Clinical Guideline for Physiotherapy treatment in patients with COVID 19 in acute hospital settings

by Public Health Update June 27, 2020

Clinical Guideline for Physiotherapy treatment in patients with COVID 19 in acute hospital settings

Nepal Physiotherapy Association (NEPTA) has developed “Clinical Guideline for Physiotherapy treatment in patients with COVID 19 in acute hospital settings” referring the international guideline of WHO (World Health Organization) and World Confederation for Physical Therapy(WCPT).

The guideline will provide background knowledge about COVID 19, effective treatment plan and precautions that should be taken by physiotherapists when treating patient with COVID – 19 cases in clinical setting of Nepal.

Scope and purpose

The guideline is intended for physiotherapy interventions for COVID-19 cases in hospital setting. It is developed specifically adopting to the resource level setting of Nepal and it should be taken as a standard for physiotherapy services to be provided for the patients with COVID-19 in wards and in critical care.

Overview

Section A: workforce planning and preparation including screening to determine indications for physiotherapy
Medical management of COVID19
Section B: Delivery of physiotherapy interventions including both respiratory and mobilization/ rehabilitation as well as PPE requirement
Further recommendations for Rehabilitation

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June 27, 2020 0 comments

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List of Approved Institutional Review Committee (IRC), NHRC

by Public Health Update June 21, 2020

written by Public Health Update

List of Approved Institutional Review Committee (IRC), NHRC

Following Institutional Review Committee (IRC) are approved by the Ethical Review Board (ERB), Nepal Health Research Council (NHRC), Ministry of Health and Population (MoHP) to review and monitor health related research in Nepal.

List of approved IRCs

S.N	Organization	Address
1	Annapurna Neurological Institute & Allied Science	Maitighar , Kathmandu
2	B & B Hospital	Gwarkhu, Lalitpur
3	B.P.Koirala Memorial Cancer Hospital	Bharatpur, Chitwan
4	Bharatpur Hospital	Bharatpur, Chitwan
5	Birat Medical College & Teaching Hospital	Biratnagar, Morang
6	Biratnagar Eye Hospital	Biratnagar, Morang
7	BP Koirala Institute of Health Sciences	Dharan, Sunsari
8	Central Institute of Science and Technology	Kathmandu
9	Chitwan Medical College	Bharatpur, Chitwan
10	Civil Service Hospital	New-Baneshwar
11	College of Medical Science and Teaching Hospital	Bharatpur, Chitwan
12	Devdaha Medical College and Research Institute Pvt. Ltd.	Rupandehi
13	Gandaki Medical College Teaching Hospital and Research Center	Kaski
14	Grande International Hospital	Tokha, Kathmandu
15	Institute of Medicine	Maharajgunj, Kathmandu
16	Institute of Science and Technology
17	Kanti Children Hospital	Maharajgunj, Kathmandu
18	Kanti Dental College Teaching Hospital and Research Centre	Basundhara, Kathmandu
19	Karnali Academy of Health Science	Jumla
20	Kathmandu Medical College and Teaching Hospital (KMCTH)	Sinamangal, Kathmandu
21	Kathmandu University School of Medical Sciences (KUMS)	Dhulikhel, Kavre
22	KIST Medical College and Teaching Hospital	Gwarkhu, Kathmandu
23	Lumbini Medical College and Teaching Hospital	Parvas, Palpa
24	Manipal Medical College of Medical Sciences	Pokhara ,Nepal
25	Manmohan Memorial Institute of Health Sciences (MMIHS)	Nakhkhu, Lalitpur
26	National Academy of Medical Sciences (NAMS)	Bir Hospital, Kathmandu
27	National Ayurveda Research and Training Center	Kritipur, Kathmandu
28	National Institute of Neurological and Allied Sciences Pvt. Ltd.	Bansbari, Kathmandu
29	National Medical College	Birgunj, Nepal
30	Nepal Army Institute of Health Sciences (NAIHS)	Sanobharyang, Kathmandu
31	Nepal Cancer Hospital & Research Center Pvt. Ltd	Lalitpur
32	Nepal Medical College	Jorpati, Kathmandu
33	Nepal Netra Jyoti Sang	Tripureswor, Kathmandu
34	Nepalgunj Medical College Teaching Hospital (NMTH)	Kohalpur, Banke
35	Nobel College	Sinamangal, Kathmandu
36	Nobel Medical College Teaching Hospital	Biratnagar, Morang
37	Paropakar Maternity and Women’s Hospital	Thapathali, Kathmandu
38	Patan Academy of Health Science (PAHS)	Lalitpur
39	People’s Dental College	Nayabazar, Kathmandu
40	Pokhara University Research Center	Lekhnath Marg, Kaski
41	Public Health Concern Trust (Phect-Nepal)	Pradarshani Marg, Kathmandu
42	Purbanchal University College of Medical and Allied Sciences	Morang
43	Scheer Memorial Adventist Hospital	Banepa, Kavre
44	Shahid Gangalal National Heart Centre	Bansbari, Kathmandu
45	Shigan Health Foundation	Narayan Gopal Chowk
46	Shree Medical and Technical College	Chitwan
47	Shree Ran Ambika Shah Eye Hospital, Lumbini Eye Institute	Rupandehi
48	Stupa Health Care Center Corporation Ltd (SHCC)	Boudha, Tusal
49	Tilganga Institute of Ophthalmology (TIO)	Gaushala, Kathmandu
50	Universal College of Medical Sciences	Bhairahawa

