Challenges of Hospital Oxygen Management during the COVID-19 Pandemic in Rural Nepal

Bhatt, Navin; Nepal, Shristi; Pinder, Richard; Lucero‐Prisno, Don Eliseo; Budhathoki, Shyam Sundar

doi:10.4269/ajtmh.21-0669

Cited by 9 publications

(7 citation statements)

References 9 publications

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“…During this time, lockdowns were managed locally (as opposed to nationally) as part of a smart lockdown strategy to contain transmission and to minimise effects on service provision, business, and movement where possible [ 27 ]. Health services were overwhelmed, and oxygen was in short supply [ 28 – 30 ].…”

Section: Introductionmentioning

confidence: 99%

Health worker perspectives on access to antenatal care in rural plains Nepal during the COVID-19 pandemic

et al. 2023

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The COVID-19 pandemic affected access to antenatal care in low and middle-income countries where anaemia in pregnancy is prevalent. We analyse how health workers provided antenatal care and the factors affecting access to antenatal care during the COVID-19 pandemic in Kapilvastu district in the western plains of Nepal. We used qualitative and quantitative methodologies, conducting eight semi-structured interviews with health workers who provided antenatal care during the pandemic, and a questionnaire containing open and closed questions with 52 female community health volunteers. Antenatal care was severely disrupted during the pandemic. Health workers had to find ways to provide care with insufficient personal protective equipment and guidance whilst facing extreme levels of stigmatisation which prevented them from providing outreach services. Pregnant women were fearful or unable to visit health institutions during the pandemic because of COVID-19 control measures. Pre-pandemic and during the pandemic health workers tried to contact pregnant and postpartum women and families over the phone, but this was challenging because of limited access to phones, and required pregnant women to make at least one antenatal care visit to give their phone number. The pandemic prevented new pregnancies from being registered, and therefore the possibilities to provide services over the phone for these pregnancies were limited. To reach the most marginalised during a pandemic or other health emergency, health volunteers and households need to exchange phone numbers, enabling proactive monitoring and care-seeking. Strengthening procurement and coordination between the municipal, provincial, and federal levels of government is needed to ensure adequacy of antenatal supplies, such as iron folic acid tablets, in health emergencies. Community engagement is important to ensure women and families are aware of the need to access antenatal care and iron folic acid, and to address stigmatisation of health workers.

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Section: Introductionmentioning

confidence: 99%

Health worker perspectives on access to antenatal care in rural plains Nepal during the COVID-19 pandemic

et al. 2023

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“…Additionally, referral mechanisms and referral adherence are highly important to reach the full potential of pulse oximetry and oxygen, as this intervention aims to filter out severely ill children at lower health care levels and treat them accordingly in higher level referral hospitals [61,62]. Following the experiences of the coronavirus disease 2019 (COVID-19) pandemic, increasing oxygen availability in settings where oxygen treatment is rarely used should be linked to capacity building [63]; the lessons learnt during the pandemic could be transferred to severe childhood pneumonia. Additional funding is needed in low-and middle-income settings to realise the potential this intervention could have for children's lives, but also to cover the rising treatment costs resulting from increased care seeking behaviour and improved diagnosis of severe illness necessitating escalated treatment [64].…”

Section: Discussionmentioning

confidence: 99%

Predicting the potential impact of scaling up four pneumonia interventions on under-five pneumonia mortality: A prospective Lives Saved Tool (LiST) analysis for Bangladesh, Chad, and Ethiopia

