Willingness of emergency and medicine department doctors to work during surge of COVID-19 patients, Patan Hospital, Nepal

Introduction: With the current COVID-19 pandemic, Patan Hospital, Patan Academy of Health Sciences (PAHS), is responding with its incident action plan which also has provision of the response in case of surge. This study aim to find out the willingness of doctors to work during the surge of COVID-19 and may help in further planning. Method: A cross-sectional descriptive study was conducted at Patan Hospital, PAHS, Nepal in April 2020. Questionnaires were circulated to the doctors via Google form to the doctors working in the emergency and medicine department. Ethical approval was obtained. Data were analyzed descriptively. Result: Out of total 73 participants, 59 (80.8%) knew about the surge plan of COVID-19 and 54 (73.9%) were willing to work during the surge. Their major motivation was the professional obligation 56 (76.7%), whereas 61(83.6%) fear about their family getting infected. More than 50% of the participants were ready to stay in-house and work in a sub-optimal environment with a feeling of making a significant contribution to the community. Conclusion: When the number of cases of COVID-19 peaks and the surge plan gets activated, the majority of doctors surveyed were found  willing to work even in sub optimal environments. Keyword: COVID-19, doctors willingness, emergency, surg

Infection prevention and control, pillar for safety of healthcare worker: COVID-19 experience, Patan Hospital, Nepal

Infection prevention and control (IPC) programs play an integral part in the safety of patients, visitors, health care workers and environment as these programs provide guidelines and standard for recognition, prevention and control of infection. With COVID-19 pandemic, Patan Hospital, Patan Academy of Health Sciences, Nepal, is amongst the few hospitals in Nepal to have undertaken the responsibility of managing COVID patients. The COVID response plan has been activated and is currently the best prepared institution to manage this pandemic. Keywords: COVID-19, Infection prevention and control (IPC), Nepa

Demographic profile of patient with acute watery diarrhea during monsoon 2022: Patan Hospital, Nepal

Introduction: Diarrhea is the passage of three or more loose or liquid stools per day or more. Acute watery diarrhea is a major public health problem worldwide.  In Nepal, diarrhea is among the top 10 inpatient morbidity. This study’s objective is to monitor demographic characteristics and laboratory findings of stool specimens of diarrhea. Method: This is a cross-sectional descriptive study done at Patan Hospital. Ethical approval was taken from the Ethical committee. Data for Monsoon 2022 (June to September 2022) were collected from the Patan Hospital record system. Cases from within the Lalitpur district were included. Result: Out of 119 cases, 50(42%) were male and 69(58%) were female. The mean age±SD was 33.28±25.38 (p=0.083) with maximum cases observed during June and a peak observed during the fourth week of June. Out of 119, 4(3.3%) were stool culture positive. Two cases of Vibrio cholera, one case of Shigella sonnei, and one case of Salmonella parathypi B were isolated. In the etiological profile, 14 Entamoeba histolytica were isolated. Conclusion: During the outbreak of diarrhea in Monsoon 2022, adults were affected most. The culture of acute watery diarrhea showed two cases of Vibrio cholera

Perception of understanding COVID-19 among doctors at Patan Hospital, Nepal

Introduction: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and presents with fever, dry cough, fatigue, myalgia, and dyspnea. This study aims to is find out the understanding of COVID-19 among doctors at Patan Hospital. Method: A cross sectional was conducted among doctors at Patan Hospital, Patan Academy of Health Sciences, Nepal. The questionnaire in Google form consisted, part1 perception on COVID-19 and part2 understanding using multiple choice questions corresponding to the one to fifteen questionnaire in part1. Ethnical approval was obtained. Result: Sixty-one doctors participated in the study, of which 65.5% were directly involved in management of COVID-19. Perception and understanding regarding transmission status in country was 65.6% and 63.95% respectively, about case definition 90.1% and 62.2%, about when to do diagnostic tests 75.4% and 90.2%. Conclusion: There was difference in perception and understanding regarding COVID-19 among doctors, and areas to be reinforced were case definition, transmission classification, diagnostic tests. Keyword: COVID-19, doctors, perception, understandin

Hospital incident command system, the pillar of COVID-19 outbreak response: An experience from Patan Hospital, Nepal

In times of disaster, hospital’s preparedness for disaster and response plan contributes significantly to better functioning of the hospital and reducing mortality and morbidity. Activating Hospital incident command system in a timely manner in Patan Hospital has showed how the hospital is better prepared to handle this epidemic outbreak. Keyword: Disaster, epidemic, hospital preparedness, incident command syste

Adverse events following Pfizer-BioNTec vaccine against COVID-19 in population more than 12 years of age, Nepal: Adverse events following Pfizer-BioNTec vaccine

Introduction: Pfizer-BioNTec vaccine was started in Nepal for the age group of more than 12 years. This study was conducted to find out the adverse event following immunization with Pfizer-BioNTech vaccine against COVID-19 at Patan Academy of Health Sciences (PAHS). Method: This is a descriptive study conducted at PAHS from November to December 2021. The vaccine recipients were called over the phone after 72 hours of receiving the vaccine to find out adverse events following immunization (AEFI). They were inquired about the list of pre-defined AEFI. Result: A total of 1377(27.4%) individuals among 5014receivingthe first dose and 983(71.4%) of 1377 receiving the second dose were enrolled in the study. Vaccine recipients who had minor AEFI in the first dose were 462(33.6%) and in the second dose were 205(20.9%). The most commonly reported AEFI in both first and second dose was pain which was reported by 377(27.4%) and 97(9.9%) respectively, while fever was the second most common AEFI in both first and second dose reported by 65(4.8%) and 91(9.3%) respectively. There were no severe AEFI reported in both doses of vaccination. Most of the AEFI started within 24 h and subsided within 72 h. Conclusion: Minor AEFI was reported with the first and second dose of the Pfizer-BioNTech vaccine. There were no severe and serious AEFI reported in this study population