Please follow, NHRC’s website for more updates.

Department of Drug Administration (DDA), Ministry of Health and Population
Department of Health Services (DoHS), Ministry of Health and Population
Department of Ayurveda and Alternative Medicine (DoAA)

June 21, 2020 0 comments

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Health benefits of Yoga

by Public Health Update June 21, 2020

written by Public Health Update

Health benefits of Yoga

Yoga brings various health benefits and improves body functions, physical as well as mental health. The benefits of doing yoga are multiple and extend beyond the physical.

Here are few physical and mental health benefits of doing Yoga;

Better body image, Perfects your posture
Manage stress
Regulates your adrenal glands and body secretions
Relieves stress
Improved respiration, energy and vitality
maintaining a balanced metabolism.
Helps with back pain
Increased flexibility.
Increased muscle strength and tone.
Cardiovascular benefits and circulatory health
Weight reduction.
Improved athletic performance.

International Day of Yoga: “Yoga for Health – Yoga at Home”

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June 21, 2020 0 comments

Health Literacy, Health Education & Promotion Life Style & Public Health Nutrition PH Important Day Public Health

International Day of Yoga: “Yoga for Health – Yoga at Home”

by Public Health Update June 21, 2020

written by Public Health Update

International Day of Yoga: “Yoga for Health – Yoga at Home”

Yoga

Yoga is an ancient physical, mental and spiritual practice that originated in India. The word ‘yoga’ derives from Sanskrit and means to join or to unite, symbolizing the union of body and consciousness. Today it is practiced in various forms around the world and continues to grow in popularity.

Department of Ayurveda and Alternative Medicine (DoAA)

International Day of Yoga

The United Nations proclaimed 21 June as the International Day of Yoga by resolution 69/131 on 11 December 2014. The draft resolution establishing the International Day of Yoga was proposed by India and endorsed by a record 175 member states. The proposal was first introduced by Prime Minister Narendra Modi in his address during the opening of the 69th session of the General Assembly, in which he said: “Yoga is an invaluable gift from our ancient tradition. Yoga embodies unity of mind and body, thought and action … a holistic approach [that] is valuable to our health and our well-being. Yoga is not just about exercise; it is a way to discover the sense of oneness with yourself, the world and the nature.”

The resolution notes

The resolution notes “the importance of individuals and populations making healthier choices and following lifestyle patterns that foster good health.” In this regard, the World Health Organization has also urged its member states to help their citizens reduce physical inactivity, which is among the top ten leading causes of death worldwide, and a key risk factor for non-communicable diseases, such as cardiovascular diseases, cancer and diabetes.

Aim

The International Day of Yoga aims to raise awareness worldwide of the many benefits of practicing yoga.

Source of information (Read more): United Nations

Guidelines for YOGA Practitioners for COVID-19

by Public Health Update June 21, 2020

written by Public Health Update

Guidelines for YOGA Practitioners for COVID-19

Yoga may play significant role in the psycho-social care and rehabilitation of COVID-19 patients in quarantine and isolation. They are particularly useful in allaying their fears and anxiety.

Overview

Guidelines for YOGA Practitioners for COVID-19 provides guidelines for yoga professionals (Certified Yoga teachers/ instructors and therapists etc.) to teach a safe set of Yoga practices based on available scientific evidences, to novices in all walks of society as a service to humanity during this pandemic of COVID -19.