Pfurtscheller,

Lam,

Shah

et al. 2024

J Glob Health

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Background Pneumonia remains the leading cause of mortality in under-five children outside the neonatal period. Progress has slowed down in the last decade, necessitating increased efforts to scale up effective pneumonia interventions. Methods We used the Lives Saved Tool (LiST), a modelling software for child mortality in low- and middle-income settings, to prospectively analyse the potential impact of upscaling pneumonia interventions in Bangladesh, Chad, and Ethiopia from 2023 to 2030. We included Haemophilus influenzae type B (Hib) vaccination, pneumococcal conjugate vaccine (PCV), oral antibiotics, pulse oximetry, and oxygen as pneumonia interventions in our analysis. Outcomes of interest were the number of pneumonia deaths averted, the proportion of deaths averted by intervention, and changes in the under-five mortality rate. Findings We found that 19 775 lives of children under-five could be saved in Bangladesh, 76 470 in Chad, and 97 343 in Ethiopia by scaling intervention coverages to ≥ 90% by 2030. Our estimated reductions in pneumonia deaths among children under five range from 44.61% to 57.91% in the respective countries. Increased coverage of oral antibiotics, pulse oximetry, and oxygen show similar effects in all three countries, averting between 18.80% and 23.65% of expected pneumonia deaths. Scaling-up PCV has a prominent effect, especially in Chad, where it could avert 14.04% of expected pneumonia deaths. Under-five mortality could be reduced by 1.42 per 1000 live births in Bangladesh, 22.52 per 1000 live births in Chad, and 5.48 per 1000 live births in Ethiopia. Conclusions This analysis shows the high impact of upscaling pneumonia interventions. The lack of data regarding coverage indicators is a barrier for further research, policy, and implementation, all requiring increased attention.

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“…COVID-19 has scourged public health in past years, causing more than 6.4 million deaths ( World Health Organization, 2022 ). Health systems in high-income countries were challenged by the pandemic, which led to long waiting and hospital admission delays ( Puerta et al, 2022 ), with the scenario being significantly worsened in low- and middle-income countries due to resource limitations ( Maguiña Vargas, 2020 ; Bhatt et al, 2022 ). Although the presence of co-infections in COVID-19 patients has been reported ( Feldman and Anderson, 2021 ; Vijay et al, 2021 ), the present series is focused on the particular scenario of multiple bacterial/fungal co-infections in patients admitted because of SARS-CoV-2 infection.…”

Section: Discussionmentioning

confidence: 99%

Super-infection by multiple microorganisms in COVID-19 patients

Gomez¹,

Ortiz²,

Valenzuela³

et al. 2023

Front. Mol. Biosci.

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Introduction: This study aimed to describe the clinical characteristics of patients with COVID-19 co-infected with multiple multidrug-resistant bacteria.Methods: Patients hospitalized in the AUNA network between January and May 2021, diagnosed with COVID-19 and at least two other infecting microorganisms, were retrospectively included in the analysis. Clinical and epidemiological data were extracted from clinical records. The susceptibility levels of the microorganisms were determined using automated methods. Antibiotic resistance was established among infecting bacteria accounting for ≥5 isolates.Results: A total of 27 patients (21 male and 6 female patients) met the inclusion criteria, with a maximum of eight co-infecting bacteria or fungi during admission time. Seven patients (25.9%) died, with a higher but not significant lethality among women (50% vs. 19.0%). A total of 15 patients presented at least one established comorbidity, with hypertension being the most frequent. The time elapsed between COVID-19 diagnosis and hospital attendance was 7.0 days, with that of patients with a fatal outcome being longer than that of living patients (10.6 vs. 5.4). Up to 20 different microorganisms were isolated, with Pseudomonas aeruginosa being the most common (34 isolates). In general, antibiotic resistance levels were high, especially in Acinetobacter baumannii isolates, with resistance levels of 88.9% to all antimicrobial agents tested, except colistin (0%).Conclusion: In conclusion, the present results show the presence of multiple microorganisms that co-infect COVID-19 patients. When fatal outcome rates are in the range of other reports, the presence of a series of multidrug-resistant microorganisms is of concern, showing the need to reinforce control measures to limit the expansion of almost untreatable microorganisms.

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Challenges of Hospital Oxygen Management during the COVID-19 Pandemic in Rural Nepal

Cited by 9 publications

References 9 publications

Health worker perspectives on access to antenatal care in rural plains Nepal during the COVID-19 pandemic

Health worker perspectives on access to antenatal care in rural plains Nepal during the COVID-19 pandemic

Predicting the potential impact of scaling up four pneumonia interventions on under-five pneumonia mortality: A prospective Lives Saved Tool (LiST) analysis for Bangladesh, Chad, and Ethiopia

Super-infection by multiple microorganisms in COVID-19 patients

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