Impact of the first phase of COVID-19 pandemic on childhood routine immunisation services in Nepal: a qualitative study on the perspectives of service providers and users

Abstract Background The COVID-19 pandemic has disproportionately affected all essential healthcare services delivery in low-resource settings. This study aimed to explore the challenges and experiences of providers and users of childhood immunisation services in Nepal during the COVID-19 pandemic. Methods Semi-structured qualitative interviews were conducted with childhood immunisation service providers and users (i.e., parents of children) from Kathmandu valley, Nepal. All interviews were conducted through phone or internet-based tools, such as Zoom, WhatsApp, and messenger. All interviews were audio-recorded, transcribed verbatim, and analysed using theme-based content analysis in an Excel spreadsheet. Results A total of 15 participants (n = 7 service providers and n = 8 service users) participated. Six themes were identified, namely: (1) impact of COVID-19 and lockdown on childhood immunisation services; (2) motivation and resilience for childhood immunisation; (3) Biosafety practices and Personal Protective Equipment (PPE) availability during the COVID-19 pandemic; (4) service adjustments and guidelines during pandemic; (5) availability of vaccines; and (6) immunisation program resilience in view of COVID-19. Service providers mentioned facing disruptions in services and some parents had decided to delay scheduled immunisation. However, most service providers showed determinations to deliver the services with high morale, while most service users reported taking their children for immunisation. Families migrating from urban to rural areas during the pandemic led to service providers having no means to confirm complete immunisation of migrating children. Service providers also experienced lack of adequate guidance to deal with the pandemic and personal protective equipment to protect themselves and service users. Conclusion Despite experiencing disruptions in childhood immunisation service due to the COVID-19 pandemic, service users and providers were determined to vaccinate the children. There is an urgent need for effective preparedness plans to be in place to address the observed barriers and to ensure resilient immunisation services during ongoing and future pandemics.

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Using Dairy Value Chains to Identify Production Constraints and Biosecurity Risks

Animals ◽

10.3390/ani10122332 ◽

2020 ◽

Vol 10 (12) ◽

pp. 2332

Author(s):

Jaswinder Singh ◽

Balbir B. Singh ◽

Harish Kumar Tiwari ◽

Harmandeep Singh Josan ◽

Nidhi Jaswal ◽

...

Keyword(s):

Personal Protective Equipment ◽

Rural Areas ◽

Foot And Mouth Disease ◽

Epidemiological Studies ◽

Value Chains ◽

Protective Equipment ◽

Dairy Farmers ◽

Production Constraints ◽

Green Fodder ◽

Biosecurity Practices

The dairy industry plays an important role in the economy and food security of India. A study of the dairy value chains was conducted in Punjab, India, to identify production constraints and biosecurity risks. Focus group discussions and key informant interviews were conducted during 2018–2019 with a total of 119 participants comprising veterinarians (41), paraveterinarians (15), veterinary academics (12), dairy farmers (46) and key informants (5). Input and output value chains were created, and potential risk nodes were identified that could facilitate the transmission of pathogens between animals, farms and villages. The majority of the participants were male (93%), middle-aged (68%) or worked in rural areas (75%). Most of the farmers self-cultivated their green fodder (82%), used the wheat straw from their own fields (60%) but purchased commercial feed (63%). Artificial insemination was used by 85% of farmers for cattle, but only 68% for buffaloes. Most of the farmers (76%) reported getting their animals vaccinated against foot-and-mouth disease and hemorrhagic septicemia. Animals were sold and purchased without any health certification and testing in most cases. Adoption of biosecurity measures by farmers and the use of personal protective equipment by veterinary personnel were very low. We recommend conducting epidemiological studies to further characterize the identified risk nodes, training of veterinary practitioners and farmers to ensure adequate biosecurity practices and the appropriate use of personal protective equipment.

