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1.
J Infect Dev Ctries ; 16(3): 469-477, 2022 Mar 31.
Article in English | MEDLINE | ID: covidwho-1786128

ABSTRACT

INTRODUCTION: There is limited data on clinical course and outcomes of hospitalized adults with COVID-19 in Nepal. Thus, it is imperative to characterize the features of this disease in the domestic context. METHODOLOGY: We identified all adult patients with laboratory-confirmed COVID-19 admitted to five different hospitals in Nepal from June 15 to July 15, 2020. We collected epidemiological, socio-cultural and clinicopathologic data, and stratified the patients based on their symptom status. RESULTS: The study included 220 patients with an overall median age of 31.5 (25-37) years, and 181 (82.3%) were males. 159 (72.3%) were asymptomatic, and 163 (74.1%) were imported cases. Of 217 patients with the available data, 110 (50.7%) reported their annual household income less than 2000 US dollars, and 122 (56.2%) practiced Pranayama (yogic rhythmic breathing techniques) regularly. Eight patients (3.6%) required supplemental oxygen and two patients (0.9%) died. None of the patients who practiced Pranayama regularly required supplemental oxygen. Compared to asymptomatic patients, symptomatic patients had greater proportion of females (31.1% vs. 12.6%, p = 0.001), imported cases (85.2% vs. 69.8%, p = 0.02), illiterates (26.8% vs. 12.1%, p = 0.01), alcohol users (43.3% vs. 24.5%, p = 0.01), and had higher platelet count (253×109/L vs. 185×109/L, p = 0.02). CONCLUSIONS: Most cases were imported, asymptomatic young males, with very few deaths. Pranayama practice was associated with protection against severe COVID-19, but more data is needed to substantiate this. The association of platelets count with symptom status in the Nepalese population needs further exploration.


Subject(s)
COVID-19 , Adult , COVID-19/epidemiology , Female , Hospitalization , Humans , Male , Nepal/epidemiology , Oxygen , Prospective Studies
2.
BMC Oral Health ; 22(1): 107, 2022 Apr 01.
Article in English | MEDLINE | ID: covidwho-1770521

ABSTRACT

BACKGROUND: During the coronavirus disease (COVID-19) pandemic, ordinary dental services were sustained in Nepal. Because a dental practice is considered to involve a high risk of infection, the needs of dentists should be identified, and demand-driven support should be provided. The purpose of this study was to investigate the situation and needs of dentists during the COVID-19 pandemic in order to guide demand-driven support. First, we investigated how the situation of Nepali dentists differed according to their types of practices between private clinics and university/government hospitals. Second, we assessed the characteristics of dentists demanding four types of support: financial, material, technical, and guidelines/guidance support. METHODS: A cross-sectional online questionnaire survey was conducted between July 28th and August 7th 2020. Closed-ended questions were prepared regarding behavior, material availability, economic and psychological impacts, training, and the main support dentists wanted to receive. The situation of dentists between private clinics and university/government hospitals was determined using a chi-squared test for each variable. To examine the association between the characteristics of dentists and four types of support, multivariable logistic regression analyses were used to estimate adjusted odds ratios (ORs) with a 95% confidence interval (CI) for each variable. RESULTS: There were 352 dentists (137 males and 215 females) included in the analysis. Private clinic dentists experienced a bigger economic impact and demanded financial support that 45.5% of them did not receive a salary, compared to 18.9% in university/government hospitals. On the contrary, university/government hospitals experienced lack of PPE and demanded material support that 79.8% had personal protective equipment, compared to 92.5% in private clinics. Financial support was demanded significantly more by male than female dentists (ORs = 5.56; 95% CI = 2.96-10.45). Material support was demanded significantly more by dentists who received training regarding COVID-19 management (ORs = 1.96; 95% CI = 1.01-3.81). Technical support was demanded significantly less by male dentists (ORs = 0.44; 95% CI = 0.23-0.83). Guideline/guidance support was demanded significantly more by dentists who answered that Nepal Dental Association provided appropriate support (ORs = 2.21; 95% CI = 1.25-3.91). CONCLUSION: This study articulated the diverse needs of Nepali dentists during the COVID-19 pandemic. Demand-driven support should be provided in the future.


