Study site and design
We used retrospective descriptive study through review of laboratory registers across three health centres in Zhemgang district, south central Bhutan. The laboratory registers have been transcribed into CSV file using Microsoft excel. Variables of interest were collected from the registers and then analysed using open statistical software R, (R Core Team (2020). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria.) and use of mStats package, (MyoMinnOo (2020). mStats: Epidemiological DataAnalysis. R package version 3.4.0.)
Three health care centres included in the study lacks ELISA testing facility. However the tests were done with SD BiolineTsutsugamushiTestTM rapid diagnostic test (RDT) kits in 2019 and Standard Q Tsutsugamushi IgM/IgG in 2020.The tests were done with SD BiolineTsutsugamushiTestTM rapid diagnostic test (RDT) kits in 2019 and Standard Q Tsutsugamushi IgM/IgG rapid test kit in 2020which has underestimated sensitivity and specificity in accuracy of test results.