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Operational Research and Capacity Building to Strengthen Health Systems for Tackling Public Health Emergencies

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A special issue of Tropical Medicine and Infectious Disease (ISSN 2414-6366).

Deadline for manuscript submissions: closed (8 May 2022) | Viewed by 19417

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Special Issue Editors

Prof. Dr. Ewan Wilkinson

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Guest Editor

College of Medicine, University of Chester, Chester CH2 1BR, UK
Interests: operational research; epidemiology; international public health

Dr. Razia Fatima

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Guest Editor

Common Management Unit (HIV,TB,Malaria) , Islamabad, Pakistan
Interests: tuberculosis; research; public health; epidemiology

Special Issue Information

Dear Colleagues,

Global health outbreaks, such as the current COVID-19 pandemic, stretch health care systems to their limits and have the potential to overwhelm health care teams. In particular, a compromised capacity to continue with monitoring and evaluation may result in sub-optimal responses due to a lack of systematic feedback loops, benchmarks and subsequent corrective actions. Experience over the years has shown that robust monitoring and evaluation systems are vital for building or strengthening health system resilience during these difficult times.

This Special Issue highlights research from the Structured Operational Research and Training Initiative (SORT IT), aimed at building sustainable capacity to generate and utilize evidence to strengthen health systems to respond to public health emergencies in southeast Asia. SORT IT aims to make the emergency response in countries “data rich, information rich and action rich”.

We welcome you to this Special Issue. The research studies within this issue cover the documentation and response to public health emergencies in Bhutan, India and Nepal, with special focus on the COVID 19 pandemic.

Prof. Dr. Ewan Wilkinson
Dr. Razia Fatima
Guest Editors

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Keywords

health system resilience
SORT IT
SDGS
public health emergency

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Published Papers (7 papers)

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Research

13 pages, 394 KiB

Open AccessArticle

Audit of Clinical Care Received by COVID-19 Patients Treated at a Tertiary Care Hospital of Nepal in 2021

by Shrawan Kumar Mandal, Jenish Neupane, Ajay M. V. Kumar, Hayk Davtyan, Pruthu Thekkur, Anup Jayaram, Bimal Sharma Chalise, Manisha Rawal, Manu Paudel, Bishwodip Baral, Rajesh Kumar Shah, Kijan Maharjan, Sanjay Shrestha, Lilanath Bhandari, Nisha K.C., Nabaraj Gautam, Avinash K. Sunny, Nishant Thakur, Koshal Chandra Subeedee, Sushil Kumar Mandal and Anup Bastola Show full author list Hide full author list

Trop. Med. Infect. Dis. 2022, 7(11), 381; https://doi.org/10.3390/tropicalmed7110381 - 16 Nov 2022

Cited by 2 | Viewed by 2640

Abstract

Like the world over, Nepal was also hard hit by the second wave of COVID-19. We audited the clinical care provided to COVID-19 patients admitted from April to June 2021 in a tertiary care hospital of Nepal. This was a cohort study using routinely collected hospital data. There were 620 patients, and most (458, 74%) had severe illness. The majority (600, 97%) of the patients were eligible for admission as per national guidelines. Laboratory tests helping to predict the outcome of COVID-19, such as D-dimer and C-reactive protein, were missing in about 25% of patients. Nearly all (>95%) patients with severe disease received corticosteroids, anticoagulants and oxygen. The use of remdesivir was low (22%). About 70% of the patients received antibiotics. Hospital exit outcomes of most (>95%) patients with mild and moderate illness were favorable (alive and discharged). Among patients with severe illness, about 25% died and 4% were critically ill, needing further referral. This is the first study from Nepal to audit and document COVID-19 clinical care provision in a tertiary care hospital, thus filling the evidence gap in this area from resource-limited settings. Adherence to admission guidelines was excellent. Laboratory testing, access to essential drugs and data management needs to be improved. Full article

(This article belongs to the Special Issue Operational Research and Capacity Building to Strengthen Health Systems for Tackling Public Health Emergencies)