Subject(s)
COVID-19 , Pandemics , COVID-19/epidemiology , Cross-Sectional Studies , Dentists/psychology , Female , Humans , Male , Nepal/epidemiology , Surveys and Questionnaires
3.
Inquiry ; 59: 469580221082783, 2022.
Article in English | MEDLINE | ID: covidwho-1765268

ABSTRACT

INTRODUCTION: Despite several attempts to control COVID-19, there was a continuous rise in the number of cases, and this has left questions unanswered on the availability of health resources in Nepal. Here, we tried to assess the level of knowledge, practice and psychological symptoms among medical laboratory staff. METHODS: An online survey was conducted in February 2021. A total of 301 completely filled responses were used to assess knowledge, practice and psychological distress. R-language software was used for data analysis and p-value less than 0.05 was considered statistically significant. RESULTS: Of the total 301 respondents, 180 (59.8%) were male and 121 (40.2%) were female. The average score of knowledge obtained in this study was 32.4 ± 5.7 on a 56-point scale. Knowledge level was significantly different among age-groups (p-value - 0.034). The average practice score obtained was 2.25 ± 0.91 on a 4-point scale. More than one psychological distress symptom was observed in nearly half (41.5%) of the participants. CONCLUSION: We conclude that medical laboratory staff in Nepal has satisfactory levels of knowledge and practice and, larger number of them has psychological distress. The study recommends further improvement in an effective information flow system, regular training, social security and psychological support.


Subject(s)
COVID-19 , Female , Humans , Male , Medical Staff , Nepal/epidemiology , Pandemics , Surveys and Questionnaires
4.
J Environ Public Health ; 2022: 3276583, 2022.
Article in English | MEDLINE | ID: covidwho-1745635

ABSTRACT

COVID-19 pandemic has overburdened the public healthcare system around the world. Further, lockdown imposed to curb the spread of pandemic has shown to have an adverse effect on economic and health status of an individual. It has also compelled us to switch from the physical world to virtual world, thus depriving us of benefits of person-to-person direct contact. People from developing countries are specially affected. An average person here lacks basic skills needed to survive in the digital world. Due to limited COVID-19 testing capacities in such countries, there is also less testing. Less testing means less contact tracing, underreported cases, and rapid spread of disease. In this paper, the underreported cases of daily infections and daily deaths are predicted using mathematical models. This is based on daily data published by the Government of Nepal. Here, Kathmandu valley is taken as a model area for estimation of underreporting. The behavior of probability of infection, probability of recovery, and probability of deaths is also mathematically analyzed. A time-dependent susceptible infected and recovered model is also proposed. Here, the second wave of COVID-19 is analyzed in detail from 1 Feb 2021 to 1 June 2021. The effect of lockdown on the psychology of people is also modeled with principal components analysis. The inherent and latent factors affecting the people in lockdown are identified. This is based on detailed primary data collected from a survey of 277 households.


Subject(s)
COVID-19 , COVID-19 Testing , Communicable Disease Control , Humans , Nepal/epidemiology , Pandemics , SARS-CoV-2
5.
JNMA J Nepal Med Assoc ; 58(224): 248-251, 2020 Apr 30.
Article in English | MEDLINE | ID: covidwho-1727356

ABSTRACT

INTRODUCTION: Coronavirus disease pandemic has affected large number of people globally and has continued to spread. Preparedness of individual nations and the hospitals is important to effectively deal with the surge of cases. We aimed to obtain nation wide data from Nepal, about hospital preparedness for COVID-19. METHODS: Online questionnaire was prepared in accordance with the Center for Disease Control recommendations to assess preparedness of hospitals for COVID-19. The questionnaire was circulated to the over 800 doctors across the nation, who are the life members of six medical societies. RESULTS: We obtained 131 completed responses from all seven provinces. Majority of respondents had anaesthesiology as the primary specialty. Only 52 (39.7%) participants mentioned that their hospital had policy to receive suspected or proven cases with COVID-19. Presence of isolation ward was mentioned by 83 (63.4%) respondents, with only 9 (6.9%)mentioning the presence of airborne isolation. Supply of personal protective equipment (PPE) was inadequate as per 124 (94.7%) respondents. Critical care services for COVID-19 patients were possible only in hospitals of 42 (32.1%)respondents. RT-polymerase chain reaction could be performed only in the hospital of 6 (4.6%) respondents. CONCLUSIONS: It is apparent that most of the hospitals are not well prepared for management of patients with COVID-19. Resource allocation and policy making should be aimed to enhance national preparedness for the pandemic.