Department of Ayurveda and Alternative Medicine (DoAA)

Objectives

This is complimentary to all measures that have been adopted. Yoga based life style modules which can be used for different sections of the society in the present scenario are presented with the following objectives.

To improve general immunity among the population.
Prehabilitation of vulnerable populations (children, elderly and those with comorbid conditions such as diabetes and hypertension) and to those patients in isolation/quarantine with or without mild symptoms.
To add-on Yoga based interventions and Meditation practices in covid-19 cases in isolation and hospitalization for psychosocial care.

To reduce disease susceptibility in high risk population This guideline recommends evidence based safe and simple yoga practices as mentioned above that promote health of the respiratory, cardiovascular and the immune systems.

This guideline consists of;

Yoga based lifestyle modules for health promotion in healthy population; Yoga Based life style module to improve immune resilience in healthy population of all age groups.
Common Yoga Protocol
Yogic Diet
Abstinence from substance abuse including tobacco,alcohol and other addictive drugs
Yoga based life style to hospitalized cases without acute respiratory distress.
Yoga Practices for prevention, rehabilitation and to increase immunity. (Do’s/ Dont’s/Benefits)
Common Yoga Protocol- 10 minutes
Common Yoga Protocol- 20 minutes
Common Yoga Protocol- 45 minutes

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Comparative Evaluation of Commercially available Rapid Diagnostic Test Kits for the use of Screening of Suspected Cases of Novel Coronavirus infection in Nepal

by Public Health Update June 17, 2020

written by Public Health Update

Comparative Evaluation of Commercially available Rapid Diagnostic Test Kits for the use of Screening of Suspected Cases of Novel Coronavirus infection in Nepal

Comparative evaluation study was conducted by Nepal Health Research Council (NHRC), in collaboration with Ministry of Health and Population (MoHP), Epidemiology and Disease Control Division (EDCD), and National Public Health Laboratory (NPHL) in Sudurpashchim Province to evaluate commercially available RDTs for SARS CoV2 (COVID 19) against the most sensitive and WHO/CDC standardized rRT-PCR and to establish the laboratory based confirmation of the COVID19 cases among the clinically suspected referred cases.

Recommended: Preparedness and Readiness of Government of Nepal Designated COVID Hospitals

A hospital based quantitative cross sectional study was conducted during ongoing outbreak of 2020 month of April. A total of 200 cases were enrolled in the study using consecutive sampling. Probable and suspected cases for COVID-19 admitted in hospitals (isolation/ quarantine for covid-19) were recruited for the study.

Sensitivity and Specificity

The result of study shows that the sensitivities of the Wondfo Kits were 50%, and the specificities were 99.5% (Compared to the reference standard (RT-PCR)). Similarly, positive and negative predictive values of the test kit were 66.7% and 99% respectively. Similarly, accuracy was 98.5%.

Sensitivity: TP/ (TP + FN) × 100, 2/4× 100 = 50%
Specificity: TN/ (TN+FP) × 100,195/196 × 100=99.5%
Positive Predictive Value (PPV): TP/ (TP + FP) × 100, 2/3 × 100 = 66.7%
Negative Predictive Value (NPV): TN/ (TN + FN) × 100, 196/197 × 100 = 99%
Accuracy: TP+TN/TP+TN+FP+FN× 100, 197/200× 100 = 98.5%

For more result please download final report (NHRC)

Comparative evaluation of RDTs and RT-PCR

RDTs (Test)	RT-PCR (confirmatory)
	Positive	Negative	Total
Positive	2 (TP)	1 (FP)	3
Negative	2 (FN)	195 (TN)	197
Total	4	196	200

Conclusion of study

Comparative evaluation of RDTs against confirmatory diagnosis of COVID-19 (RT-PCR) showed moderate sensitivity, but high specificity and desirable accuracy. The accurate diagnosis of people infected with the SARS-CoV-2 is essential to control the global spread of COVID-1. The existing clinical accuracy of rapid tests still needs to be stringently evaluated before they are authorized for the mass screening of COVID-19. Hence, RDTS could be used as complementary to the existing RT-PCR assays, which could lead to much better diagnosis of COVID-19 and provide additional information about the immune status of the cases and community as well as for rapid surveillance where there is no amenities of laboratory facilities for RT-PCR test.

For more results please download final report (NHRC)

For additional information, please contact: Nepal Health Research Council (NHRC) Ramshah Path, Kathmandu Phone no: +977-1-4254220 / +977-1-4254220 Email: nhrc@nhrc.gov.np

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June 17, 2020 0 comments

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Preparedness and Readiness of Government of Nepal Designated COVID Hospitals

by Public Health Update June 17, 2020

written by Public Health Update

Assessment of Health-related Country Preparedness and Readiness of Nepal for Responding to COVID-19 Pandemic.

