Assessment of service availability and Infection prevention measures in hospitals of Nepal during the transition phase of COVID-19 case surge

  1. Suraj Bhattarai
  2. Jaya Dhungana
  3. Tim Ensor
  4. Uttam Babu Shrestha

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Abstract

As with other coronavirus-affected countries, Nepalese medical fraternity also expressed concerns regarding public health strategies of government and hospital readiness in response to upgoing case surge. To gauge such response, we assessed service availability and Infection prevention and control (IPC) status in 110 hospitals situated across seven provinces. An electronic survey was sent out to the frontline clinicians working on those hospitals between 24th March and 7th April 2020; one response per hospital was analyzed. Hospitals were divided into small, medium, and large based on the total number of beds (small:<=15; medium:16-50; large:>50), and further categorized into public, private, and mixed based on the ownership. Out of 110 hospitals, 81% (22/27) of small, 39% (11/28) of medium, and 33% (18/55) of large hospitals had not allocated isolation beds for COVID-19 suspects. All small, majority of medium (89%; 25/28), and 50% of large hospitals did not have a functional intensive care unit (ICU) at the time of study. Nasopharyngeal (NP)/throat swab kits were available in one-third (35/110), whereas viral transport media (VTM), portable fridge box, and refrigerator were available in one-fifth (20%) of hospitals. Only one hospital (large/tertiary) had a functional PCR machine. Except for General practitioners, other health cadres- crucial during pandemics, were low in number. On IPC measures, the supplies of simple face masks, gloves, and hand sanitizers were adequate in the majority of hospitals, however, N95-respirators, Filter masks, and PPE-suits were grossly lacking. Government COVID-19 support was unevenly distributed across provinces; health facilities in Province 2, Gandaki, and Province 5 received fewer resources than others. Our findings alert the Nepalese and other governments to act early and proactively during health emergencies and not wait until the disease disrupts their health systems. Other countries of similar economic levels may undertake similar surveys to measure and improve their pandemic response.

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    SciScore for 10.1101/2020.05.13.20097675: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: Informed consent was obtained from each study participant on the digital/electronic format.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    We generated frequency tables out of coded data using SPSS 16.0 and prepared maps using ArcGIS.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)
    ArcGIS
    suggested: (ArcGIS for Desktop Basic, RRID:SCR_011081)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Utilizing the relatively larger window of preparedness opportunity compared to hard-hit countries, these facilities could have adopted full preparation gears early on adhering to the relevant national guidelines and service standards, for example, Hospital Management Strengthening Program (HMSP)—Minimum Service Standards (MSS) checklist for hospitals, Nepal Health Infrastructure Development Standards (HIDS).(19)(20) With the above findings, it is worthwhile to mention few limitations of this study. First, it was conducted using internet-based tool considering the government’s strict orders for travel restriction and infection prevention. A field-based observational study would better reflect the scenario of services and IPC measures adopted by the hospitals. Second, the study did not cover all hospitals of the country; only a few-select hospitals could be included. Third, the study took the perspectives of frontline physicians only, excluding other cadres of health workforce (nurses, paramedics) who were also involved in the response.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.05.13.20097675v1 on medRxiv