Subject(s)
Civil Defense , Coronavirus Infections , Coronavirus , Emergency Service, Hospital/organization & administration , Pandemics , Pneumonia, Viral , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Emergencies , Humans , Nepal/epidemiology , Personal Protective Equipment/supply & distribution , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , SARS-CoV-2 , Surveys and Questionnaires
6.
Int J Environ Res Public Health ; 19(5)2022 Feb 24.
Article in English | MEDLINE | ID: covidwho-1715335

ABSTRACT

The recent global pandemic of the novel coronavirus disease 2019 (COVID-19) is affecting the entire population of Nepal, and the outcome of the epidemic varies from place to place. A district-level analysis was conducted to identify socio-demographic risk factors that drive the large variations in COVID-19 mortality and related health outcomes, as of 22 January 2021. Data on COVID-19 extracted from relevant reports and websites of the Ministry of Health and Population of Nepal, and the National Population and Housing Census and the Nepal Demographic and Health Survey were the main data sources for the district-level socio-demographic characteristics. We calculated the COVID-19 incidence, recovered cases, and deaths per 100,000 population, then estimated the associations with the risk factors using regression models. COVID-19 outcomes were positively associated with population density. A higher incidence of COVID-19 was associated with districts with a higher percentage of overcrowded households and without access to handwashing facilities. Adult literacy rate was negatively associated with the COVID-19 incidence. Increased mortality was significantly associated with a higher obesity prevalence in women and a higher smoking prevalence in men. Access to health care facilities reduced mortality. Population density was the most important driver behind the large variations in COVID-19 outcomes. This study identifies critical risk factors of COVID-19 outcomes, including population density, crowding, education, and hand hygiene, and these factors should be considered to address inequities in the burden of COVID-19 across districts.


Subject(s)
COVID-19 , Adult , COVID-19/epidemiology , Female , Humans , Incidence , Male , Nepal/epidemiology , Risk Factors , SARS-CoV-2
7.
J Nepal Health Res Counc ; 19(3): 587-595, 2021 Dec 15.
Article in English | MEDLINE | ID: covidwho-1687866

ABSTRACT

BACKGROUND: Pandemic of COVID-19 has engulfed Nepal as well. In this paper, we studied the demographic, clinical, laboratory findings as well as the treatment modalities, prognostic factors and outcome of patients admitted with COVID-19. METHODS: This was an observational cross-sectional study that included all patients admitted to the General Medicine Department of College of Medical Sciences, Bharatpur, during the first wave of COVID-19 from April 2020 to February 2021 after obtaining the ethical clearance. Data analysis was done using statistical packages for social sciences version 16. RESULTS: A total of 119 patients with mean age of 61.5 years were admitted. They had a mean duration of onset of symptoms of 7.1 days. Commonest symptoms were fever (70.6%), cough (67.2%) and dyspnea (64.7%). Severe COVID-19 at admission with a median CT severity score of 15 was found in 49.7% of them. Total 83.2% patients required ICU care and 10.9% required mechanical ventilation. ARDS and secondary infection occurred in 17.6% each. Median length of hospital stay was 6 days. In total, 56.3% recovered 27.7% left against medical advice and 16.0% expired. Severity of COVID at admission, CT severity score at presentation and D-dimer at admission were found to be significantly associated with mortality (P<0.05).Neither of the age, duration of illness, CRP at admission nor the use of remdesivir or convalescent plasma had significant relation with the mortality (P>0.05). CONCLUSIONS: Severity of illness at presentation, CT severity score and D-dimer level at admission are significantly associated with mortality of the patients admitted with COVID-19.


Subject(s)
COVID-19 , COVID-19/diagnosis , COVID-19/therapy , Cross-Sectional Studies , Hospitals , Humans , Immunization, Passive , Intensive Care Units , Middle Aged , Nepal/epidemiology , SARS-CoV-2
8.
J Nepal Health Res Counc ; 19(3): 460-466, 2021 Dec 10.
Article in English | MEDLINE | ID: covidwho-1687865

ABSTRACT

BACKGROUND: Pneumomediastinum, an uncommon entity, has been on the rise with increasing cases of COVID-Acute respiratory distress syndrome. It has been unclear whether this entity represents an indicator of poor clinical outcome or not. The aims of this study were to find out the incidence of pneumomediastinum in COVID-Acute respiratory distress syndrome patients, describe their clinical characteristics and try to explain its plausible mechanisms.. METHODS: A descriptive, cross-sectional study was carried out in the ICU of our hospital among 280 patients admitted with COVID-Acute respiratory distress syndrome over a period of 6 months. Demographics along with various clinical, laboratory, and radiological parameters were analyzed. Relevant statistical analyses were done to summarize our findings. RESULTS: The incidence of pneumomediastinum in COVID-ARDS patients was 2.8%. All patients were male, none had pulmonary co-morbidities and six of them (60%) were on invasive mechanical ventilation. All intubated patients were on lung protective mechanical ventilation. The median PEEP, peak airway pressure and plateau pressure were 10 (IQR: 4), 29 (IQR: 8) and 28 (IQR: 4) respectively. The mean CT severity score was 22.7 (SD: 1.64). Five patients died after 6.8 days (SD: 4.8) of diagnosis. The average hospital stay was of 34 days. CONCLUSIONS: Pneumomediastinum is a possible complication of COVID-Acute respiratory distress syndrome which could signify the disease severity and vice versa. Furthermore, it could be an indicator of relatively poor prognosis and therefore requires larger studies to establish the association.