Preparedness and Readiness of Government of Nepal Designated COVID Hospitals

A nation-wide study was conducted to assess the preparedness and readiness of Government of Nepal (GoN) designated COVID hospitals to respond to COVID-19 pandemic. A cross-sectional study was conducted among 30 COVID hospitals via face to face and telephonic interviews with focal persons. Among them, telephonic interviews were carried out with focal persons of few unreachable hospitals.

A total of 30 COVID hospitals were included in the study, among which Level 1, Level 2 and Level 3 hospitals were 15 (50%), 12 (40%) and 3 (10%) respectively. The data was collected during the time period of one month (26 April 2020 to 27 May 2020). All the designated COVID hospitals were included in the study and the response rate was 100%.

Recommended: Preparedness and Readiness of Government of Nepal Designated Hospital running COVID Clinics

This fact sheet summarizes the main indicators of designated hospitals related to COVID-19 preparedness and readiness. It will support the GoN/Ministry of Health and Population (MoHP) to assess the current status of the hospitals, find the gaps and align the practices and resources for better preparedness and readiness to respond against COVID-19.

This study gathered data on general information of the hospitals including 12 domains as described below;

1. Health care facility preparedness and planning

25 (83.3%) of 30 designated hospitals were existing functional hospitals and among them 4 (16%) had shifted the non-COVID patients to alternate hospitals.
All the hospitals coordinated with the government and had COVID management core team (96.7%); and COVID-19 Preparedness response plan (93.3%), while only 19 (60.3%) had an Infection Prevention Committee (IPC).
All designated hospitals had the provision of hand washing (soap water/ alcohol-based hand rub) at the hospital entrance.
The provision of Infra-red thermometer was available at the entrance of 93.3% of the hospitals.

2. Infrastructure

All the hospitals had adequate space between the beds (at least 1 meter).
Provision of 24 hours electricity and water supply were available in all the hospitals.
There were a total of 1,926 number of beds allocated for COVID patients.
23 (92%), 22 (88%) and 19 (76%) COVID clinics of the respective hospitals had waiting/holding areas, separate examination areas and triage systems respectively.

3. Clinical services

Only 7 (23.3%) hospitals had designated emergency services for COVID patients.
20 hospitals (66.7%) had Intensive Care Unit (ICU) facilities with a total of 235 ICU beds. Among them, very few, 4 (13.3%) hospitals had provision of negative pressure ICU. 7 (23.3%) hospitals had High Dependency Unit (HDU)/ Step down with a total number of 95 functional beds.

Critical equipment in ICU

Slightly more than half 17 (56.7%) of the hospitals had functional ICU ventilators, and 18 BiPAP machines were available in 10 (33.3%) hospitals. There were a total of 98 functional ICU ventilators. 19 (63%) of the hospitals had a defibrillator and only 8 (26.7 %) hospitals had the ABG machine.
None of the hospitals had availability of Extra-Corporeal Membrane Oxygenator (ECMO).
A total of 10 Neonatal Intensive Care Unit (NICU) beds and 21 Pediatric Intensive Care Unit (PICU) beds were available in 3 (10%) and 1 (3.3%) hospitals respectively.
11 (36.7%) hospitals had operation theatres (OT) among which there were 30 OT rooms with 29 functional OT ventilators. Only 10 (33.3%) hospitals had Ante-room attached to the OT facility for PPE donning and doffing.

Laboratory services

Out of 29 hospitals who had facilities of special blood test, only 10% conducted D-dimer test, whereas Lactate Dehydrogenase level was conducted by 63.3%, Quantitative C-reactive protein by 53.3%, Troponin by (76.7% and Ferritin by 33.3% respectively.
Most of the hospitals conducted tropical disease profile tests like Scrub Typhus (50%), Dengue (66.7%), Leptospirosis (23.3%), Malaria (76.7%), Kala-azar (66.7%), Brucellosis (16.7%), Typhoid (90%), and Tuberculosis (76.7%).

COVID Investigation provision and services

More than a quarter (30%) of the COVID hospitals did not have the provision of investigation in the same hospital and 13.3% did not have separate designated areas for sample collection.
17 (56.7%) hospitals had the provision of RDT services whereas, only 10 (33.3%) hospitals had the provision of RT-PCR services.
There were 70 trained human resources to conduct RT-PCR in 19 (63.3%) hospitals.