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Practices of Healthcare Workers regarding Infection Prevention in Bale Zone Hospitals, Southeast Ethiopia

Advances in Public Health ◽

10.1155/2020/4198081 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Demisu Zenbaba ◽

Biniyam Sahiledengle ◽

Daniel Bogale

Keyword(s):

Personal Protective Equipment ◽

Healthcare Workers ◽

Infection Prevention ◽

Simple Random Sampling ◽

Healthcare Services ◽

Good Knowledge ◽

Work Place ◽

Protective Equipment ◽

Cross Sectional ◽

Bale Zone

Introduction. In Ethiopia, infection prevention to protect patients, healthcare workers, and visitors from healthcare-acquired infections is one of a number of nationwide transformational initiatives to ensure the provision of quality healthcare services. The aim of this research was to assess the practice of healthcare workers regarding infection prevention and its associated factors in Bale zone Hospitals. Methods. A cross-sectional study targeted 402 healthcare workers using simple random sampling to learn about their practices related to infection prevention. Data were collected in interviews using pretested, structured questionnaires. Returned questionnaires were checked for completeness and then data were entered into a database and analyzed using SPSS Version 20. Adjusted odd ratio (AOR) with a 95% confidence interval was calculated to determine the strength of association, and variables with a p value <0.05 in the final model were considered as statistically significant. Results. Three hundred ninety-four healthcare workers participated in the study. Of these; 145 (36.8%, 95% CI 32, 42%) of them were found to have self-reported good infection prevention practice. Good knowledge towards infection prevention (AOR = 1.84, 95% CI 1.02, 3.31), availability of personal protective equipment (AOR = 1.96, 95% CI 1.16, 3.32), and water (AOR = 4.42, 95% 2.66, 7.34) at workplace were found to have a statistically significant association with healthcare workers self-reported good infection prevention practices. Conclusions. In this study, slightly more than one-third of the healthcare workers reported to have good infection prevention practice. Good knowledge towards infection prevention, working in departments, availability of personal protective equipment, and water at work place were found to have statistically significant association with self-reported good infection prevention practices.

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COVID-19 Pandemisinde Enfeksiyon Kontrol Çalışmaları Çerçevesinde Çocuk Hastalarla Çalışan Sağlık Personeli Eğitimi

Çocuk Enfeksiyon Dergisi/Journal of Pediatric Infection ◽

10.5578/ced.70235 ◽

2020 ◽

Vol 54 (4) ◽

pp. 195-200

Author(s):

Pembe Derin Oygar ◽

Ayşe Büyükçam ◽

Zümrüt Şahbudak Bal ◽

Nazan Dalgıç ◽

Şefika Elmas Bozdemir ◽

...

Keyword(s):

Great Risk ◽

Personal Protective Equipment ◽

Healthcare Workers ◽

Pediatric Patients ◽

Healthcare Services ◽

Healthcare Personnel ◽

Protective Equipment ◽

Emerging Pathogens ◽

Early Stages ◽

Applied Education

Objective: In the early stages of any epidemic caused by new emerging pathogens healthcare personnel is subject to a great risk. Pandemic caused by SARS-CoV-2, proved to be no exception. Many healthcare workers died in the early stages of pandemic due to inadequate precautions and insufficient protection. It is essential to protect and maintain the safety of healthcare personnel for the confinement of pandemic as well as continuity of qualified healthcare services which is already under strain. Educating healthcare personnel on appropiate use of personal protective equipment (PPE) is as essential as procuring them. Material and Methods: A survey is conducted on 4927 healthcare personnel working solely with pediatric patients from 32 different centers. Education given on PPE usage were questioned and analyzed depending on age, sex, occupation and region. Results: Among four thousand nine hundred twelve healthcare personnel from 32 different centers 91% (n= 4457) received education on PPE usage. Of those who received education only 36% was given both theoretical and applied education. Although there was no differences among different occupation groups, receiving education depended on regions. Conclusion: It is essential to educate healthcare personnel appropiately nationwidely for the continuity of qualified healthcare services during the pandemic.

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Challenges Facing Healthcare Delivery Systems in Low-, Middle-, and High-Income Countries

Advances in Healthcare Information Systems and Administration - Advanced Systems for Improved Public Healthcare and Disease Prevention ◽

10.4018/978-1-5225-5528-5.ch001 ◽

2018 ◽

pp. 1-69

Keyword(s):