Subject(s)
COVID-19 , Mediastinal Emphysema , Respiratory Distress Syndrome , Cross-Sectional Studies , Humans , Male , Mediastinal Emphysema/diagnostic imaging , Mediastinal Emphysema/epidemiology , Nepal/epidemiology , Respiration, Artificial , Respiratory Distress Syndrome/epidemiology , SARS-CoV-2
9.
Sci Total Environ ; 824: 153816, 2022 Jun 10.
Article in English | MEDLINE | ID: covidwho-1676914

ABSTRACT

The applicability of wastewater-based epidemiology (WBE) has been extensively studied throughout the world with remarkable findings. This study reports the presence and reduction of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at two wastewater treatment plants (WWTPs) of Nepal, along with river water, hospital wastewater (HWW), and wastewater from sewer lines collected between July 2020 and February 2021. SARS-CoV-2 RNA was detected in 50%, 54%, 100%, and 100% of water samples from WWTPs, river hospitals, and sewer lines, respectively, by at least one of four quantitative PCR assays tested (CDC-N1, CDC-N2, NIID_2019-nCOV_N, and N_Sarbeco). The CDC-N2 assay detected SARS-CoV-2 RNA in the highest number of raw influent samples of both WWTPs. The highest concentration was observed for an influent sample of WWTP A (5.5 ± 1.0 log10 genome copies/L) by the N_Sarbeco assay. SARS-CoV-2 was detected in 47% (16/34) of the total treated effluents of WWTPs, indicating that biological treatments installed at the tested WWTPs are not enough to eliminate SARS-CoV-2 RNA. One influent sample was positive for N501Y mutation using the mutation-specific qPCR, highlighting a need for further typing of water samples to detect Variants of Concern. Furthermore, crAssphage-normalized SARS-CoV-2 RNA concentrations in raw wastewater did not show any significant association with the number of new coronavirus disease 2019 (COVID-19) cases in the whole district where the WWTPs were located, suggesting a need for further studies focusing on suitability of viral as well as biochemical markers as a population normalizing factor. Detection of SARS-CoV-2 RNA before, after, and during the peaking in number of COVID-19 cases suggests that WBE is a useful tool for COVID-19 case estimation in developing countries.


Subject(s)
COVID-19 , Waste Water , COVID-19/epidemiology , Hospitals , Humans , Nepal/epidemiology , RNA, Viral , Rivers , SARS-CoV-2/genetics , Water
10.
BMJ Open ; 12(2): e056342, 2022 02 03.
Article in English | MEDLINE | ID: covidwho-1673444

ABSTRACT

BACKGROUND: COVID-19 has greatly impacted older adults with pre-existing noncommunicable conditions (hereafter called pre-existing conditions) in terms of their access to essential healthcare services. Based on the theory of vertical health equity, this study investigated access to healthcare by Nepali older adults with pre-existing conditions during the COVID-19 pandemic. METHODS: A cross-sectional study surveyed 847 randomly selected older adults (≥60 years) in three districts of eastern Nepal. Survey questionnaires, administered by trained community health workers, collected information on participants reported difficulty obtaining routine care and medications during the pandemic, in addition to questions on demographics, socioeconomic factors and pre-existing conditions. Cumulative scores for pre-existing conditions were recoded as no pre-existing condition, single condition and multimorbidity for the analyses. χ2 tests and binary logistic regressions determined inferences. RESULTS: Nearly two-thirds of the participants had a pre-existing condition (43.8% single condition and 22.8% multimorbid) and reported experiencing difficulty obtaining routine care (52.8%) and medications (13.5%). Participants with single (OR 3.06, 95% CI 2.17 to 4.32) and multimorbid (OR 5.62, 95% CI 3.63 to 8.71) conditions had threefold and fivefold increased odds of experiencing difficulty accessing routine care. Findings were similar for difficulty obtaining medication (OR single: 3.12, 95% CI 1.71 to 5.69; OR multimorbid: 3.98, 95% CI 2.01 to 7.87) where odds were greater than threefolds. CONCLUSIONS: Older adults with pre-existing conditions in Nepal, who require routine medical care and medication, faced significant difficulties obtaining them during the pandemic, which may lead to deterioration in their pre-existing conditions. Public health emergency preparedness should incorporate plans for both managing the emergency and providing continuing care.


