Perceptions around COVID-19 and vaccine hesitancy: A qualitative study in Kaski district, Western Nepal

Burgeoning morbidity and mortality due to COVID-19 pandemic including the peaks in outbreaks due to different variants have attracted global attention. Although the development and rolling out of vaccines have been impressive, low- and middle-income countries suffer from a double burden: (1) lack of adequate vaccines;and (2) low vaccine uptake (vaccine hesitancy). The main objective of this study was to explore perceptions around COVID-19 and vaccine hesitancy among urban and rural population in Western Nepal. A qualitative study was conducted in six urban wards of Pokhara municipality and four rural municipalities in Kaski district of Nepal. A semi-structured interview guide was used to interview participants who were selected purposively to explore the perceived burden of COVID-19 pandemic, roles, and contributions of vaccine. Nineteen interviews were conducted by telephone following a government recommendation to avoid face-to-face meetings. Audio-recorded interviews were thematically analysed after transcription and translation into English. COVID-19 is a major (public) health concern and affects people at an individual, societal and national level. People dreaded its health hazards and consequences and seemed to be compliant with public health measures such as maintaining social distance, wearing masks and maintaining hygiene. Vaccine was considered to be a major intervention to fight the pandemic, nonetheless, the rationale and benefits of vaccines were blemished by the perceived lack of the vaccine's effectiveness, duration of protection, and its potential side-events. Expedited development of vaccine was embraced with suspicion that vaccine may have incurred compromise in quality. Science and rationale behind vaccine were smeared by misinformation and clearly counteracting the misinformation were deemed critical. Providing information about vaccines through government entities (who are trusted) and respected individuals may engender trust and uptake of vaccine. Fighting off misinformation of COVID-19 is critical to curb the course of pandemic. Increased attention towards monitoring and investing in legitimacy of information and offering information through trusted sources can help improve the vaccine coverage.

Social and mental health impact of COVID-19 pandemic among health professionals of Gandaki Province, Nepal: A mixed method study.

BACKGROUND: The frontline health workers are the key players in the fight against the COVID-19 pandemic, however, several incidences of attacks, stigmatization, and discrimination towards them have been reported throughout the world during the peak of infection. The social impact experienced by health professionals can alter their efficiency and also lead to mental distress. This study aimed to examine the extent of social impact experienced by health professionals currently working in Gandaki Province, Nepal along with the factors associated with their depression status. METHODS: This was a mixed-method study where a cross-sectional online survey was executed among 418 health professionals followed by in-depth interviews with 14 health professionals of Gandaki Province. The bivariate analysis and multivariate logistic regression were performed to identify the factors associated with depression at 5% level of significance. The information collected from the in-depth interviews was clustered into themes by the researchers. RESULTS: Out of 418 health professionals, 304 (72.7%) expressed that COVID-19 has impacted their family relationships, whereas 293 (70.1%) expressed that it impacted their relationships with friends and relatives, and 282 (68.1%) expressed it impacted their relationships with community people. The prevalence of depression among health professionals was noted at 39.0%. Being a female (aOR:1.425,95% CI:1.220-2.410), job dissatisfaction (aOR:1.826, 95% CI:1.105-3.016), COVID-19 impact on family relation (aOR:2.080, 95% CI:1.081-4.002), COVID-19 impact on relationship with friends and relatives (aOR:3.765, 95% CI:1.989-7.177), being badly treated (aOR:2.169, 95% CI:1.303-3.610) and experiencing moderate (aOR:1.655, 95% CI:1.036-2.645) and severe fear (aOR:2.395, 95% CI:1.116-5.137) of COVID-19 were found to the independent predictors of depression. It was noted that the pandemic has an effect on the social relations of health professionals in multiple ways. CONCLUSION: This study noted that there is a significant impact of COVID-19 on health professionals in terms of their social and mental health aspects. The social impact experienced by health professionals is an important predictor of their mental health. The mental health and well-being of these vital workforces can be enhanced by focusing on the social aspect during the pandemic.

Anxiety and depression among people with type 2 diabetes visiting diabetes clinics of Pokhara Metropolitan, Nepal: a cross-sectional study.