Rural Areas ◽

Care Delivery ◽

Healthcare Delivery ◽

Healthcare Services ◽

Access To Healthcare ◽

Services Delivery ◽

The Poor ◽

Poor Access ◽

The World ◽

Healthcare Insurance

In the USA, there exist inequities in health delivery depending on whether you have healthcare insurance or not. People living in rural areas also are facing limited access to healthcare. The other high-income countries present, however, another picture. Healthcare insurance is mandatory and thus enables access to healthcare services. Nevertheless, these countries also face challenges such as the poor access to the healthcare services delivery in rural areas because of lack of general physicians. The cost burden is an important point that impacts the access to healthcare and care delivery to a certain group of individuals such as elderly people. The healthcare systems also are facing off-label-use challenges (see Chapter 5) that can also negatively impact the care delivery. In the low- and middle-income countries, the developing world, the poor access to healthcare services delivery is due to infrastructural, structural issues, and poor funding. Information exchanges and communication remain a challenge facing all public healthcare systems around the world, though at diverse level. This chapter aims at investigating the challenges facing the healthcare delivery systems around the world and proposing information and communication-technology-based solutions to tackle some challenges. The chapter further focuses on two case studies and generalizes the results and solution approaches to the other countries. For these purposes, the Republic of Benin, representing the developing world, and the Federal Republic of Germany, representing the developed world, are selected as study cases.

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Medical Doctors Awareness, Perception, and Attitude towards COVID-19 in Bangladesh: A Cross sectional study

10.1101/2020.05.14.20101659 ◽

2020 ◽

Author(s):

Sadia Biswas Mumu ◽

Most Nasrin Aktar ◽

Zabun Nahar ◽

Shahana Sharmin ◽

Md Shaki Mostaid

Keyword(s):

Incubation Period ◽

Personal Protective Equipment ◽

Rural Areas ◽

Cross Sectional Study ◽

Protective Equipment ◽

Medical Doctors ◽

Online Questionnaire ◽

Cross Sectional ◽

Health Authorities ◽

Mode Of Transmission

Objective: COVID-19 has emerged as a pandemic and during the first week of May Bangladesh has reported more than 10,000 cases. A lack of awareness and poor understanding of the disease may result in rapid transmission of the disease in Bangladesh. This study aimed to investigate the awareness, perception, and attitude towards COVID-19 among Bangladeshi medical doctors. Method: This cross sectional, web-based study was conducted with the help of an online questionnaire and sent to the doctors which comprised of a series of questions regarding demographics of the participants, symptoms and incubation period of COVID-19, mode of transmission, measures to prevent transmission, availability of training and personal protective equipment in Bangladeshi hospitals, and attitude of doctors towards the treatment of suspected patients with COVID-19. Results: Of 800 medical doctors, a total 545 completed the survey (response 68.13%). Among the participants, 52.3% were females, 72.8% were below 30 years of age, and majority (52.8%) were working outside the cities in the villages and rural areas. A total of 404 (74.1%) doctors reported the correct incubation period of COVID-19. Majority doctors were aware of the symptoms with mode of transmission of COVID-19, measures to prevent hospital transmission, along with ways of identifying suspected patients with COVID-19. However, more than 90% of the doctors reported of inadequate intensive care unit and ventilator facilities along with extreme scarcity of personal protective equipment in the hospitals. 65.7% doctors prefer avoid working with a COVID-19 patient and more than 50% doctors have expressed that they would send the suspected COVID-19 patients to designated hospitals without providing treatment. Conclusion: The health authorities should take appropriate training measures to increase the awareness of the medical doctors along with providing sufficient amount of personal protective equipment for the medical doctors and supporting staff before deploying them in hospitals.

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Hospital care in Departments defined as COVID-free: A proposal for a safe hospitalization protecting healthcare professionals and patients not affected by COVID-19

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2020.2.67 ◽

2020 ◽

Vol 92 (2) ◽

Cited By ~ 1

Author(s):

Rosario Leonardi ◽

Piera Bellinzoni ◽

Luigi Broglia ◽

Renzo Colombo ◽

Davide De Marchi ◽

...

Keyword(s):