Adverse events following Immunization with Sinopharm (Vero Cell) inactivated COVID-19 vaccine: Adverse events of Vero Cell vaccine

Introduction: Various types of COVID 19 vaccines are being used globally to control the current pandemic. Post-licensure surveillance of vaccines is essential to ensure safety. This study aimed to determine Adverse Events Following Immunization (AEFIs) of Sinopharm (Vero cell), the inactivated COVID-19 vaccine from China.   Method: This is a cross-sectional observational study conducted at Patan hospital, Patan Academy of Health Sciences (PAHS). Vaccine recipients between April and May were contacted through a phone call after 72 h of vaccination to record the AEFIs. Pattern and distribution of AEFIs were analyzed. Ethical approval was taken from PAHS IRC.   Result: A total of 6142 individuals got the first dose of the vaccine and out of them we were able to contact 4574 through phone calls. Of the 4574, only 941 were included for the follow-up phone call after the second dose of the vaccine. A total of 1336 AEFIs were reported in 868(19%) first dose vaccine recipients while 147 AFEIs were reported in 105(11.2%) second dose vaccine recipients.  The frequently reported AEFIs were pain at the injection site, lethargy, headache, muscle ache, and fever. All the AEFIs were mild to moderate in severity. Most of the AEFIs started within 24 h and resolved within 72 h.   Conclusion: The Sinopharm (Vero cell) vaccine was found to have mild to moderate AEFIs in our study cohort and no case of severe AEFI was identified.

Has Data Quality of an Antimicrobial Resistance Surveillance System in a Province of Nepal Improved between 2019 and 2022?

An operational research study was conducted in 2019 to assess the quality of data submitted by antimicrobial resistance (AMR) surveillance sites in the Bagmati Province of Nepal to the National Public Health Laboratory for Global Antimicrobial Resistance and Use Surveillance System (GLASS). Measures were implemented to enhance the quality of AMR surveillance by strengthening capacity, improving infrastructure, implementing data sharing guidelines, and supervision. The current study examined reports submitted by surveillance sites in the same province in 2022 to assess whether the data quality had improved since 2019. The availability of infrastructure at the sites was assessed. Of the nine surveillance sites in the province, seven submitted reports in 2022 versus five in 2019. Completeness in reporting improved significantly from 19% in 2019 to 100% in 2022 (p < 0.001). Timely reports were received from two sites in 2019 and only one site in 2022. Specimen–pathogen consistency in accordance with the GLASS guidelines for urine, feces, and genital swab specimens improved, with ≥90% consistency at all sites. Overall, the pathogen–antibacterial consistency improved significantly for each GLASS priority pathogen. The study highlights the importance of dedicated infrastructure and institutional arrangements for AMR surveillance. Similar assessments covering all provinces of the country can provide a more complete country-wide picture

Quality Assessment of an Antimicrobial Resistance Surveillance System in a Province of Nepal

Antimicrobial resistance (AMR) is a global problem, and Nepal is no exception. Countries are expected to report annually to the World Health Organization on their AMR surveillance progress through a Global Antimicrobial Resistance Surveillance System, in which Nepal enrolled in 2017. We assessed the quality of AMR surveillance data during 2019–2020 at nine surveillance sites in Province 3 of Nepal for completeness, consistency, and timeliness and examined barriers for non-reporting sites. Here, we present the results of this cross-sectional descriptive study of secondary AMR data from five reporting sites and barriers identified through a structured questionnaire completed by representatives at the five reporting and four non-reporting sites. Among the 1584 records from the reporting sites assessed for consistency and completeness, 77–92% were consistent and 88–100% were complete, with inter-site variation. Data from two sites were received by the 15th day of the following month, whereas receipt was delayed by a mean of 175 days at three other sites. All four non-reporting sites lacked dedicated data personnel, and two lacked computers. The AMR surveillance data collection process needs improvement in completeness, consistency, and timeliness. Non-reporting sites need support to meet the specific requirements for data compilation and sharing

Impact of vaccination on Haemophilus influenzae type b carriage in healthy children less than 5 years of age in an urban population in Nepal

Background Reduction in detection of asymptomatic carriage of Haemophilus influenzae type b (Hib) can be used to assess vaccine impact. In Nepal, routine vaccination against Hib in children at 6, 10, and 14 weeks of age was introduced in 2009. Before vaccine introduction, Hib carriage was estimated at 5.0% among children aged <13 years in Nepal, with higher rates among children under 5. Large-scale evaluation of Hib carriage in children has not been investigated since the introduction of the pentavalent diphtheria-tetanus-pertussis/Hib/hepatitis B (DTP-Hib-HepB) vaccine in Nepal. Methods A total of 666 oropharyngeal swabs were collected between August and December 2018 from healthy children between 6 months and 5 years of age attending the vaccination clinic at Patan Hospital, Kathmandu, Nepal. Of these 666 swabs, 528 (79.3%) were tested for Hib by culture. Demographic and vaccination data were collected. Results Among 528 swabs tested for Hib, 100% came from fully vaccinated children. No swabs were positive for Hib (95% confidence interval, .0–.7). The absence of Hib in 2018 suggests vaccine-induced protection against Hib carriage 9 years after vaccine introduction. Conclusions Following 3 doses of pentavalent DTP-Hib-HepB vaccine, Hib carriage in children under the age of 5 years in Nepal is no longer common. Ongoing high coverage with Hib vaccine in early childhood is expected to maintain protection against Hib disease in Nepal