OBJECTIVES: To estimate the prevalence of anxiety and depression and identify the associated factors among people with type 2 diabetes mellitus (T2DM) visiting diabetes clinics of Pokhara Metropolitan, Nepal. DESIGN: Cross-sectional study. SETTING: Three diabetes clinics in Pokhara Metropolitan, Nepal, from May to July 2021. PARTICIPANTS: 283 people with T2DM visiting selected diabetes centres of Pokhara Metropolitan. OUTCOME MEASURES: Anxiety and depression were the outcome measures. Face-to-face interviews were conducted using a structured questionnaire comprising information related to participants' sociodemographic profile and several factors along with Hospital Anxiety and Depression-Anxiety subscale and Patient Health Questionnaire-9 to assess the levels of anxiety and depression, respectively. Pearson's Χ2 tests and binary logistic regression were performed to examine association between dependent and independent variables at 5% level of significance. RESULTS: The prevalence of anxiety and depression was 31.4% (95% CI 26.2% to 37.5%) and 36.4% (95% CI 30.8% to 42.0%), respectively. Anxiety was found to be associated with a lower level of perceived social support (adjusted OR (AOR) 2.442, 95% CI 1.020 to 5.845), multiple complications (AOR 2.758, 95% CI 1.015 to 7.334) and comorbidities (AOR 2.110, 95% CI 1.004 to 4.436), severe COVID-19 fear (AOR 2.343, 95% CI 1.123 to 4.887) and sleep dissatisfaction (AOR 1.912, 95% CI 1.073 to 3.047). Economical dependency (AOR 1.890, 95% CI 1.026 to 3.482), no insurance (AOR 2.973, 95% CI 1.134 to 7.093), lower perceived social support (AOR 2.883, 95% CI 1.158 to 7.181), multiple complications (AOR 2.308, 95% CI 1.585 to 6.422) and comorbidities (AOR 2.575, 95% CI 1.180 to 5.617), severe COVID-19 fear (AOR 2.117, 95% CI 1.009 to 4.573), alcohol use (AOR 2.401, 95% CI 1.199 to 4.806) and sleep dissatisfaction (AOR 1.995, 95% CI 1.093 to 3.644) were found to be associated with depression. CONCLUSION: This study showed high prevalence levels of anxiety and depression among people with T2DM. Strengthening social support and focusing on people with diabetes suffering from comorbidity and complications could help to reduce their risk of mental health problems.

Health System Preparedness for COVID-19 and Its Impacts on Frontline Health-Care Workers in Nepal: A Qualitative Study Among Frontline Health-Care Workers and Policy-Makers.

BACKGROUND: Rapidly growing coronavirus disease 2019 (COVID-19) pandemic has brought unprecedented challenges to the health system in Nepal. The main objective of this study was to explore the health system preparedness for COVID-19 and its impacts on frontline health-care workers in Nepal. METHODS: Semi-structured interviews were conducted among 32 health-care workers who were involved in clinical care of COVID-19 patients and four policy-makers who were responsible for COVID-19 control and management at central and provincial level. Interviews were conducted through telephone or Internet-based tools such as Zoom and Skype. All interviews were audio-recorded, transcribed into English, and coded using inductive and deductive approaches. RESULTS: Both health-care workers and policy-makers reported failure to initiate pre-emptive control measures at the early stages of the outbreak as the pivot in pandemic control. Although several measures were rolled out when cases started to appear, the overall health system preparedness was low. The poor governance, and coordination between three tiers of government was compounded by the inadequate personal protective equipment for health-care workers, insufficient isolation beds for patients, and poor engagement of the private sector. Frontline health-care workers experienced various degrees of stigma because of their profession and yet were able to maintain their motivation to continue serving patients. CONCLUSION: Preparedness for COVID-19 was affected by the poor coordination between three tiers of governance. Specifically, the lack of human resources, inadequate logistic chain management and laboratory facilities for testing COVID-19 appeared to have jeopardized the health system preparedness and escalated the pandemic in Nepal. Despite the poor preparedness, and health and safety concerns, health-care workers maintained their motivation. There is an urgent need for an effective coordination mechanism between various tiers of health structure (including private sector) in addition to incentivizing the health-care workers for the current and future pandemics.

Anxiety and Depression Among Health Sciences Students in Home Quarantine During the COVID-19 Pandemic in Selected Provinces of Nepal.

Aim: This study aimed to assess anxiety and depression among health sciences students at home quarantine during the COVID-19 pandemic in selected provinces of Nepal. Methods: A web-based cross-sectional study was conducted among 409 health science students enrolled at graduate and post-graduate levels in selected universities and their affiliated colleges. Students from selected colleges were asked to fill out a survey, that was made available through email and social media outlets such as Facebook and Viber. The data were downloaded in Excel and imported to SPSS version 16 for analysis. Results : The prevalence of anxiety and depression was 15.7 and 10.7%, respectively. The study showed significant associations between (i) place of province and anxiety; (ii) sleep per day and depression; (iii) hours spent on the internet per day for education and depression; (iv) postponement of final exams and depression. There were no significant associations with the socio-demographic variables. Conclusion: Anxiety and depression in health science students showed correlation with the province, internet use for education, and postponement of exams. These correlations could be common among students in other fields as well. A large-scale study covering a wider geographical area and various fields of education is necessary to further evaluate the impact of COVID-19 on (health sciences) students. The integration of mental health programs both as an intervention and a curriculum level among students is critical to ensure the health of the students.

