Use of antimicrobials during the COVID-19 pandemic: a qualitative study among stakeholders in Nepal (preprint)

Introduction The COVID-19 pandemic was a major public health threat and posed tremendous pressure to develop a cure for it. Apart from ongoing efforts in developing vaccines, a lot of empirical treatments were recommended, that may have expedited the use of antimicrobials. The main objective of this study was to explore if and how the pandemic posed pressure on antimicrobials in Nepal using semi-structured interviews (SSIs) among patients, clinicians and drug dispensers. Methods A total of 30 stakeholders (10 each among clinicians, dispensers and COVID-19 patients) were identified purposively and were approached for SSIs. Clinicians and dispensers working in three tertiary hospitals in Kathmandu were first approached and were asked for their support to reach out to COVID-19 patients who were on follow-up at their out-patient department. SSIs were audio recorded, translated and transcribed into English, and were analyzed for thematic synthesis. Results Over-the-counter (OTC) uses of antibiotics was widespread during the pandemic, and were mostly rooted to patients attempts to halt the potential severity due to respiratory like illnesses, and the fear of being identified as a COVID-19 patients. Being identified as a COVID-19 patient was feared because of the stigmatization and social isolation. Patients who visited the drug shops and physicians were reported to make demands on specific medicines including antibiotics that may have added pressure among physicians and dispensers. Clinicians reported a degree of uncertainty related to treatment and that may have added pressure to prescribe antimicrobials. All stakeholders, although mostly patients and dispensers with limited understanding of what constitutes antimicrobials and the mechanisms underpinning it reported that the pressure during the pandemic may have added to the adversities such as antimicrobials resistance. Conclusions COVID-19 added a pressure to prescribe, dispense and overuse antimicrobials and may have accentuated the pre-existing OTC use of antimicrobials. Future pandemics including infectious disease outbreaks are major public health incidents that warrant a special caution on inappropriate pressure on antimicrobials. Strict policies related to the use of antimicrobials are urgent to redress their use during normal and pandemic situations.

Anxiety and depression among people living in quarantine centers during COVID-19 pandemic: A mixed method study from western Nepal (preprint)

BackgroundIn response to the COVID-19 pandemic, incoming travelers were quarantined at specific centers in Nepal and major checkpoints in Nepal-India border. Nepal adopted a generic public health approaches to control and quarantine returnee migrants, with little attention towards the quality of quarantine facilities and its aftermath, such as the poor mental health of the returnee migrants. The main objective of this study was to explore the status of anxiety and depression, and factors affecting them among returnee migrants living in institutional quarantine centers of western Nepal. MethodsA mixed method approach was used which included a quantitative survey and in-depth interviews (IDIs). Survey questionnaire utilized Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) tools, which were administered among 441 quarantined returnee migrants and IDIs were conducted among 12 participants which included a mix of quarantined migrants and healthcare workers from the quarantine centres. Descriptive and inferential analyses were conducted on quantitative data; and thematic analysis was utilized for qualitative data. ResultsMild depression (9.1%; 40/441) and anxiety (16.1%, 71/441) was common among respondents followed by moderate depression and anxiety {depression (3.4%; 15/441), anxiety (4.1%, 18/441)} and severe depression and anxiety {depression (1.1%; 5/441), anxiety (0.7%, 3/441)}. Anxiety and depression were independent of their socio-demographic characteristics. Perceived fear of contracting COVID-19, severity and death were prominent among the respondents. Respondents experienced stigma and discrimination in addition to being at the risk of disease and possible loss of employment and financial responsibilities. In addition, poor (quality and access to) health services, and poor living condition at the quarantine centres adversely affected respondents mental health. ConclusionDepression and anxiety among quarantined population warrants more research. Institutional quarantine centers of Karnali province of Nepal were in poor conditions which adversely impacted mental health of the respondents. Poor resources allocation for health, hygiene and living conditions can be counterproductive to the population quarantined.