Health: Miracles and Issues

Of conjoined twins (Omphalopagus), Anaemia and Quality of Life

l Tenzin Lhamo & Kinzang Namgay/Thimphu


The Third International Conference on Medical and Health Science, which started on November 3, 2017, at the convention Hall of the Royal University of Bhutan (RUB), here, highlights the dramatic strides that Bhutan’s Health delivery system has made.

In a publication titled “Lifestyle Related Diseases: Opportunities and Challenges,” Rihan Raj Gurung, a resident from the Department of Surgery, Khesar Gyalpo University of Medical Science of Bhutan (KGUMSB), presents a case study of  conjoined twins or Omphalopagus, which is the first recorded case of such type of conjoined twins in the country.

With a reported incidence of 1 in 250,000 live births, such cases are said to be extremely rare.  “The twins were born at term to a 36-year-old female, at Phuentsholing hospital by cesarean section with a combined birth weight of 4.4 k. The antenatal diagnosis was twin pregnancy but conjoined twins with Omphalopagus were born. Subsequent clinical and imaging studies revealed the twins had separate internal organs. The twins are doing well at home with a plan for surgical separation at around six months of age,” Gurung states.

It is also being mentioned that thorough preoperative planning is important, but how separation will be performed is best decided during the operation itself because operative findings will often dictate a different sequence. “This is the first reported case of conjoined twins with a favorable outcome in the country.”

A surgeon at the Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), who did not want to be named, said that the fact that such cases are being successfully addressed within the country speaks of the giant step ahead that the Health System in Bhutan has taken.

The Conference also saw the release of a publication, the “Bhutan Health Journal, November 2017,” and sheds light on challenges confronted, with Anemia, being one.

A study conducted by three professionals; two from the University and one from JDWNRH; reveals that there is a very high prevalence of anemia of 58.4% among hospitalized children six to 59 months old. “Children less than two years were affected more. The risk   factors associated with moderate to severe anemia, low monthly family income and chronic illness of the children,” the study has found out.

It was undertaken to determine the prevalence of anemia among hospitalized children and the common factors associated with moderate to severe anemia in children aged six months to 59 months. The study had a total of 353 children. Of 353 children, 206 were anemic, so the prevalence of anemia in children aged six months to 59 months was 58.4% of which 58.7% were male and 41.3%were female.

“This hospital – based descriptive cross section study was carried out at the pediatric ward of Jigme Dorji Wangchuck, National Referral Hospital (JDWNRH) for a period of one year from 1st January 2016 to 31st December 2016. All the children aged 6 to 59 months were included in the study,” it says.

Data pertaining to gender, age, and hemoglobin level and admission diagnosis were collected from the patient admission chart. The admission complete Blood Count (CBC) was reviewed for anemia.  A data collecting proforma was used to collect and record information such as age of the children, gender, gestational age at birth, birth weight, duration of exclusive breast-feeding , education of caretaker . family type , religion of family , number of children < five years in the family , immunization status , availability of health service., history of taking tea with meal, history of  chronic illness and dietary habit of the child.

Anaemia is pointed out as a major public health problem and the most common nutritional issue in many parts of the world, especially in developing countries. Anemia can lead to a number of problems such as increased perinatal mortality, impaired cognitive development, weakened immune system and decrease workplace performance in children. There is multiple cause of anemia, with iron deficiency being the commonest cause in developing countries.  Other cause of anemia is chronic infections, hemoglobinopathies, vitamin deficiency such as folic acid and vitamin B12, bleeding disorders and malignancies. The global estimate of childhood anemia indicates that 293.1 million children under five, approximately 43%, are anemic worldwide. South East Asia has the world’s highest prevalence of anemia.

Another study undertaken, speaks about research into quality of life (QOL) among older adults. Exploratory sequential mixed-method was designed to investigate the correlates of QOL and wellbeing among 391 older adults aged between 60 and 101 years in four major towns of Bhutan.

The results showed above average mean scores for the overall QOL and wellbeing. Both qualitative and quantitative survey confirmed forced labor contribution; assume an adult role while still a child death of close family members as common adverse life experiences influencing QOL and wellbeing of elderly. Adjusting for socio-demographic characteristics, physical and mental health conditions, spiritual and social connectedness were significant correlates of QOL.

It is mentioned that exploration on the immediate and long term impacts of adverse childhood experiences (ACEs) and stressful life events (SLEs), indicated profound effects on health persisting for many years. Determinants of QOL have not been explored among senior citizens of Bhutan. Many older adults continues to live traditionally in highly integrated communities where social causes of health and QOL could be different from western societies.

The findings would assist in the development of socially and culturally appropriate interventions to promote health, wellbeing, and QOL of elderly people. It would also help inform policy makers about the probable affects especially adverse childhood experiences that appear to have impact into adulthood.

Organized by the Medical Education Center for Research, Innovation and Training of the KGUMSB, the Conference ends today.

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