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12 pages, 1716 KiB

Open AccessEditor’s ChoiceArticle

Trends in Influenza Infections in Three States of India from 2015–2021: Has There Been a Change during COVID-19 Pandemic?

by Anup Jayaram, Anitha Jagadesh, Ajay M. V. Kumar, Hayk Davtyan, Pruthu Thekkur, Victor J. Del Rio Vilas, Shrawan Kumar Mandal, Robin Sudandiradas, Naren Babu, Prasad Varamballi, Ujwal Shetty and Chiranjay Mukhopadhyay

Trop. Med. Infect. Dis. 2022, 7(6), 110; https://doi.org/10.3390/tropicalmed7060110 - 19 Jun 2022

Cited by 5 | Viewed by 2779

Abstract

The COVID-19 pandemic and public health response to the pandemic has caused huge setbacks in the management of other infectious diseases. In the present study, we aimed to (i) assess the trends in numbers of samples from patients with influenza-like illness and severe acute respiratory syndrome tested for influenza and the number and proportion of cases detected from 2015–2021 and (ii) examine if there were changes during the COVID-19 period (2020–2021) compared to the pre-COVID-19 period (2015–2019) in three states of India. The median (IQR) number of samples tested per month during the pre-COVID-19 period was 653 (395–1245), compared to 27 (11–98) during the COVID-19 period (p value < 0.001). The median (IQR) number of influenza cases detected per month during the pre-COVID-19 period was 190 (113–372), compared to 29 (27–30) during the COVID-19 period (p value < 0.001). Interrupted time series analysis (adjusting for seasonality and testing charges) confirmed a significant reduction in the total number of samples tested and influenza cases detected during the COVID-19 period. However, there was no change in the influenza positivity rate between pre-COVID-19 (29%) and COVID-19 (30%) period. These findings suggest that COVID-19-related disruptions, poor health-seeking behavior, and overburdened health systems might have led to a reduction in reported influenza cases rather than a true reduction in disease transmission. Full article

(This article belongs to the Special Issue Operational Research and Capacity Building to Strengthen Health Systems for Tackling Public Health Emergencies)

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14 pages, 2621 KiB

Open AccessArticle

Epidemiology and Response to the COVID-19 Pandemic in Kerala, India, 2020–2021: A Cross-Sectional Study

by Ajan Maheswaran Jaya, Anthony D. Harries, Anisur Rahman, Mohammed Khogali, Palanivel Chinnakali, Lakshmi Geetha Gopalakrishnan and Mahesh Narayana Pillai

Trop. Med. Infect. Dis. 2022, 7(6), 105; https://doi.org/10.3390/tropicalmed7060105 - 14 Jun 2022

Cited by 4 | Viewed by 2822

Abstract

Kerala, a southern state in India, experienced a slightly different COVID-19 pandemic than the rest of India. Using data from daily COVID-19 bulletins and two other Kerala health information systems, this study reported on epidemiological characteristics and response measures of the COVID-19 pandemic between January 2020 and December 2021. After the first six months, Kerala experienced three distinct phases, with COVID-19 cases peaking in October 2020, May 2021, and August 2021. This contrasts with India, which experienced two main peaks in September 2020 and May 2021. The demographic profile of cases aligned with the national profile except for a slight increase of COVID-19 in persons aged ≥60 years. Monthly COVID-19 deaths increased dramatically from May 2021 onwards in line with case numbers but also reflecting changes in definitions of COVID-19 deaths. Case fatality for the two years was significantly higher in males than females, increased with increasing age groups, and varied between districts (p < 0.001). Trends in bed occupancy in field hospitals, hospitals for severe disease, intensive care units, and mechanical ventilation mirrored the different phases of the pandemic. The monitoring system in Kerala allowed certain aspects of the pandemic to be mapped, but it would benefit from further strengthening. Full article

(This article belongs to the Special Issue Operational Research and Capacity Building to Strengthen Health Systems for Tackling Public Health Emergencies)

