Assessment of geographical accessibility to COVID-19 testing facilities in Nepal (2021).

Background: Ensuring equitable physical access to SARS-CoV-2 testing has proven to be crucial for controlling the COVID-19 epidemic, especially in countries like Nepal with its challenging terrain. During the second wave of the pandemic in May 2021, there was immense pressure to expand the laboratory network in Nepal to ensure calibration of epidemic response. The expansion led to an increase in the number of testing facilities from 69 laboratories in May 2021 to 89 laboratories by November 2021. We assessed the equity of physical access to COVID-19 testing facilities in Nepal during 2021. Furthermore, we investigated the potential of mathematical optimisation in improving accessibility to COVID-19 testing facilities. Methods: Based on up-to-date publicly available data sets and on the COVID-19-related daily reports published by Nepal's Ministry of Health and Population from May 1 to November 15, 2021, we measured the disparities in geographical accessibility to COVID-19 testing across Nepal at a resolution of 1 km2. In addition, we proposed an optimisation model to prescribe the best possible locations to set up testing laboratories maximizing access, and tested its potential impact in Nepal. Findings: The analysis identified vulnerable districts where, despite ramping up efforts, physical accessibility to testing facilities remains low under two modes of travel-walking and motorized driving. Both geographical accessibility and its equality were better under the motorised mode compared with the walking mode. If motorised transportation were available to everyone, the population coverage within 60 min of any testing facility (public and private) would be close to threefold the coverage for pedestrians within the same hour: 61.4% motorised against 22.2% pedestrian access within the hour, considering the whole population of Nepal. Very low accessibility was found in most areas except those with private test centres concentrated in the capital city of Kathmandu. The hypothetical use of mathematical optimisation to select 20 laboratories to add to the original 69 could have improved access from the observed 61.4% offered by the laboratories operating in November to 71.4%, if those 20 could be chosen optimally from all existing healthcare facilities in Nepal. In mountainous terrain, accessibility is very low and could not be improved, even considering all existing healthcare facilities as potential testing locations. Interpretation: The findings related to geographical accessibility to COVID-19 testing facilities should provide valuable information for health-related planning in Nepal, especially in emergencies where data might be limited and decisions time-sensitive. The potential use of publicly available data and mathematical optimisation could be considered in the future. Funding: WHO Special Programme for Research and Training in Tropical Diseases (TDR).

Surgical Antibiotic Prophylaxis Administration Improved after introducing Dedicated Guidelines: A Before-and-After Study from Dhulikhel Hospital in Nepal (2019-2023).

(1) Background: Surgical antibiotic prophylaxis (SAP) is important for reducing surgical site infections. The development of a dedicated hospital SAP guideline in the Dhulikhel Hospital was a recommendation from a baseline study on SAP compliance. Compliance with this new guideline was enhanced through the establishment of a hospital committee, the establishment of an antibiotic stewardship program and the funding and training of healthcare professionals. Using the baseline and a follow-up study after introducing dedicated hospital SAP guidelines, we compared: (a) overall compliance with the SAP guidelines and (b) the proportion of eligible and non-eligible patients who received initial and redosing of SAP; (2) Methods: A before-and-after cohort study was conducted to compare SAP compliance between a baseline study (July 2019-December 2019) and a follow-up study (January 2023-April 2023); (3) Results: A total of 874 patients were in the baseline study and 751 in the follow-up study. Overall SAP compliance increased from 75% (baseline) to 85% in the follow-up study (p < 0.001). Over 90% of those eligible for the initial dose of SAP received it in both studies. Inappropriate use for those not eligible for an initial dose was reduced from 50% to 38% (p = 0.04). For those eligible for redosing, this increased from 14% to 22% but was not statistically significant (p = 0.272); (4) Conclusions: Although there is room for improvement, introduction of dedicated SAP guidelines was associated with improved overall SAP compliance. This study highlights the role of operational research in triggering favorable interventions in hospital clinical care.

