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Meningoencephalitis, an inflammation of the membranes of the brain and the adjoining cerebral tissue, is one of the main causes of deaths in children in the country, according to health officials.

Mortality from meningitis or encephalitis in the country increased to 47 in 2016 from 28 in 2012. Of a total of 222 reported cases last year, about 160 were children below 15 years.

Infection of the meninges, the membranes that surround the brain and spinal cord, is called meningitis. Inflammation of the brain itself is called encephalitis.

Viral infections are the common cause of meningitis, followed by bacterial infections and, rarely, fungal infections.

The Department of Pediatrics at the national referral hospital in Thimphu which provides health care services to children less than 12 years admitted 4,169 patients which accounts to 24 percent of the total hospital admission.

Health officials with the department said the outpatient department has observed an increased number of patients. About 72,264 cases were seen in 2016 alone.

Pneumonia, bronchiolitis, aspiration pneumonia, followed by meningitis and meningoencephalitis are the main causes of admission of patients to Pediatric Intensive Care (PICU) Unit at the national referral hospital.

The unit was started in September 2012 as a four-bedded ward.

The Head of Department of Pediatrics at the JDWNRH, Dr Mimi Lhamu, said that basic unit with beds brought in from adult ICU and other units and equipment were shared from Neonatal and adult ICU.

“Nevertheless, we did start with the PICU because there was a need to separate the PICU from the Pediatric ward so that we can give proper quality care to the patients,” she said.

In 2014, another bed was added to the ward because there was a shortage of beds in the unit. “In addition to this, we were able to procure good quality machines like ventilators and CP monitors for each bed,” she added.

Currently, the PICU at JDWNRH has five beds.

Late referral from other dzongkhags was one of the reasons for high mortality rates in the PICU, she added.

The other reasons are that the department doesn’t have a dedicated pediatric critical care specialist, all nurses are not trained in pediatric critical care, no dialysis facilities for small children and no PICU in other hospitals because of which most of the referrals come to the national referral hospital.

Dr Mimi Lhamu said there is a need to improve the quality of care because, ideally, the nurse to bed ratio in ICU should be 1:1 and the unit is not able to provide that right now.

Currently, ICU is run by general paediatricians.

The unit also faces shortage of beds during seasonal times.

“We have a large number of babies and children getting admitted to ICU between July to October and November whereas in the winter months the admission rate is very low with only about two to three patients,” Dr Mimi Lhamu said.

Due to acute shortages of beds in PICU during the seasonal time, Dr Mimi Lhamu said that most of the time children who are not fully stable or who are not fit to be discharged from the ICU has to be shifted to the ward so that children who are more sick get a bed.

“Many a time it leads to readmission of the patient to the PICU. Occasionally we have to keep the children in the adult ICU and again it’s a challenge to the nurses and other staff at the adult ICU to manage children,” she said.

In 2017, bed occupancy rate in PICU was 82 percent. Whenever the bed occupancy rate goes beyond 75 percent in the ICU, it indicates that it is time for expansion.

She said there is a need to expand the PICU by two beds and procure quality medical equipment.

Nu 6M that was donated by Her Majesty Gyalyum Tshering Pem Wangchuck to the hospital, last week will be used to purchase two sets of ICU equipment that includes ICU bed.

“We will be working towards improving the quality of care in the ICU and also improve the patient and family experience while their stay in ICU,” Dr Mimi Lhamu said.

Dechen Tshomo

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