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14 pages, 270 KiB

Open AccessArticle

Compliance with Medication amongst Persons with Diabetes Mellitus during the COVID-19 Pandemic, Kerala, India: A Cross Sectional Study

by Ajan Maheswaran Jaya, Anthony D. Harries, Anisur Rahman, Mohammed Khogali, Palanivel Chinnakali and Bipin Gopal

Trop. Med. Infect. Dis. 2022, 7(6), 104; https://doi.org/10.3390/tropicalmed7060104 - 14 Jun 2022

Cited by 3 | Viewed by 2373

Abstract

Compliance with medication in persons with diabetes mellitus (DM) has been a challenge during the COVID-19 pandemic, leading to poor glycemic control and higher risk of complications. In the state of Kerala, India, 20–25% of adults have DM. Our cross-sectional study aimed to assess medication compliance and factors associated with poor compliance in DM persons attending selected primary care government facilities in Kerala during the COVID-19 pandemic. Persons registered with DM for >6 months were consecutively interviewed between August and September 2021. Poor compliance was defined as answering “No” to one or more of three questions related to access and intake of medication two weeks prior to and the day before the interview. Factors independently associated with poor compliance were assessed using adjusted prevalence ratios (aPr) and 95% confidence intervals. Of the 560 DM persons included, 209 (37%) exhibited poor compliance. Factors associated with poor compliance were age 19–45 years (aPr 1.4, 1.1–1.9); inability to be blood glucose tested during the COVID-19 pandemic (aPr 3.6, 2.9–4.3); not having COVID-19 (aPr 1.4, 1.0–1.9); and being double vaccinated against COVID-19 (aPr 1.4, 1.1–2.0). Focused attention must be paid to these groups to improve medication compliance and prevent DM complications and severe COVID-19-related disease. Full article

(This article belongs to the Special Issue Operational Research and Capacity Building to Strengthen Health Systems for Tackling Public Health Emergencies)

12 pages, 773 KiB

Open AccessArticle

COVID-19 Amongst Travelers at Points of Entry in Nepal: Screening, Testing, Diagnosis and Isolation Practices

by Koshal Chandra Subedee, Krishna Prasad Paudel, Mohammed Khogali, Amrit Pokhrel, Palanivel Chinnakali, Nishant Thakur, Deepak Timsina, Rabin Gautam, Anisur Rahman, Shrawan Kumar Mandal, Mahendra Dhose Adhikari and Anthony D. Harries

Trop. Med. Infect. Dis. 2022, 7(6), 99; https://doi.org/10.3390/tropicalmed7060099 - 10 Jun 2022

Cited by 2 | Viewed by 2890

Abstract

WHO recommends surveillance for COVID-19 among travelers at Points of Entry (POE) to countries. At 13 selected POE at the Nepal-India border, between March 2021 and July 2021, we describe the screening, testing, diagnosis and isolation practices of COVID-19 amongst travelers. Those who stayed in India or elsewhere for > one day and those who did not have a negative RT-PCR result within the last 72 h of travel were tested for COVID-19 with rapid antigen diagnostic tests. Daily surveillance reports maintained at POE were used for analysis. Of 337,338 travelers screened, 69,886 (21%) were tested and 3907 (6%) were diagnosed with COVID-19. The proportions tested averaged 15% during April-May when screened numbers were high and increased to 35% in July when screened numbers had decreased. The proportions diagnosed positive peaked at 10% in April-May, but decreased to below 1% in June and July. Testing coverage varied from 0–99% in the different POE. Most COVID-19 cases were Nepalese, male, <60 years of age, migrant workers and presented with fever. Of COVID-19 cases, 32% had home-based isolation, 64% underwent community-based isolation and the remainder either went to hospital or returned to India. In conclusion, about one fifth of travelers overall were tested, with coverage varying considerably over time and among different POE. Strengthening surveillance processes at POE is needed. Full article

(This article belongs to the Special Issue Operational Research and Capacity Building to Strengthen Health Systems for Tackling Public Health Emergencies)