Seroprevalence of SARS-CoV-2 infection in the general population of Nepal during the first and second generalized waves of the COVID-19 pandemic-2020-2021.

Few seroprevalence studies have been conducted on coronavirus disease (COVID-19) in Nepal. Here, we aimed to estimate seroprevalence and assess risk factors for infection in the general population of Nepal by conducting two rounds of sampling. The first round was in October 2020, at the peak of the first generalized wave of COVID-19, and the second round in July-August 2021, following the peak of the wave caused by the delta variant of SARS-CoV-2. We used cross-sectional probability-to-size (PPS)-based multistage cluster sampling to estimate the seroprevalence in the general population of Nepal at the national and provincial levels. We tested for anti-SARS-CoV-2 total antibody using the WANTAI SARS-CoV-2 Ab ELISA kit. In Round 1, the overall national seroprevalence was 14.4%, with provincial estimates ranging from 5.3% in Sudurpaschim to 27.3% in Madhesh Province. In Round 2, the estimated national seroprevalence was 70.7%, with the highest in the Madhesh Province (84.8%) and the lowest in the Gandaki Province (62.9%). Seroprevalence was comparable between males and females (Round 1, 15.8% vs. 12.2% and Round 2, 72.3% vs. 68.7%). The seroprevalence in the ecozones-Terai, hills, and mountains-was 76.3%, 65.3%, and 60.5% in Round 2 and 17.7%, 11.7%, and 4.6% in Round 1, respectively. In Nepal, COVID-19 vaccination was introduced in January 2021. At the peak of the first generalized wave of COVID-19, most of the population of Nepal remained unexposed to SARS-CoV-2. Towards the end of the second generalized wave in April 2021, two thirds of the population was exposed.

Anterior Cruciate Ligament Injury and its Rehabilitation in Nepal.

Anterior cruciate ligament is one of the most common ligaments to get injured especially in athletic population. It is a band of dense connective tissue which arises from the antero-medial aspect of the inter condylar area on the tibial plateau and passes upwards and backwards to attach to the posteromedial aspect of the lateral femoral condyle. There is increasing rate of its reported injuries among athletes in Nepal and surgeons report increased consultations among athletes regarding adequate intervention strategies. Factors like over use, inadequate recovery time, playing surface, fitness incompatibility are involved in the increase of anterior cruciate ligament injury among athletes in Nepal. Treatment approach for anterior cruciate ligament injury is ever evolving with regular studies and innovation, but constant guidance and rehabilitation in an institution-based setting have shown positive feedback in recovery and return to play.

High Resistance of Salmonella spp. and Shigella spp. in Blood and Stool Cultures from the Sukraraj Tropical and Infectious Disease Hospital, Kathmandu, Nepal, 2015-2019.

Antimicrobial resistance (AMR) is an increasing global concern, particularly in Southeast Asian countries like Nepal. The aim of this study was to determine the proportion of Salmonella spp. and Shigella spp. among culture-positive bacterial isolates in blood and stool samples from 2015 to 2019 and their AMR pattern. Routinely collected data were abstracted from medical records and laboratory electronic databases of the Sukraraj Tropical and Infectious Disease Hospital (STIDH), Kathmandu, Nepal. All culture-positive bacterial isolates from blood and stool samples were included in the study. Among 390 blood cultures positive for bacterial isolates, Salmonella spp. were isolated in 44%, with S. Typhi being the most frequent (34%). Antibiotic resistance was demonstrated among Salmonella spp. to ciprofloxacin (68%), ofloxacin (16%), amoxicillin (13%) and cotrimoxazole (5%). Of the 357 stool cultures positive for bacterial isolates, the proportion of Shigella spp. isolated was 31%. Antibiotic resistance among Shigella spp. was demonstrated to cotrimoxazole (59%), tetracycline (40%), amoxicillin (38%) and ciprofloxacin (25%). Salmonella spp. and Shigella spp. were the most predominant organisms among all the bacterial isolates in blood and stool cultures, respectively. Nalidixic acid was the antibiotic to which both Salmonella spp. and Shigella spp. were most resistant.