Isolation Facilities

25 (83.3%) hospitals had the provision of isolation facilities with total beds of 729 for the suspected cases until the test results were available. Among them, 88% had ante-room attached for PPE donning and doffing.
25 (83.3%) hospitals had a provision of admitting confirmed cases with a total number of 836 beds. Among them, 70% had an ante-room attached for PPE donning and doffing.

Personal Protective Equipment (PPE)

Only 12 (40%) of the designated hospitals had categorized PPE sets according to MoHP and Nepal Medical Council (NMC) guidelines.
There were altogether 9,280 N95 masks; 3,796 Goggles or Visor and 3,805 Water resistant OR standard disposable gowns.

4. Support services

More than a half (53.3%) of the COVID hospitals had provision of Central Pipeline Oxygen Supply (CPOS). Similarly, in the COVID clinic, less than half (46.7%) were facilitated with CPOS. Altogether, 503 beds were covered with CPOS in hospitals.
73.3% of the hospitals had mechanized laundry facilities.
36.7% of the hospitals had blood banks or storage units.
Ambulance services were available in 23 (76.7%) hospitals with a total number of 41 ambulances.

Diagnostic services

76.7% and 73.3% of the hospitals had portable X-ray and portable Ultrasonography (USG) respectively.
Very few hospitals 11(36.7%) had provision of CT scan facilities.

5. Human resources

83.3%, 76.7%, 30%, 16.75% and 20% of the hospitals had General Practitioner/Emergency Medicine, Anesthesiologists, Pulmonologists/ Respiratory physicians, Infectious disease specialists and critical care specialists respectively.
Almost half (46.7%) and 63.3% of the hospitals had trained Nursing staff for isolation wards and intensive care respectively. Capacity building (Training/ Orientation)
Majority 24 (80%) of the COVID hospitals had provided training on COVID-19 testing and sample handling; and use of PPE.
Only 13 (43.3%) hospitals had given orientation about handling the dead body to their health care workers.

6. Infection, Prevention and Control (IPC)

Almost all the hospitals 28 (93.3%) segregated and transported waste as per Health care waste management guidelines 2014 published by MoHP.
Majority of the hospitals used Hypochlorite solution 28 (93.3%) as disinfection modality for PPE followed by autoclave 25 (83.3%) and UV sterilization 3 (10%).

7. Medicine and Consumables

Majority 29 (96.7%) of the hospitals had Essential emergency medicines and 28 (93.3%) had recommended drugs for COVID19.
Hydroxychloroquine, Chloroquine and Azithromycin were available in almost all the hospitals. However, none of the hospitals had Ramdesivir, Tocilizumab (IL-6 blocker) or provision of convalescent plasma.

8. Referral

More than two third (70%) of the facilities had provision of referral to higher level COVID hospitals.

9. Discharge and Follow up

Most of the COVID hospitals (90%) had the provision of ambulance service for the patients at the time of discharge.
93.3% hospitals had the provision of contact and follow up of the discharged patients along with counseling provision for home isolation. 10. Safety provisions for staffs
80% and 93.3% of the hospitals had the provision of COVID-19 testing and quarantine provision for their staff respectively.

11. Handling of dead body

Very few (20%) COVID hospitals had body bags for dead bodies available in their hospitals.
The total number of body bags were 109. 12. Presence of printed copies of Guidelines and Directives published or endorsed by Ministry of Health and Populations
All the guidelines and directives published/endorsed by MoHP during the study period had been archived by more than 50% of the hospitals.

DOWNLOAD: FACT-SHEET

For additional information, please contact: Nepal Health Research Council (NHRC) Ramshah Path, Kathmandu Phone no: +977-1-4254220 / +977-1-4254220 Email: nhrc@nhrc.gov.np

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June 17, 2020 0 comments

Fact Sheet Health in Data National Plan, Policy & Guidelines Outbreak News Public Health Public Health Update Reports Research & Publication

Preparedness and Readiness of Government of Nepal Designated Hospital running COVID Clinics

by Public Health Update June 17, 2020

written by Public Health Update

Assessment of Health-related Country Preparedness and Readiness of Nepal for Responding to COVID-19 Pandemic

Preparedness and Readiness of Government of Nepal Designated Hospital-running-COVID Clinics

A nation-wide study was conducted to assess the preparedness and readiness of the Government of Nepal (GoN) designated Hospital running-COVID Clinics to respond to COVID-19 pandemic. A cross-sectional study was conducted among 95 COVID Clinics via face to face and telephonic interviews with focal persons. Among them, telephonic interviews were carried out in few unreachable COVID Clinics due to national lockdown. A total of 95 COVID Clinics were included in the study, among which two of the hospitals were found not to be running COVID Clinics. Hence, a total of 93 hospitals served as COVID Clinics. The data was collected during the time period of one month (26 April 2020 to 27 May 2020).