Subject(s)
COVID-19 , Aged , Cross-Sectional Studies , Health Services Accessibility , Humans , Nepal/epidemiology , Pandemics , Preexisting Condition Coverage , SARS-CoV-2
11.
JNMA J Nepal Med Assoc ; 60(245): 40-46, 2022 Jan 15.
Article in English | MEDLINE | ID: covidwho-1675618

ABSTRACT

INTRODUCTION: Amidst the chaos of COVID-19, health care practitioners are persistently providing services and experiencing many challenges. This study aimed to determine the perception of health care practitioners of government designated COVID-19 hospitals of Nepal towards the management of COVID-19 pandemic. METHODS: A descriptive cross-sectional study was conducted among the frontline health care practitioners working in the government designated COVID-19 hospitals in Nepal from 21st June, 2020 to 15th August, 2020. Ethical approval was obtained from the Ethical Review Board of the Nepal Health Research Council (Reference number: 347/2020 P). A total of 252 health care practitioners (doctors, nurses, and paramedics) working at the forefront in the emergency ward, general wards, intensive care units, isolation centers, fever clinics, laboratory, quarantine centers, help desks, etc. in the designated hospitals who consented to participate were included in the study. Convenience sampling was used. The data was analyzed using Statistical Package for the Social Sciences version 16.0. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. RESULTS: Only 41 (16.3%) (11.73-20.86 at 95% Confidence Interval) of the health care practitioners were found to have satisfactory perception towards the management of COVID-19 pandemic in Nepal. CONCLUSIONS: The satisfactory perception of the health care practitioners in our study towards the management of COVID-19 pandemic in Nepal is lower as compared to the other studies in Nepal and abroad.


Subject(s)
COVID-19 , Cross-Sectional Studies , Delivery of Health Care , Government , Hospitals , Humans , Nepal/epidemiology , Pandemics , Perception , SARS-CoV-2
12.
PLoS One ; 17(1): e0262958, 2022.
Article in English | MEDLINE | ID: covidwho-1648374

ABSTRACT

BACKGROUND: Past works have linked the COVID-19 pandemic and subsequent public health responses such as isolation, quarantine, and lockdown to increased anxiety, sleep disorders, depressive symptoms, and suicidal ideation. Only a few studies, mostly carried out in high-income countries, have investigated the association between the pandemic and suicide rate. We seek to investigate the changes in the monthly suicide rates during the COVID-19 pandemic in Nepal, compared to the pre-pandemic suicide rates. METHODS AND FINDINGS: This is a retrospective study investigating the changes in suicide rates in Nepal during the COVID-19 pandemic period (April 2020 to June 2021), compared to the pre-pandemic period (July 2017 to March 2020), adjusted for seasonality and long-term trend in the suicide rate. We performed analysis for the entire country as well as sub-sample analyses stratified by gender and provinces. A total of 24350 suicides deaths during four years of the study window were analyzed. We found an overall increase in the monthly suicide rate in Nepal with an average increase of 0.28 (CI: 0.12,0.45) suicide per 100,000 during the pandemic months. The increase in suicide rate was significant both among males (increase in rate = 0.26, CI: 0.02,0.50) and females (increase in rate = 0.30, CI: 0.18,0.43). The most striking increments in suicide rates were observed in June, July, and August 2020. The pattern of increased suicide rates faded away early on among males, but the effect was sustained for a longer duration among females. Sudurpaschim and Karnali provinces had the highest increase in suicide rates associated with the COVID-19 pandemic. CONCLUSIONS: The COVID-19 pandemic is associated with an increased suicide rate in Nepal. The findings may inform policymakers in designing appropriate public health responses to the pandemic that are considerate of the potential impact on mental health and suicide.


Subject(s)
Anxiety/psychology , COVID-19/psychology , Depression/psychology , Social Isolation/psychology , Suicidal Ideation , Suicide/psychology , Adult , Anxiety/epidemiology , COVID-19/epidemiology , Depression/epidemiology , Female , Humans , Male , Mental Health/statistics & numerical data , Nepal/epidemiology , Quarantine/psychology , Retrospective Studies , SARS-CoV-2/pathogenicity , Suicide/statistics & numerical data
13.
PLoS One ; 16(12): e0260638, 2021.
Article in English | MEDLINE | ID: covidwho-1638085

