pain. We studied the weight of schoolbags and the prevalence of musculoskeletal pain related to carrying schoolbags among children in Thimphu, Bhutan. Methods: This was a cross-sectional study, with a multistage cluster sampling, conducted amongst grade 8 and 10 students. Data were collected using a standardized self-administered questionnaire and weights of students and schoolbags were measured. Descriptive statistics were used to present the findings. Means were compared using t test and risk factors were identified using logistic regression. Results: There were 131 students whose schoolbags weighed >10% body weight (BW). The mean weight of schoolbags was 4.6 ±1.5 kg for grade 8 students and 4.0 ±1.5 kg for grade 10 students. Musculoskeletal pain in at least one body region was reported by 411 students. Schoolbags weighing >10% BW and carrying the bags over only one shoulder were significant risk factors for reporting musculoskeletal pain. There were 197 students whose schoolbags did not have any safety feature; students did not use them consistently even if they were present. Conclusions: The weight of school bags that were more than the recommended ≤10% BW was a strong factor in reporting musculoskeletal pain. Parents and students may be educated on the use of schoolbags with safety features. Measures such as providing storage facilities in schools may reduce the weight of bags.

Background: The third Sustainable Development Goal aims to reduce maternal and newborn deaths. Pregnant women’s understanding of danger signs is an important factor in seeking timely care during emergencies. We assessed knowledge of obstetric danger signs using both recall and understanding of appropriate action required during obstetric emergencies.Methods: This was a cross-sectional study among pregnant women attending antenatal clinic at Bhutan’s largest hospital in Thimphu. Recall was assessed against seven obstetric danger signs outlined in the Mother and Child Health Handbook (7 points). Understanding of danger signs was tested using 13 multiple choice questions (13 points). Knowledge was scored out of 20 points and reported as “good” (≥80%), “satisfactory” (60 – 79%) and “poor” (<60%). Association between knowledge score and participant characteristics were tested using Chi-square, Fisher’s Exact and t-tests. Corresponding non-parametric tests were performed where appropriate. Correlation between participant characteristics and knowledge score as well as number of danger signs recalled was tested using Pearson’s correlation coefficient. Results with p<0.05 were considered significant.Results: Four hundred and twenty-two women responded to the survey (response rate = 96.0%). Mean (±SD) knowledge score was 12 (±2.5). Twenty women (4.7%) had “good knowledge”, 245 (58.1%) had “satisfactory knowledge” and 157 (37.2%) had “poor knowledge”. The median number of danger signs recalled was 2 (IQR 1, 3) while 68 (20.3%) women could not recall any danger signs. Women were most knowledgeable about pre-labour rupture of membranes (96.0%) and least knowledgeable about spotting during pregnancy (19.9%). Knowledge level was significantly associated with reading Mother and Child Health Handbook, mother’s education level, husband’s education level, number of antenatal care visits, gestational age and past surgery on reproductive tract. Both knowledge score and number of danger signs recalled significantly correlated with the period of gestation. Conclusions: Most pregnant women had satisfactory knowledge score but recognized the appropriate actions warranted during obstetric emergencies. The MCH Handbook has played a significant role in improving knowledge and understanding of danger signs.

Background: The third Sustainable Development Goal for 2030 development agenda aims to reduce maternal and newborn deaths. Pregnant women’s understanding of danger signs is an important factor in seeking timely care during emergencies. We assessed knowledge of obstetric danger signs using both recall and understanding of appropriate action required during obstetric emergencies. Methods: This was a cross-sectional study among pregnant women attending antenatal clinic at Bhutan’s largest hospital in Thimphu. Recall was assessed against seven obstetric danger signs outlined in the Mother and Child Health Handbook (7 points). Understanding of danger signs was tested using 13 multiple choice questions (13 points). Knowledge was scored out of 20 points and reported as “good” (≥80%), “satisfactory” (60 – 79%) and “poor” (<60%). Correlation between participant characteristics and knowledge score as well as number of danger signs recalled was tested using Pearson’s correlation coefficient. Association between knowledge score and participant characteristics were tested using t-tests (and Kruskal-Wallis test) for numeric variables. Socio-demographic and clinical characteristics associated with the level of knowledge (“good” versus “satisfactory and poor” combined) were assessed with odds ratios (OR) using a log-binomial regression model. All results with p < 0.05 were considered significant.Results: Four hundred and twenty-two women responded to the survey (response rate = 96.0%). Mean (±SD) knowledge score was 12 (±2.5). Twenty women (4.7%) had “good knowledge”, 245 (58.1%) had “satisfactory knowledge” and 157 (37.2%) had “poor knowledge”. The median number of danger signs recalled was 2 (IQR 1, 3) while 68 (20.3%) women could not recall any danger signs. Most women were knowledgeable about pre-labour rupture of membranes (96.0%) while very few women were knowledgeable about spotting during pregnancy (19.9%). Both knowledge score and number of danger signs recalled had significant correlation with the period of gestation. Women with previous surgery on the reproductive tract had higher odds of having good level of knowledge. Conclusions: Most pregnant women had satisfactory knowledge score with poor explicit recall of danger signs. However, women recognized obstetric emergencies and identified the appropriate action warranted.