All the designated COVID Clinics were included in the study and the response rate was 100%. This fact sheet summarizes the main indicators of designated COVID Clinics related to COVID-19 preparedness and readiness. It will support the GoN/ Ministry of Health and Population (MoHP) to assess the current status of the Clinics, find the gaps and align the practices and resources for better preparedness and readiness to respond against COVID-19.

This study gathered data on general information of the Hospitals-running-COVID Clinics including 11 domains as described below;

1. Health care facility preparedness and planning

Majority of the COVID Clinics (99%) coordinated with the government and had COVID-19 task force committee (80%), management core team (96.7%), and COVID-19 Preparedness response plan (93.3%) respectively, while only 60.3% had an Infection Prevention Committee (IPC).
95.8% of the COVID Clinics had provision of hand washing, (soap water/ alcohol-based hand rub).
The provision of Infra-red thermometer was available at 92.6% of the hospital entrance.

2. Infrastructure
For COVID Clinic

80 (86%) and 83 (89.2%) COVID Clinics had provision of waiting area/holding area and examination area respectively while only half of the Clinics 46 (49.5%) had provision of triage system.
Only 52 (55.9%) COVID Clinics provided 24 hours service.

Recommended: Preparedness and Readiness of Government of Nepal Designated COVID Hospitals

For Whole-Hospital

Designated Emergency for non COVID patients were available in all the hospitals.
There were a total of 13,724 beds in 93 hospitals.
35 hospitals (37.6%) had Intensive Care Unit (ICU) facilities with a total of 809 ICU beds and 314 functional ICU ventilators. Among them, very few, 10 (28.6%) hospitals had provision for negative pressure ICU. 23 (23.3%) hospitals had High Dependency Unit (HDU)/ Step down with a total number of 279 functional beds.
Very few (3.2%) hospitals had availability of Extra- Corporeal Membrane Oxygenator (ECMO)
More than a third of the hospitals (29%) had provision for Neonatal ICU (NICU) while only 22.6% of the hospitals had Pediatric ICU (PICU) provision.
93.5% of the hospital had Operation Theatres (OT) with a total of 273 OT rooms and 170 OT ventilators.

3. Clinical services

About 7 in 10 COVID Clinics (71%) had provision of investigations (RDT and/or RT-PCR) in the same hospital.
61 (65.6%) Clinics had provision of providing RDT services whereas only 3.2% had RT-PCR facilities.
Trained human resources to conduct RT-PCR were available in only one-third (33.3%) of the hospitals.

Laboratory services

None of the COVID Clinics had dedicated Laboratory services (Routine Blood tests, Special blood tests, Culture and Tropical Disease Profile Test). However, all of them shared such laboratory facilities with their respective hospital services.
Almost 9 in 10 hospitals had the facilities for testing Malaria, Typhoid and Tuberculosis, while about three-fourth (75.3%) of the hospital had the capacity for testing Dengue.

Isolation Facilities

About 96% of the COVID Clinics had provision of Isolation for COVID suspected cases till the result was available, among which 68.5% had ante-room attached for PPE donning and doffing.
There were a total of 1, 185 beds in isolation for suspected cases.
Provision of admitting confirmed COVID patients were only present in 15 (16.1%) COVID Clinics and among them 11 (73.3%) hospitals had ante-room attached for PPE donning and doffing.
There were in total 243 beds for the confirmed cases.

Personal Protective Equipment (PPE)

Among 93 (33.3%) COVID Clinics, only 42 (45.2%) of them had categorized PPE sets according to MoHP and NMC guidelines.
There were altogether 10,761 N95 masks; 5,454 Goggles or Visor; 213,033 Gloves (loose/ Surgical gloves); 5,310 Water resistant or standard disposable gowns; 107,173 Caps, 1,97,360 surgical masks; 1,81,029 non-surgical gloves; 5,331 Gowns, and 2,643 Eye protection.