Operating Room ◽

Personal Protective Equipment ◽

Outpatient Care ◽

Healthcare Professionals ◽

Healthcare Services ◽

Care Process ◽

Protective Equipment ◽

Administrative Staff ◽

Process Of Care ◽

Waiting Room

The COVID-19 pandemic influenced the normal course of clinical practice leading to significant delays in the delivery of healthcare services for patients non affected by COVID-19. In the near future, it will be crucial to identify facilities capable of providing health care in compliance with the safety of healthcare professionals, administrative staff and patients. All the staff involved in the project of a Covid-free hospital should be subjected to a diagnostic swab for COVID-19 before the beginning of healthcare activity and then periodically in order to avoid the risk of contamination of patients during the process of care. The modifications of various activities involved in the process of care are described: outpatient care, reception of inpatients, inpatient ward and operating room. For outpatient care, modality of appointment procedure, characteristics of waiting room and personal protective equipment (PPE) for healthcare professionals and administrative staff are presented. Reception of inpatients shall be conditional on a negative swab for COVID-19 obtained with a drive-in procedure. The management of the operating room represents the most crucial step of the patient's care process. The surgical team should be restricted and monitored with periodic swabs; surgical procedures should be performed by experienced surgeons according to standard procedures; surgical training experimental treatments and research protocols should be suspended. Adequate personal protective equipment and measures to reduce aerosolization in the operating room (closed circuits, continuous cycle insufflators, fume extraction) should be adopted. Prevention of possible transmission of the virus during procedures in open, laparoscopic and endoscopic surgery is to use a multi-tactic approach, which includes correct filtration and ventilation of the operating room, the use of appropriate PPE (FFP3 plus surgical mask and protective visor for all the staff working in the operating room) and smoke evacuation devices with a suction and filter system. on behalf of the UrOP Executive CommitteeGiuseppe Ludovico, Angelo Cafarelli, Ottavio De Cobelli, Ferdinando De Marco, Giovanni Ferrari, Stefano Pecoraro, Angelo Porreca, Domenico Tuzzolo

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Using Agrochemicals in Farming and Its Ecological Impact in Rural Areas in Eastern Bankura of West Bengal

Current Journal of Applied Science and Technology ◽

10.9734/cjast/2020/v39i830589 ◽

2020 ◽

pp. 23-30

Author(s):

Moumita Dey Gupta ◽

F. H. Rahman ◽

Kalyan Mitra ◽

Arup Dey ◽

Shubhadip Dasgupta

Keyword(s):

Focus Group ◽

Adverse Effects ◽

Personal Protective Equipment ◽

Rural Areas ◽

West Bengal ◽

Pearson Correlation ◽

Ecological Impact ◽

Protective Equipment ◽

Socioeconomic Variables ◽

Key Informant

United Nations Hunger Task Force listed eight goals and conservation of nature and protection of environment is one of them. Different practices involved in use of agrochemicals like mishandling, indiscriminate use, disposal could have adverse health and environmental impact. This experiment was done in eight selected villages of Sonamukhi block in Bankura district of West Bengal with the main objectives of assessing the knowledge and practices regarding agrochemicals stewardship role performed at the end user level i.e. farmers; exploring the farmers perceptions of agrochemical use and its potential adverse effects on health and identifying socioeconomic variables which influence this role and perception. Two types of Methodology involved in this study among which participatory types are cross sectional survey, focus group discussions, key informant interviews along with descriptive statistics and Pearson Correlation Analysis. Pesticides which are highly hazardous according to WHO report, are very much in use for different purposes in the study area. All total of 300 farmers were interviewed, among them 20% stored agrochemicals in their homes prior to usage. Eighty percent of the respondents do not use anything to mix the chemicals and they do it bare hand, Unsafe dispose of empty sacs or containers of agrochemicals found in 40% of the respondents and whereas almost 25% of the respondents reused containers/sacks to store materials at homes. A minimal number of them i.e. only 5% of the respondents used sufficient personal protective equipment during application of agrochemicals. Participatory and bottom-up approaches like focus group discussion and key informant interviews divulged that awareness and perception regarding adverse effects of agrochemicals is moderate among the participants. The practice of handling of agrochemicals without proper protection and unsafe disposal of pesticide containers appears to be widely prevalent in the study villages. It was found the though respondent possess moderate knowledge of health and environmental hazard but the implementation of this perceived knowledge is very low. Among the different socioeconomic variables age and size of land holding has negative but significant, whereas education has shown positive and significant correlation with the use of Personal Protective Equipment. A holistic program for increasing awareness for safe management, handling and disposal of pesticides among both users and agricultural input dealers is required to address this important health and environmental problem.