Impact of COVID-19 on community health: A systematic review of a population of 82 million

The novel coronavirus disease 2019 (COVID-19) outbreak, caused by the pathogenic severe acute respiratory syndrome-2 (SARS-CoV-2) virus, is exponentially spreading across the globe. As there is paucity of published literature, the influence of COVID-19 on community health remains unclear. Therefore, we aimed to conduct a systematic review of the literature on the impact of COVID-19 on community health. The current systematic review was performed utilizing electronic databases, i.e., PubMed, MEDLINE, and EMBASE. We searched for the keywords "COVID-19" AND "community health" between January 1, 2020, until May 10, 2020. Although, limited evidence is available regarding quarantine to prevent COVID‐19, most studies considered quarantine as an essential public health measure to minimize rate of infection and mortality. Under these circumstances, people should focus on maintaining personal hygiene, proper nutrition, and extreme social distancing to reduce the risk of COVID-19. Besides, that there is a need to provide professional psychological support to reduce mental ill-health. We have highlighted two different public health approaches in South Asian countries, namely Nepal and India.

How should Nepal apply lock-down exit strategy against rising COVID-19 burden in Nepal?

COVID-19 epidemic in Nepal is escalating with new cases/admissions at hospitals in recent weeks. The rise in cases is contributed by importation from India and has also led to an increase in the number of local/community transmission. While long-term lockdown can have devastating consequences in population, it is high time to consider the possibilities of exit strategies. The main objective of this piece is to explore the literature to lay out the possible measures for exit from the lockdown in Nepal. We used a descriptive review approach to compare and analyze the published academic and non-academic articles related to COVID-19 and lockdown until date. Post lifting plan should be in place as a roadmap to recovery. An exit strategy can be enacted effectively only when the community complies with new normal adjustments aided with effective public health measures and restrictions. Phase-wise measures should be employed while sudden loosening of restriction might result in detrimental effects.

COVID-19 Pandemic: What can Nepal do to Curb the Potential Public Health Disaster?

COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become the pandemic. Since its first report in late December from Wuhan, China, it has spread in 211 countries and has infected more than a million population claiming more than 81,000 lives until 7th April 2020. Although heterogeneous between countries, the recent trend shows that almost 10% of the infected persons are at the risk of death. The case-fatality has been reported to be at 2.3% in China, 7.2% in Italy, 1.73% in South Korea. One of the dreadful characteristics of the COVID-19 is that it is highly efficient at transmission from human to human. SARS-CoV-2 transmits from one human to another through respiratory droplets and close physical contact. Droplet transmission may also occur through fomites in the immediate environment around the infected person. Although there have been multiple studies and trials, no effective vaccines or anti-viral treatments have been effective to prevent or treat SARS-CoV-2 infection and can take another 12-18 months for the evidence to be generated. In this context, the only remained options would be to explore the epidemiological trend and learn from countries who have controlled the infection successfully. The early detection of cases and community containment have been some of the successful strategies. South Korea was able to lower the COVID-19 cases by an extensive and concerted community testing. The traditional strategies of isolation, quarantine, social distancing and community containment helped China to hold its level of infection after the second half of March 2020. With the increasing number of cases, Italy, the United State and the United Kingdom have increased their testing facilities. Germany, for instance, started mass testing and community surveillance quite early on (proactive community testing) reflected on its low fatality rate. In Nepal by 5 April 2020, only 1,521 tests have been performed only among the suspected cases (a reactive testing method) who attend the hospital and so far 9 has been confirmed cases. Though the case was identified in January, the country-wide lockdown came into effect only on 24 March 2020. Based on the report provided by the Ministry of Health and Population, Nepal is trying its best to increase the number of isolation and quarantine facilities along with the provision of essential PPE. Nepal is at stage II (evidence of local transmission as opposed to imported cases only) of a pandemic but it is difficult to say how the disease is circulating in our population due to poor testing coverage and no proactive community testing. Current public health measures that are cost-effective, although not ideal would be to stringently follow social distancing. Social distance alone would be futile unless, other measures are in place that includes proactive community testing, providing essential medical equipment such as personal protective equipment (PPE), isolation and quarantine spaces, medical logistics such as infection control gears, and ICU facilities with adequate ventilators. While social distancing is the best measure, for now, community outreach for proactive testing with mobilization of community health workers and the use of technologies to inform the preventive measures and to dispel the fears, and rumors can be promising. Including the general public, health workers and policymakers require a strong collaborative platform to work together to consolidate the measures ahead to prevent the COVID-19 disaster in Nepal.