Respiratory Tract Infections in Bhutan: Challenges and Solutions

This essay examines the critical issue of respiratory tract infections (RTIs) in Bhutan, focusing on their impact on public health and the country's efforts to achieve global health objectives. It delves into the prevalence of influenza and acute respiratory infections (ARIs), highlighting the burden of hospitalization and the need for vaccination programs. The essay explores the epidemiology of RTIs, differentiating between upper and lower respiratory infections and discussing the higher risks faced by children in certain environments. It compares Bhutan's immunization and vaccination levels to other countries, emphasizing the need for continuous efforts to improve healthcare quality. The analysis also covers the mortality rates associated with RTIs, along with the contributing factors like exposure to toxic substances, stress, and low birth weights. The essay investigates the aetiology of RTIs, the role of various viral and bacterial agents, and the impact of HIV infection. It further identifies factors that increase the risks of RTIs, including migration, alcohol consumption, environmental pollution from industries and vehicles, cigarette smoking, conflicts, overcrowding, and the use of solid fuels. The essay concludes by emphasizing the need for vaccination, understanding the aetiology and epidemiology, and employing advanced treatments to improve the health outcomes related to RTIs in Bhutan.

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RESPIRATORY TRACT INFECTION IN BHUTAN
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Introduction
Health is the most imperative aspect of one’s life and the basis of the country’s economy.
Healthy individuals are more prolific and vigorously engage in activities of making any country
successful. Equity and justice in ensuring that health services delivery is of proper and sound
manner are paramount. Medical ministry in countries with collaboration to the world health
organization should be with similar aims of eradicating infections. This essay focuses on the best
ways that can be employed in Bhutan as one of the target objectives of achieving global health in
the 21st century especially respiratory tract infection.
Respiratory tract and influenza-associated diseases
Respiratory system health is very vital since it entails all organs that aids in gaseous exchange.
Those organs are very delicate and prone to get damaged from any destructor substances. Bhutan
has experienced a huge burden, particularly due to the hospitalization of individuals with
influenza-associated diseases (Akter, Uddin, and Biswas, 2019). Influenza encumbrance
estimates help convey confirmation to sustenance influenza preclusion and control plans. Bhutan
should consider an obligation to introduce vaccinations for respiratory tract diseases, influenza
being the priority (Holloway et al., 2017). This because proper actions are not put in place;
spreading such infections is possible from country to country. Thus, achieving global health
equality in the 21st century would be a dream, not a reality as it ought to be.
Acute respiratory infections (ARL)
Research shows that a large population of individuals in Bhutan gets hospitalized every month
with acute respiratory infections. Respiratory infections lead to huge spending of the country
since the budget allocated to that sector is large yet Bhutan is a low capital country. Acute

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respiratory infections (ARI) have conventional far less courtesy in humanitarian respite policies
and plans. This is very worrying since ARL is the major contributor to disability-adjusted life-
years (DALYs) lost as well as the prominent single origin of death among children below five
years globally (Vaideeswar, and Marathe, 2018).
Epidemiology of respiratory infections
Respiratory infections can be classified into two major categories depending on regions infected
as upper and lower acute respiratory infections. Several areas prone to infection are nose, larynx,
pharynx, middle ear, sinuses, lungs, and bronchi (Bhandari and Morawakkorala, 2015). Infection
that occurs in the upper is mild, which is occasionally caused by viruses. The devastating
majority of ARL demise and severe ailment episodes are due to lower infections. Children in
overpopulated areas or those living in quarters fall at high risks of deaths due to lower ARLs, yet
they are hoping for generations' continuity (Lee, and Pradhan, 2019).
Immunization and vaccination level in Bhutan in comparison to other countries
Reports show that in Bhutan, there is decrease coverage of expanded platform of immunization
interpolations, together with pertussis, Hib vaccinations, and measles (Tshokey et al., 2017) All
these vaccinations were previously introduced but no aspects of continuity to take actions are
seen in Bhutan. Other countries have better and more functioning methods of immunization and
vaccine administration from the early ages of life. This disparity in quality of health care
received in different countries, some having the best and other poor medical services, hinders the
objective of attaining equal global heath.

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Mortality and respiratory tract infections
Respiratory infection is not the only cause of deaths in Bhutan either, but also factors like
exposure to toxic artilleries, psychological stress, high tendencies of low natal weights,
prematurity, and airborne particulates contribute to mortality (Yeshi et al., 2018). These aspects
facilitate the danger of spread and infection, the advancement of disease to those infected,
leading to a severe case like pneumonia.
Aetiology of respiratory tract infections
The aetiology of lower ARL, as well as pneumonia, specifically, is tough to establish. Obtaining
body fluids specimens for use in microbiologic tracing from the organ infected is only possible
to a few individuals. Aetiology research is thus conducted either insensitive and unspecified
strategies like serology, blood culture, or microbiology diagnosis of the higher airways.
Research reveals that about a quarter to half of childhood pneumonia scenarios appears to have a
previously viral aetiologic agent like respiratory syncytial virus (RSV) in humans (Tshering et
al.,2018). Other agent includes influenza and parainfluenza viruses while more than half of
diseases are due to bacteria which reflects as a secondary attack. HIV infection contributes to the
maximum dangers of attack by hemophilic influenza and Streptococcus pneumonia necessary for
most pneumonia deaths.
Bacteria incidents of pneumonia are seen to be responsible for large severity and incidents of
fatality rates than viral episodes. Additionally, these factors maximize the risks of respiratory
infections in a synergistic manner where pathogens causing such infections become dramatically
increased in number. See the table below, highlighting the level of respiratory viral infection
according to seasons.

