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7. TRENDS IN HEALTH STATUS

Related Links

      Burden of Disease - WHO/HQ

7.1 Life expectancy

Bhutanese life expectancy has increased from 48 years in 1984 to 66.1 year in 2003. Even the population growth rate of 3.1 percent, which was a concern for the government, has also dropped to 1.3 percent by 2005 through intensified health education and increased access to contraceptives. There is a nominal difference in life expectancy for male and female as female are supposed to live up to 66.2 years and male 66 years (as per Annual Health Bulletin, 2003, Royal Government of Bhutan, Ministry of Health).

In Bhutan, Healthy life expectancy is 52.9 years for both males and females (as per WHO Core Indicators, 2005).

Related Links

      Life Expectancy – WHO/HQ

      Healthy Life Expectancy 2002 - WHO/HQ

7.2 Mortality

Infant mortality rate has dropped from 102.9 per 1,000 live births in 1984 to 40 per 1000 live births in 2005. There is no marked difference in IMR for males and females.

Under 5 Mortality Rate (U5MR) has also declined significantly from 162.4 per 1000 live births in 1984 to 61 per 1000 live births in 2005.

Reviews conducted in 1984, 1994 and 2000 revealed good progress in the health sector since the start of the planned development four decades ago. Maternal mortality ratio has decreased from 770 per 100,000 live births in 1984 to 255 in 2000.

The cure rate for tuberculosis is 90 percent and the case fatality rate show steady decline from 48.8 per 1000 cases in 1995 to 45.6 in 2001. DOTS strategy has been used since 1997 and standard reporting and recording system for patients are in place although there are still cases of double recording or patients lost to follow up. However, the increasing number of HIV cases is now challenging this progress.

So far, 50 HIV positive cases have been detected in the country. Out of these, 10 have died - 1 due to cerebral malaria and 9 due to ARC. Taking into account the detected cases, there has been almost 100 percent increase in the cases between 2001 and 2002.

For malaria, capacity for control has certainly been increased with the strengthening of the programme and establishment of an entomological unit. Efforts are now bearing fruit as indicated by the declining number of Plasmodium falciparum and Plasmodium vivax cases (these are the two prevalent types of malaria in the country). Plasmodium vivax was seen as the most predominant infection all through the decade from 1990. However, Plasmodium falciparum cases exhibited a sudden increase to 12,966 in 1991 as compared to Plasmodium vivax cases of 9,160 during the same year.

On the whole, the malaria situation started to get worse from 1990 onwards with Annual Parasite Infection increasing from 53.6 reaching a peak of 111.1 in 1994. After that the annual infection showed marked improvement between 1995 and 2000 with a declining trend from 66.2 to 16.9 with some increase in 1999.

Acute respiratory infections in winter and diarrhoeal diseases in summer still top the list of infant morbidity and also contribute to mortality in the basic health units. This is usually attributed to poor nutrition and living environment of the children in the rural communities, dry atmosphere in the winter, poor quality of drinking water and sanitation in summer. The programmes on Integrated Management of Childhood Illnesses, Water Supply and Sanitation, Nutrition have been introduced to improve the situation but more work is required to coordinate their efforts to have a positive impact on child health. 

While some progress has been made in controlling communicable diseases, there is also an ever-growing problem of non-communicable diseases. With the changing of life-style from the agrarian society to more complex modern competitive world, rheumatic heart diseases, diabetes, cancer, especially cervical cancer, are on increase. Even within a peaceful country like Bhutan, preliminary assessments reveal that the situation of mental health is not much different from any other county. Presently, most of cancer cases are referred outside the country, which takes away a large portion of the hospital funds. The government is now initiating actions to have programmes in place to deal with this aspect of health problem.

Related Links

      Health statistics and health information systems - WHO/HQ

7.3 Morbidity

In Bhutan, most common cause of morbidity among 10 causes is common cold and then skin infection.  The 10 major causes of morbidity are given here under:

Ten most common health problems in Bhutan in 2006

(As per Annual Health Bulletin, 2007, Royal Government of Bhutan, Ministry of Health).

Related Links

      Morbidity Report for BHUs, Bhutan

      Disability and Rehab - WHO/SEARO

      Disability and Rehabilitation Team (DAR) - WHO/HQ