ABSTRACT

INTRODUCTION: The study aimed at exploring the adverse events following immunization (AEFI) and their incidences among health workers in three different districts of central and western Nepal following the first dose of Covishield vaccine,. It also aimed at studying the association of AEFI with demographic and clinical characteristics of vaccinees, pre-vaccination anxiety level and prior history of COVID-19 infection (RT- PCR confirmed) status. MATERIALS AND METHODS: This was a cross-sectional study carried out via face-to-face or telephonic interview among 1006 health workers one week after receiving their first dose of the Covishield vaccine. Incidence of adverse events was calculated in percentage while Chi-square Test was used to check the association of AEFI with independent variables. Logistic regression was used to find out the adjusted odd's ratio at 95% CI. RESULTS: Incidence of AEFI was 79.8% with local and systemic AEFI being 68.0% and 59.7% respectively. Injection site tenderness was the commonest manifestation. Local and systemic symptoms resolved in less than one week among 96.8% and 98.7% vaccinees respectively. Females were more likely to develop AEFI than males (AOR = 1.7, 95% CI = 1.2-2.4). Vaccinees aged 45-59 years were 50% less likely to develop AEFI as compared to those aged less than 30 years (AOR 0.5, 95% CI = 0.3-0.8). Most of the vaccinees had not undergone RT-PCR testing for COVID-19 (59.8%). Those who were not tested for COVID-19 prior were 1.5 odds more likely to develop AEFI compared to those who were negative (AOR = 1.5, 95% CI = 1.1-2.1). CONCLUSION: More than two-third of the vaccinees developed one or more forms of adverse events, but most events were self-limiting. Females and young adults were more prone to develop AEFI.


Subject(s)
/adverse effects , Health Personnel/statistics & numerical data , Acetaminophen/pharmacology , Adult , Aged , COVID-19/epidemiology , Comorbidity , Cross-Sectional Studies , Female , Health Personnel/psychology , Humans , Male , Middle Aged , Nepal/epidemiology , Time Factors , Vaccination/adverse effects , Vaccination/psychology
14.
PLoS One ; 16(12): e0261524, 2021.
Article in English | MEDLINE | ID: covidwho-1591594

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has affected the health systems in many ways. It has put unprecedented strain on health systems worldwide and exposed gaps in public health infrastructure. A health system comprises all institutions and resources working towards improving and maintaining health. Among the different aspects of health system strengthening, a patient's experiences and expectations play a crucial role in determining how well the health facilities function. This study aims to explore health system strengthening's implications based on experiences and feedback provided by COVID-19 patients admitted to a government tropical and infectious disease hospital in Nepal. METHODS: In this qualitative study, we collected the voluntary handwritten feedback by the admitted COVID-19 patients to document the feedback and experiences from a book, maintained by the hospital. We performed thematic content analysis using the World Health Organization's six building blocks of health system as a theoretical framework which included service delivery, health workforce, information, leadership and governance, financing, and access to medicines. RESULTS: Most patients in this study had positive experiences on service delivery and health workforce. Some also highlighted the gaps in infrastructure, cleanliness, and hygiene. Many suggested positive experiences on other dimensions of the health system such as financing, governance and leadership, and access to medicines reflected upon by the patients' thankfulness to the hospital and the government for the treatment they received. The responses also reflected the inter-connectedness between the different building blocks of health system. CONCLUSION: This study approached a unique way to strengthen the health system by exploring patients' feedback, which suggested an overall positive impression on most building blocks of health system. However, it also highlighted certain gaps in infrastructure, cleanliness, and hygiene. It reinforces the hospital management and government's role to continue its efforts to strengthen the health system.


Subject(s)
COVID-19/epidemiology , Delivery of Health Care , Pandemics , Patient Reported Outcome Measures , Government Programs , Hospitals , Humans , Nepal/epidemiology , Qualitative Research , Surveys and Questionnaires
15.
Trop Med Int Health ; 27(2): 165-173, 2022 02.
Article in English | MEDLINE | ID: covidwho-1583250

ABSTRACT

OBJECTIVES: To understand COVID-19 worries and how they influence COVID-19 mitigation behaviours, especially in communities prior to case surges, in Nepal. METHODS: Data related to COVID-19 impacts on life disruptions were collected from households in the Chitwan Valley Family Study, a 25-year community panel study, during February-April 2021. COVID-19 worry was measured by the extent of respondent concern for themselves or household members getting COVID-19 in the prior 2 weeks. 11 items examined COVID-19 mitigation behaviours. Logistic regression models assessed associations between socio-demographic characteristics and COVID-19 worry and then the influence of worry on any mitigation behaviour and behaviour type adjusting for age, education, sex, ethnicity and COVID-19 exposure, accounting for neighbourhood clustering. RESULTS: Of 2,678 households with a responding adult, ages 18-88, 394 (14.7%) reported moderate-to-extreme COVID-19 worry and 1,214 (45.3%) engaged in three or more mitigation behaviours. Prevalence of mitigation behaviours was higher among those with COVID-19 worry (e.g. avoided crowds: 62.7% versus 40.5% in those with minimal worry). Respondents self-reporting COVID-19 had higher odds of worry (adjusted odds ratio [aOR]: 2.73, 95% confidence interval [CI]: 1.13, 6.57). Odds of any mitigation behaviour were higher among those with COVID-19 worry compared to those with minimal worry (aOR: 6.19, 95% CI = 1.88, 20.35). CONCLUSIONS: COVID-19 mitigation behaviours were more common in people with COVID-19 worry. To address current and potential future waves of the pandemic, public health efforts should include informational campaigns about mitigation behaviours particularly for those unconcerned with COVID-19 risks.


