Quality Assessment of an Antimicrobial Resistance Surveillance System in a Province of Nepal

Abstract

Antimicrobial resistance (AMR) is a global problem, and Nepal is no exception. Countries are expected to report annually to the World Health Organization on their AMR surveillance progress through a Global Antimicrobial Resistance Surveillance System, in which Nepal enrolled in 2017. We assessed the quality of AMR surveillance data during 2019–2020 at nine surveillance sites in Province 3 of Nepal for completeness, consistency, and timeliness and examined barriers for non-reporting sites. Here, we present the results of this cross-sectional descriptive study of secondary AMR data from five reporting sites and barriers identified through a structured questionnaire completed by representatives at the five reporting and four non-reporting sites. Among the 1584 records from the reporting sites assessed for consistency and completeness, 77–92% were consistent and 88–100% were complete, with inter-site variation. Data from two sites were received by the 15th day of the following month, whereas receipt was delayed by a mean of 175 days at three other sites. All four non-reporting sites lacked dedicated data personnel, and two lacked computers. The AMR surveillance data collection process needs improvement in completeness, consistency, and timeliness. Non-reporting sites need support to meet the specific requirements for data compilation and sharing.

The Resistance Patterns in E. coli Isolates among Apparently Healthy Adults and Local Drivers of Antimicrobial Resistance: A Mixed-Methods Study in a Suburban Area of Nepal

“…A study conducted in Bagmati province assessed the quality of AMR data supplied to the National Public Health Laboratory (NPHL) of Nepal from five AMR surveillance sites. Unfortunately, despite considerable volume, the data lacked completeness and consistency [ 75 ]. Such deficient AMR surveillance systems fail to inform health care providers about the circulating resistant microorganisms and the effective treatment regimens to be used.…”

Recording and Reporting of Antimicrobial Resistance (AMR) Priority Variables and Its Implication on Expanding Surveillance Sites in Nepal: A CAPTURA Experience

“…The NPHL analyzes data from sentinel sites for submission to GLASS [ 2 ]. Our study locations consisted of 11 sentinel sites under the NPHL: 5 government-run, 3 private, and 3 public-private sites.…”

“…However, the NPHL monitors laboratories with bacterial culturing facilities and encourages them to generate higher volumes of data, although the exact expected volume remains undefined. The AMR reporting system is gradually being streamlined under the NPHL's leadership, but issues continue to be encountered regarding receiving complete, consistent, and uniformly stored data from the surveillance sites [ 2 ], owing to a shortage of dedicated and trained data handling personnel, frequent staff turnover, limited access to quality reagents and storage facilities, power outages, insufficient funding due to competing priorities, a lack of adequate training opportunities and infrastructure, and frequent policy changes [ 3 , 4 ].…”

Integrative Digital Tools to Strengthen Data Management for Antimicrobial Resistance Surveillance in the “One Health” Domain in Nepal

“…Thus, NPHL and CVL face many challenges in terms of cleaning, collating, analyzing, and visualizing the AMR surveillance data. This is due to erratic data reporting, arising from manual data entry into the laboratory recoding register, discrepancies in the laboratory information management systems (LIMS) used for data recording and reporting across laboratories, and constraints in terms of human resources at both the national and sentinel laboratories [17,18]. The various versions of LIMS used by different sentinel laboratories mean that the surveillance data collected arrive in different file formats, have many inconsistencies, and do not adhere to the standard reporting format.…”

“…Cleaning, collating, and analyzing such data is labor-intensive and inefficient; this situation is exacerbated by the limited number of staff at the reference laboratories, who must spend a considerable amount of time and energy on this task. NPHL and CVL also face challenges in maintaining a reliable AMR surveillance data management and visualization system for evidence-based decision-making [18].…”