4. Support services

Only 3.2 % of the COVID Clinics had dedicated diagnostics services, while almost 95% reported to share such services with respective hospitals if needed.
None of the Clinics had CT scan service. Very few Clinics (3.2%) had designated Portable X-ray and Ultrasonography (USG) facilities.
Only few Clinics (19.4%) had facilities of Central Pipeline Oxygen Supply (CPOS).
Designated ambulance services were available in 40 (43%) hospitals with a total number of 53 ambulances.

5. Human resources

Only 14 % of COVID Clinics had dedicated medical officers whereas, 86% of the Clinics had medical officers pooled from respective hospitals.
On an average 3 Health Care Workers (doctors and/or nurses) worked in one shift in the COVID Clinics. They worked for 9 hours on an average in a single shift.

Capacity building (Training/ Orientation)

Only 60.2% of the Clinics had orientated their health Care workers on running COVID Clinics.
67 (72%) of the Clinics had provided training on COVID-19 testing and sample handling whereas training on use of PPE was provided by 76.3% of Clinics.
Only 25 (26.9%) Clinics had given orientation about handling the dead body to their health care workers.

6. Infection, Prevention and Control (IPC)

The practice of segregation and transportation of waste as per Health care waste management guidelines 2014 was present in 80 (86%) of COVID Clinics.
There was provision of disinfecting modality for PPE by Hypochlorite solution in 89.2%, UV sterilization in 10.8%, and autoclave in 83.9% Clinics respectively.

7. Medicine and Consumables

Majority 90 (96.8%) of the COVID Clinic had essential Emergency medicines and 74 (79.6%) had recommended drugs for COVID-19.
Hydroxychloroquine, Chloroquine and Azithromycin were available in almost all COVID Clinics. However, none of the Clinics had Ramdesivir, Tocilizumab (IL-6 blocker) or provision of convalescent plasma.

8. Discharge and Follow up

Most of the COVID Clinics (68%) had the provision of ambulance service for the patients at the time of discharge.
78% of Clinics had the provision of contact and follow up of discharged patients and 73% of Clinics had counseling provision for home isolation.

9. Safety provisions for staffs

54.8% and 49.5% of the hospitals had the provision of COVID-19 testing and quarantine facilities for their staffs respectively.

10. Handling of dead body

Very few (6.5%) COVID Clinics had availability of body bags.
The total number of body bags were 214.

11. Presence of printed copies of Guidelines and Directives published or endorsed by Ministry of Health and Population

Except one, all the guidelines and directives published/endorsed by MoHP during the study period had been archived by more than 50% of the hospitals.

DOWNLOAD FACT SHEET FOR MORE INFORMATION: NHRC

For additional information, please contact: Nepal Health Research Council (NHRC) Ramshah Path, Kathmandu Phone no: +977-1-4254220 / +977-1-4254220 Email: nhrc@nhrc.gov.np

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June 17, 2020 0 comments

Global Health News Outbreak News Public Health Public Health Innovation Public Health News Public Health Update

WHO welcomes preliminary results about dexamethasone use in treating critically ill COVID-19 patients

by Public Health Update June 17, 2020

written by Public Health Update

WHO welcomes preliminary results about dexamethasone use in treating critically ill COVID-19 patients

16 June 2020

News release

The World Health Organization (WHO) welcomes the initial clinical trial results from the United Kingdom (UK) that show dexamethasone, a corticosteroid, can be lifesaving for patients who are critically ill with COVID-19. For patients on ventilators, the treatment was shown to reduce mortality by about one third, and for patients requiring only oxygen, mortality was cut by about one fifth, according to preliminary findings shared with WHO.

The benefit was only seen in patients seriously ill with COVID-19, and was not observed in patients with milder disease.

Dexamethasone reduces death in hospitalised patients with severe respiratory complications of COVID-19

“This is the first treatment to be shown to reduce mortality in patients with COVID-19 requiring oxygen or ventilator support,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This is great news and I congratulate the Government of the UK, the University of Oxford, and the many hospitals and patients in the UK who have contributed to this lifesaving scientific breakthrough.”

Dexamethasone is a steroid that has been used since the 1960s to reduce inflammation in a range of conditions, including inflammatory disorders and certain cancers. It has been listed on the WHO Model List of Essential Medicines since 1977 in multiple formulations, and is currently off-patent and affordably available in most countries.

The researchers shared initial insights about the results of the trial with WHO, and we are looking forward to the full data analysis in the coming days. WHO will coordinate a meta-analysis to increase our overall understanding of this intervention. WHO clinical guidance will be updated to reflect how and when the drug should be used in COVID-19.