Subject(s)
COVID-19/epidemiology , COVID-19/psychology , Social Behavior , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/ethnology , Educational Status , Female , Humans , Logistic Models , Male , Middle Aged , Nepal/epidemiology , Prevalence , Young Adult
16.
JNMA J Nepal Med Assoc ; 59(244): 1293-1296, 2021 Dec 11.
Article in English | MEDLINE | ID: covidwho-1579277

ABSTRACT

INTRODUCTION: The outbreak of COVID-19  as changed patterns of mortality in different setups. The rate of suicide has increased in some countries during the pandemic while the overall death rates  have decreased. The study was conducted with objective to find out the prevalence of unnatural deaths among the autopsy cases brought at tertiary care hospital during COVID-19 pandemic period. METHODS: This is a descriptive cross-sectional study using the records of the medico legal autopsies conducted from 24th March 2020 to 23rd August 2020 during the COVID-19 pandemic in Pokhara Academy of Health Sciences. Ethical approval was taken from Institutional Review Committee of Pokhara Academy of Health Sciences (Reference number 28.2077/78). Whole sampling method was used. Records which were available were included in the study whereas those cases whose complete records were not available were excluded. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. RESULTS: Out of 188 deaths studied at the autopsy during the COVID-19 pandemic period, the prevalence of unnatural deaths was 147 (78.19%) (71.04-85.33 at 95% Confidence Interval). Among these deaths, 109 (74.14%) were males and 38 (25.85%) were females. Suicide was the most common manner attributing to 78 (53.06%) of the unnatural deaths. CONCLUSIONS: The prevalence of suicide was more than those demonstrated by earlier observations in similar settings before the pandemic period. Suicidal deaths were more common during the COVID 19 pandemic. This is an indicator of frustration of the people and necessary steps have to be taken to decrease such deaths in similar conditions to come.


Subject(s)
COVID-19 , Autopsy , Cross-Sectional Studies , Female , Humans , Male , Nepal/epidemiology , Pandemics , SARS-CoV-2 , Tertiary Care Centers
17.
JNMA J Nepal Med Assoc ; 59(244): 1326-1327, 2021 Dec 11.
Article in English | MEDLINE | ID: covidwho-1579276

ABSTRACT

The government of Nepal proposed to provide  health services for both  COVID and non-COVID infected patients through telemedicine.After the outbreak of the COVID-19 in Nepal, the number of people taking online health services, including counselling, increased by 70% as compared to last year in the Kathmandu valley. People being depressed staying alone in isolation and quarantine can get an opportunity to talk and share their problems with doctors through the means of telemedicine. Telemedicine has saved the time, effort and money of people living in remote areas.


Subject(s)
COVID-19 , Telemedicine , Humans , Nepal/epidemiology , Pandemics , SARS-CoV-2
18.
PLoS One ; 16(12): e0260435, 2021.
Article in English | MEDLINE | ID: covidwho-1560860

ABSTRACT

INTRODUCTION: There is a paucity of data on the impact of COVID-19 pandemic on girls and young women. The study examines the prevalence and correlates of violence and sexual and reproductive health (SRH) service disruption among girls and young women during COVID-19 restrictions and lockdown. METHODS: An interactive voice response survey was conducted among girls and women aged 18-24 years between 10th March to 24th April 2021. The survey enrolled 1314 participants. Descriptive analysis was used to assess prevalence of violence and SRH service disruption. Two sampled test of proportion was used to asses difference in prevalence of violence before and after the pandemic. Logistic regression was used to examine relationship between the outcome variables and socio demographic predictors. RESULTS: The study did not find significant difference in prevalence of violence before and after the pandemic. Education was found to be protective against experience of both physical and sexual violence after the pandemic. Dalit participants were four times more likely to report physical violence after the pandemic than Brahmin/Chhetri participants (OR:3.80; CI:1.41-10.24). Participants from 22-24-year age group were twice as likely to experience sexual violence compared to girls and participants from 18-21year age group (OR:2.25; CI:1.04-4.84). Participants from urban municipalities were 29% less likely to report SRH services disruption than participants from rural municipalities (OR-0.71, 95% CI: 0.55-0.91). Participants with disability were twice as likely to report disruption than participants without disability (OR-2.35, 95% CI: 1.45-3.82). CONCLUSIONS: To reduce violence against girls and women due to the pandemic, interventions should focus on Dalit women and on preventing education discontinuation among girls and women. SRH service during the pandemic needs to be improved for girls and women with focus on girls and women from rural municipalities and girls and women with disability.