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9 pages, 598 KiB

Open AccessArticle

Operational Gaps in Implementing the COVID-19 Case Investigation and Contact Tracing in Madhesh Province of Nepal, May–July 2021

by Nishant Thakur, Florian Vogt, Srinath Satyanarayana, Divya Nair, Krishna Garu, Koshal Chandra Subedee, Shrawan Kumar Mandal, Amrit Pokhrel, Dipendra Gautam and Krishna Prasad Paudel

Trop. Med. Infect. Dis. 2022, 7(6), 98; https://doi.org/10.3390/tropicalmed7060098 - 10 Jun 2022

Cited by 1 | Viewed by 2440

Abstract

In Nepal, case investigation and contact tracing (CICT) was adopted as an important public health measure to reduce COVID-19 transmission. In this study, we assessed the performance of CICT in Madhesh Province of Nepal against national benchmarks, using routine programmatic data reported by district CICT teams. Between May and July 2021, 17,943 COVID-19 cases were declared in the province, among which case investigation was performed for 30% (95% CI: 29.6–31.0%) within 24 h (against 80% benchmark). As a result of case investigations, 6067 contacts were identified (3 contacts per 10 cases), of which 40% were traced and tested for SARS-CoV-2 infection (against 100% benchmark). About 60% of the contacts tested positive. At most 14% (95% CI: 13.1% to 14.9%) of traced contacts underwent a 14-day follow-up assessment (against 100% benchmark). We found the performance of the CICT program in Madhesh Province to be sub-optimal and call for corrective measures to strengthen CICT in the province and the country at large. Similar studies with wider geographical scope and longer time frames are needed to identify and address deficiencies in data recording and reporting systems for COVID-19, in low- and middle-income countries like Nepal and others. Full article

(This article belongs to the Special Issue Operational Research and Capacity Building to Strengthen Health Systems for Tackling Public Health Emergencies)

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12 pages, 1257 KiB

Open AccessArticle

Performance of an Emergency Road Ambulance Service in Bhutan: Response Time, Utilization, and Outcomes

by Tshokey Tshokey, Ugyen Tshering, Karma Lhazeen, Arpine Abrahamyan, Collins Timire, Bikash Gurung, Devi Charan Subedi, Kencho Wangdi, Victor Del Rio Vilas and Rony Zachariah

Trop. Med. Infect. Dis. 2022, 7(6), 87; https://doi.org/10.3390/tropicalmed7060087 - 31 May 2022

Cited by 5 | Viewed by 2537

Abstract

Background: An efficient ambulance service is a vital component of emergency medical services. We determined the emergency ambulance response and transport times and ambulance exit outcomes in Bhutan. Methods: A cross-sectional study involving real-time monitoring of emergency ambulance deployments managed by a central toll-free (112) hotline (20 October 2021 to 20 January 2022) was carried out. Results: Of 5092 ambulance deployments, 4291 (84%) were inter-facility transfers, and 801 (16%) were for emergencies. Of the latter, 703 (88%) were for non-pregnancy-related emergencies (i.e., medical, surgical, and accidents), while 98 (12%) were for pregnancy-related emergencies. The median ambulance response and patient transport times were 42 (IQR 3–271) and 41 (IQR 2–272) minutes, respectively. The median round-trip distance travelled by ambulances was 18 km (range 1–186 km). For ambulance exit outcomes that were pregnancy-related (n = 98), 89 (91%) reached the health facility successfully, 8 delivered prior to ambulance arrival at the scene or in the ambulance during transport, and 1 had no outcome record. For the remaining 703 non-pregnancy deployments, 29 (4.1%) deployments were deemed not required or refusals, and 656 (93.3%) reached the health facility successfully; 16 (2.3%) died before the ambulance’s arrival at the scene, and 2 (0.3%) were not recorded. Conclusions: This first countrywide real-time operational research showed acceptable ambulance exit outcomes. Improving ambulance response and transport times might reduce morbidities and mortalities further. Full article

(This article belongs to the Special Issue Operational Research and Capacity Building to Strengthen Health Systems for Tackling Public Health Emergencies)

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