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Factors that increase the risks of respiratory tract infection in Bhutan are:
Migration
Displacements of populations in Bhutan leads to an increase in figures of individuals who require
to be immunized. The purpose of immunizing is to strengthen an individual immune as well as
enhancing adaptations to a new environment. Unlike many large-burden infectious maladies,
there are no particular endorsements for deterrence and regulation of acute respiratory infections
in crunches. Several studies help to establish situations under which such endorsements can be
formulated.
Qualitative details on lower and upper acute respiratory infections are revealed under
international cataloging of diseases like influenza. In every pre-crisis disbursement, respiratory
infections are the chief infection that results in huge deaths (Jokinen, 2019). This calls for alarm
for the government to consider such circumstances by implementing realistic strategies on how

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mortality can be prevented. Under normal situations, people keep on moving from place to place
due to reasons such as job, schooling, climates, war, and betterment purposes.
Alcoholic beverages
Alcohol consumption is also a prominent cause of respiratory complications. Bearing in mind
that none of the alcoholic beverage is consumed while hot, people often take cold alcohol even
during cold seasons due to addiction. Lungs of the body are very sensitive to cold environments
and respond negatively to such a state. Bronchi, which are housed in the lungs, tends to contract
when exposed to too much cold. As a result, very little air inhaled is accommodated by
contracted bronchi, and this leads to breathing problems to the individual (Wangchuk et al.,
2013).
Additional aids to support the breathing of an individual with complications like asthma
respiratory diseases are a requirement. People are supposed to be aware of such an effect in order
to take care of their health appropriately. The goal of achieving global health does not lie only to
the health practitioners but to each person. Health education can be done through health
campaigns, mass media and publishing health articles to ensure that people are well informed.
Toxic smoke emitted by industries
Environmental conditions of the country contribute largely to the respiratory health state. For
instance, industrial processes that emit toxic smoke to the environment. Toxic smoke emitted by
such industries is inhaled by individuals around the vicinity and cause respiratory problems.
Additionally, people working in such industries have no choice rather than inhaling that polluted
air (Raheem, Binns, and Chih, 2017). This continues to increase people's risks of respiratory

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infections as well as the burden of the country in terms of health service delivery (Global Burden
of Disease Study 2017).
Cigarette smoking
Smoking cigarettes has got the highest rates of damaging the organs involved in respiration. For
example, liver cirrhosis, lung cancer, and tracheal cancer. This is the principal organs for
respiration and a large number of patient records show that diagnosis of respiratory problems
comes from cigarette smokers. Health ministry together with the government should take
measures that hinder smoking as well as controlling those who are already addicts (Ferkol and
Schraufnagel, 2014).
Smoke emitted by motor vehicles
Motor vehicles also emit smoke that gets into the atmospheric air and pollutes it. Every air
pollution is a huge crisis since it is inhaled together with the oxygen necessary for human beings
to survive. As outlined explained previously in this essay, it is the responsibility of everyone to
ensure that global health is achieved, and thus, the ministry of transport services should labor
enough to devise fuels that can emit minimally or even zero air pollution.
Conflicts and overcrowding camps
Other factors that hinder total respiratory health promotion are conflicts in the country; thus,
overcrowding into camps and host homesteads. Studies made on acute respiratory infection
attributable cohort death rate among Bhutanese refugees in Nepal shows that 0.29 mortality rate
per 10000 individuals days were as a result of lower ARL (Feldman, and Anderson, 2013). The
condition is defined then as fever and cough which lead to greater than 50 mortalities per minute.
This makes the respiratory infection to remain the major cause of deaths as analysis revels.

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Solid fuels
Use of solid fuels while people remain indoors in places with conflicts and fresh air is not able
to circulate properly. Malnutrition is the other contributing aspect of both acute and chronic
respiratory infections (Jackson,2013). Peace is thus paramount to attain equitable global health.
A country that remains ever in war and conflicts have less time to improve on the health of the
people. Thus, Bhutan should be one of the countries that focus on embracing the peace that
create humble time for its growth in totality.
Conclusion
The analysis of respiratory infections being one of the keys is a cause burden in achieving global
health calls for realistic action to be applied. Such measures are the introduction of relevant
vaccination strategies for both adults and children. Also, excellent characterization of the
aetiology and epidemiology of respiratory infections is vital in order to rationalize infection
priorities. In addition to device prospective impact of advanced treatment and diagnostic, elevate
cure algorithms and create the best usage of accessible and novel vaccines against respiratory
infections.

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