Subject(s)
COVID-19/epidemiology , Physical Abuse/statistics & numerical data , Reproductive Health Services/statistics & numerical data , Sex Offenses/statistics & numerical data , Adolescent , COVID-19/virology , Cross-Sectional Studies , Disabled Persons/psychology , Female , Humans , Nepal/epidemiology , Pandemics , Rural Population , SARS-CoV-2/isolation & purification , Surveys and Questionnaires , Urban Population , Young Adult
19.
JNMA J Nepal Med Assoc ; 59(242): 983-986, 2021 Oct 15.
Article in English | MEDLINE | ID: covidwho-1547960

ABSTRACT

INTRODUCTION: The world has been threatened with the emergence of the Novel Corona Virus straining the health care system and creating a global pandemic. This is not the first pandemic, and it certainly will not be the last to affect humanity. As the medical community is exposed to these highly contagious new diseases with arrays of symptoms like fever, cough, shortness of breath, anosmia, insomnia, and myalgia. Back pain can also be considered as one of the symptoms of COVID-19 infection. Therefore, this study aimed to find out the prevalence of back pain among the Health care workers who were tested positive for COVID-19 by the end of their isolation period. METHODS: This descriptive cross-sectional study was done from April 2021 to June 2021 in KIST Medical College and Teaching Hospital, Imadol, Lalitpur, Nepal, after receiving ethical approval from the Institutional Review Committee (Registration number: 2077/078/57). Convenience sampling was done. Data collection and entry were done in Microsoft excel, point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Out of 156 COVID-19 positive patients, the prevalence of back pain was seen among 64 (41%) patients (95% Confidence Interval= 42.23-57.75). Among them 21 (32.8%) were males and 43 (67.2%) were females. Likewise, the minimum age was 20 years and the maximum was 68 years with a mean of 33.5±10.28. CONCLUSIONS: This study demonstrated that a high proportion of healthcare workers were suffering from back pain and the findings are similar to the data from other international studies.


Subject(s)
COVID-19 , Adult , Back Pain/epidemiology , Cross-Sectional Studies , Female , Health Personnel , Humans , Male , Nepal/epidemiology , SARS-CoV-2 , Tertiary Care Centers , Young Adult
20.
JNMA J Nepal Med Assoc ; 59(242): 987-991, 2021 Oct 15.
Article in English | MEDLINE | ID: covidwho-1547956

ABSTRACT

INTRODUCTION: COVID-19 has a wide spectrum of clinical presentation ranging from asymptomatic infection to acute respiratory distress syndrome and multi organ dysfunction. Data regarding this is scarce in our setting. This study aims to study the prevalence of fever in confirmed COVID-19 cases in a tertiary care hospital of western Nepal. METHODS: We conducted a descriptive cross-sectional study among patients admitted to COVID-19 wards and intensive care units of a tertiary care hospital. We enrolled patients from August 2020 to January 2021 and the study proposal was approved by the Institutional Review Committee (reference number: 069/20). Convenience sampling method was used. Data entry and descriptive analysis were done in Statistical Package for the Social Sciences version 16.0. Point estimate at 95% Confidence Interval was calculated along with frequency and descriptive statistics. RESULTS: Among 206 cases of COVID-19, the most common symptom was fever 136 (66.1%) (95% Confidence Interval= 58.14.63-74.05). Sixty-seven (49.3%) of those with fever required intensive care units admission whereas 27 (19.9%) of patients with fever had mortality. Most common comorbidities in the patient having fever is Diabetes mellitus 41 (66.1%) followed by hypertension 20 (62.5%). CONCLUSIONS: Fever was the most common presenting complaint with high prevalence as compared to similar studies done in similar settings. We stress the importance of considering the presence of COVID-19 even in the absence of fever as many patients presented without fever.


Subject(s)
COVID-19 , Cross-Sectional Studies , Humans , Nepal/epidemiology , SARS-CoV-2 , Tertiary Care Centers
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