Medicinal plant diversity and traditional healing practices in eastern Nepal.

ETHNOPHARMACOLOGICAL RELEVANCE: The rich floral and ethnic composition of eastern Nepal and the widespread utilization of locally available medicinal plants offer remarkable opportunity for ethnomedicinal research. The present paper aims to explore medicinal plant diversity and use in the remote villages of eastern Nepal. It also aims to evaluate ethnopharmacological significance of the documented use reports and identify species of high indigenous priority. MATERIALS AND METHODS: The study was undertaken in four villages located in the Sankhuwasabha district in eastern Nepal. Ethnomedicinal information was collected through structured interviews. The homogeneity of informant's knowledge and the relative importance of documented medicinal plants were validated by informant consensus factor and use value, respectively. Species preference for treatment of particular diseases was evaluated through fidelity level. RESULTS: We reported medicinal properties of 48 species belonging to 33 families and 40 genera, for the treatment of 37 human ailments. The uses of 10 medicinal plants were previously undocumented. The informant consensus factor (FIC) ranged between 0.38 and 1 with about 50% of values greater than 0.80 and over 75% of values greater than 0.70, indicating moderate to high consensus among the informants on the use of medicinal plants in the region. Swertia chirayita was the most preferred species with significantly high use values, followed by Paris polyphylla and Neopicrorhiza scrophulariiflora. CONCLUSIONS: The remote villages in eastern Nepal possess rich floral and cultural diversity with strong consensus among informants on utilization of plants for local healthcare. The direct pharmacological evidence for medicinal properties of most species indicates high reliability of documented information. Careful and systematic screening of compounds isolated from these plants could possibly provide good opportunity for the discovery of novel medicines to treat life-threatening human diseases. We recommend prioritization of medicinal plants and reinforcement of existing cultivation practices for sustainable management of high-priority species.

Ethnomedicinal practices in the highlands of central Nepal: a case study of Syaphru and Langtang village in Rasuwa district.

ETHNOPHARMACOLOGICAL RELEVANCE: The present paper documents the utilization of medicinal plants for the treatment of various human ailments in two village development committees in the Rasuwa district of central Nepal. It also evaluates the ethnopharmacological significance of the documented reports and identifies species of high indigenous priority in local therapeutics. MATERIALS AND METHODS: The ethnobotanical information was collected by interviews and group discussions using standard ethnobotanical procedures. The homogeneity of informant׳s knowledge was validated by Informant consensus factor (F(IC)) and the relative importance of a plant species used as medicine in the study area was calculated with the help of use value (UV). RESULTS: The present study identified a total of 46 medicinal plants belonging to 26 families used for the treatment of 38 human ailments. Besides medicinal uses, the study has also documented the culinary and cultural use of 13 species of medicinal plants. The most commonly used part was root constituting about 42% of the total utilized plants. The most commonly used form of preparation was paste (31.91%). We found new usage reports for 9 medicinal plants. The F(IC) value in the present study ranged from 0.66 to 1 with 84.6% values greater than 0.8 indicating high consensus among the informants. The most preferred species was Neopicrorhiza scrophulariflora (UV=0.96) and the lowest used value was found for Lyonia ovalifolia (UV=0.32). CONCLUSIONS: People of Rasuwa possess rich traditional knowledge in medicinal plants utilization with strong consensus among local people on the utilization of species evident by higher F(IC) values in different ailment categories. Strong pharmacological evidence for a majority of species being currently used as medicines shows that the plants used in local therapeutics are likely to be more effective in treating different medical ailments. The bioactive compounds extracted from these medicinal plants could subsequently be used in the creation of novel drugs to treat life threatening human diseases. The species with high use values are the ones likely to be more vulnerable because of high demand and high collection pressure. Therefore, it is imperative to prioritize such species for cultivation and sustainable management in order to ensure their long term availability.