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OCCUPATIONAL HEALTH AND SAFETY OF HEALTH CARE WORKERS IN COVID 19: A RISING CONCERN IN INDIA

Journal of medical pharmaceutical and allied sciences ◽

10.22270/jmpas.v10i3.1123 ◽

2021 ◽

pp. 2866-2870

Author(s):

Waqar M. Naqvi

Keyword(s):

Health Care ◽

Health Care Workers ◽

Personal Protective Equipment ◽

Healthcare Providers ◽

Health And Safety ◽

Healthcare Services ◽

Protective Equipment ◽

Care Workers ◽

Before And After ◽

Emotional Strain

The COVID-19 pandemic has put a strain on healthcare services all over the world. With the rising range of healthcare providers diagnosed with COVID globally and with the second wave in India, the crisis has gained global attention and assistance. The healthcare system in India is under strain, putting frontline healthcare staff on edge. Long and exhausting work hours, quickly depleting supplies of personal protective equipment, day-to-night news reports of COVID-19 statistics, inadequate availability of particular drugs, and insufficient societal assistance may all lead to the additional emotional strain of these HCWs. Depression, anxiety, insomnia, and stress are very prevalent among HCWs. Employed in the high-risk division like infectious disorder and pulmonology, and to see a family member that has been diagnosed, deficient or inadequate hand hygiene before and after interaction with patients, insufficient PPE, direct patient interaction (12 times a day), long daily contact hours (15 hrs), and uncontrolled exposure were all linked to COVID-19 risk among Health Care Workers. Working with COVID-19 has demonstrated the interdependence of various components of the work system, such as personal protective equipment (PPE), ventilators, monitoring equipment, staffing, work setting, and so on. Healthcare workers should also implement a detailed ‘infectious disease preparedness and recovery strategy' to train and protect staff before and after a pandemic. Workers must be closely watched, supported, and, when possible, supplied with evidence-based practice after the crisis has passed.

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Challenges Facing Healthcare Delivery Systems in Low-, Middle-, and High-Income Countries

Research Anthology on Public Health Services, Policies, and Education ◽

10.4018/978-1-7998-8960-1.ch014 ◽

2021 ◽

pp. 299-352

Author(s):

Thierry Oscar Edoh

Keyword(s):

Rural Areas ◽

Care Delivery ◽

Healthcare Delivery ◽

Healthcare Services ◽

Access To Healthcare ◽

Services Delivery ◽

The Poor ◽

Poor Access ◽

The World ◽

Healthcare Insurance

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Bundled interventions for consumption management and monitoring of personal protective equipment in COVID-19 pandemic in Hong Kong local hospitals

BMJ Open Quality ◽

10.1136/bmjoq-2020-000990 ◽

2020 ◽

Vol 9 (4) ◽

pp. e000990

Author(s):

Wai-Man Kwan ◽

Chun-Keung Mok ◽

Yick-Ting Kwok ◽

Hon-Wai Lam ◽

Kwan-Ho Chan ◽

...

Keyword(s):

Hong Kong ◽

Personal Protective Equipment ◽

Healthcare Services ◽

Protective Equipment ◽

Clinical Settings ◽

Distribution Centre ◽

Individual Unit ◽

Operating Theatres ◽

Consumption Rates ◽

Set Up

Since the outbreak of COVID-19 in December 2019, there had been global shortage of personal protective equipment (PPE) supply due to the breakage of supply chain and also the forbidding of PPE exported by various countries. This situation had greatly affected the healthcare services in local hospitals of Hong Kong. To maintain the availability of PPE for healthcare workers in high-risk clinical settings, the cluster management of New Territories West Cluster, Hospital Authority, had implemented a bundle of interventions in controlling and managing the PPE consumption and ensuring its proper use. A Taskforce on Management of PPE was set up in February 2020 with the aim to monitor and manage the use of PPE in five local hospitals and eight general outpatient clinics of New Territories West Cluster, which were governed in a cluster basis, under the COVID-19 epidemic. Interventions including cutting down non-essential services, implementing telecare, monitoring PPE consumption at unit level and PPE stock at the Cluster Central Distribution Centre and forming mobile infection teams were implemented. The updated PPE standards and usage guidelines to clinical staff were promulgated through forums, newsletters and unit visits. The PPE consumption rates of individual unit were reviewed. Significant decrease in PPE consumption rates was noted when comparing with the baseline data. Comparing the data between 20 February and 1 June 2020, the overall PPE consumption rates were reduced by 64% (r=−0.841; p<0.001) while the PPE consumption rates in anaesthesia and operating theatres, and isolation and surveillance wards were reduced by 47% (r=−0.506; p=0.023) and 49% (r=−0.810; p<0.001), respectively. A bundled approach, including both administrative measures and staff education, is effective in managing PPE consumption during major infection outbreaks especially when PPE supply is at risk.

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