Today’s news builds off the WHO Research & Development Blueprint meeting, which took place in Geneva in mid-February to accelerate health technologies for COVID-19, where further research into the use of steroids was highlighted as a priority. The findings reinforce the importance of large randomized control trials that produce actionable evidence. WHO will continue to work together with all partners to further develop lifesaving therapeutics and vaccines to tackle COVID-19 including under the umbrella of the Access to COVID-19 Tools Accelerator.

WHO 16 June 2020 News release

WHO welcomes preliminary results about dexamethasone use in treating critically ill COVID-19 patients
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June 17, 2020 0 comments

Global Health News Outbreak News Public Health Public Health Innovation Public Health News Public Health Update Research & Publication

Dexamethasone reduces death in hospitalised patients with severe respiratory complications of COVID-19

by Public Health Update June 17, 2020

written by Public Health Update

Dexamethasone reduces death in hospitalised patients with severe respiratory complications of COVID-19

In March 2020, the RECOVERY (Randomised Evaluation of COVid-19 thERapY) trial was established as a randomised clinical trial to test a range of potential treatments for COVID-19, including low-dose dexamethasone (a steroid treatment). Over 11,500 patients have been enrolled from over 175 NHS hospitals in the UK.

WHO welcomes preliminary results about dexamethasone use in treating critically ill COVID-19 patients

On 8 June, recruitment to the dexamethasone arm was halted since, in the view of the trial Steering Committee, sufficient patients had been enrolled to establish whether or not the drug had a meaningful benefit.

A total of 2,104 patients were randomised to receive dexamethasone 6 mg once per day (either by mouth or by intravenous injection) for ten days and were compared with 4,321 patients randomised to usual care alone. Among the patients who received usual care alone, 28-day mortality was highest in those who required ventilation (41%), intermediate in those patients who required oxygen only (25%), and lowest among those who did not require any respiratory intervention (13%).

Dexamethasone reduced deaths by one-third in ventilated patients (rate ratio 0.65 [95% confidence interval 0.48 to 0.88]; p=0.0003) and by one fifth in other patients receiving oxygen only (0.80 [0.67 to 0.96]; p=0.0021). There was no benefit among those patients who did not require respiratory support (1.22 [0.86 to 1.75; p=0.14).

Based on these results, 1 death would be prevented by treatment of around 8 ventilated patients or around 25 patients requiring oxygen alone.

Given the public health importance of these results, the researchers are now working to publish the full details as soon as possible.

Peter Horby, Professor of Emerging Infectious Diseases in the Nuffield Department of Medicine, University of Oxford, and one of the Chief Investigators for the trial, said, ‘Dexamethasone is the first drug to be shown to improve survival in COVID-19. This is an extremely welcome result. The survival benefit is clear and large in those patients who are sick enough to require oxygen treatment, so dexamethasone should now become standard of care in these patients. Dexamethasone is inexpensive, on the shelf, and can be used immediately to save lives worldwide.’

Martin Landray, Professor of Medicine and Epidemiology at the Nuffield Department of Population Health, University of Oxford, one of the Chief Investigators, said, ‘Since the appearance of COVID-19 six months ago, the search has been on for treatments that can improve survival, particularly in the sickest patients. These preliminary results from the RECOVERY trial are very clear – dexamethasone reduces the risk of death among patients with severe respiratory complications. COVID-19 is a global disease – it is fantastic that the first treatment demonstrated to reduce mortality is one that is instantly available and affordable worldwide.’

Dexamethasone reduces death in hospitalised patients with severe respiratory complications of COVID-19

The UK Government’s Chief Scientific Adviser, Sir Patrick Vallance, said, ‘This is tremendous news today from the Recovery trial showing that dexamethasone is the first drug to reduce mortality from COVID-19. It is particularly exciting as this is an inexpensive widely available medicine. This is a ground-breaking development in our fight against the disease, and the speed at which researchers have progressed finding an effective treatment is truly remarkable. It shows the importance of doing high quality clinical trials and basing decisions on the results of those trials.’

16TH JUNE 2020 News release: RECOVERY trial

WHO welcomes preliminary results about dexamethasone use in treating critically ill COVID-19 patients
Dexamethasone reduces death in hospitalised patients with severe respiratory complications of COVID-19
WHO convenes manufacturers, regulatory authorities meet on COVID-19 vaccines
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June 17, 2020 0 comments

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