Establishment and Management Of COVID-19 Testing Molecular Laboratory in Minimal Resource Setting, Challenges and Issues Reported From Birgunj, Nepal – An Experience of Pathologist

The Coronavirus pandemic is recording numerous deaths worldwide. The temporal distribution and burden of the disease varies from setting to setting based on economic status, demography and geographic location. Nepal reported the first COVID-19 case on January 23, 2020. A rapid increase in the number of COVID-19 cases was being reported in Nepal as of June 2020. Limited molecular laboratory capacity in resource limited settings is a challenge in the diagnosis of the ever-increasing cases and the overall management of the disease. In this article, we share the experience, challenges and prospects in the rapid establishment of COVID-19 testing laboratory in Birgunj from available resources. We provide empirical evidence from Parsa district, as this is one of the SARS-CoV-2 transmission hotspots in Nepal and it is likely generalizable to other similar settings in the country. The first step in establishing the COVID-19 molecular testing laboratory were i) identifying a suitable space ii) renovating it and iii) mobilizing materials including consumables, mainly from the hospital store and administration. A chain of experimental design was set up with distinct laboratories to standardize the extraction of samples, preparation of the master mix and detection. At the commencement of sample reception and testing, laboratory contamination was among the primary challenges faced. The source of the contamination was identified in the master mix room and resolved. In summary, the established COVID-19 testing lab (Narayani PCR Lab) has tested more than 40,000 samples (January 2021) and is now the preferred setting for CoVID-19 testing. The lessons learnt may benefit the further establishment of testing laboratories for COVID-19 and/or other epidemic/pandemic diseases in resource-limited settings.

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A Population-Specific Optimized GeneXpert Pooling Algorithm for Chlamydia trachomatis and Neisseria gonorrhoeae To Reduce Cost of Molecular Sexually Transmitted Infection Screening in Resource-Limited Settings

Journal of Clinical Microbiology ◽

10.1128/jcm.00176-20 ◽

2020 ◽

Vol 58 (9) ◽

Author(s):

Sarah Connolly ◽

William Kilembe ◽

Mubiana Inambao ◽

Ana-Maria Visoiu ◽

Tyronza Sharkey ◽

...

Keyword(s):

Trichomonas Vaginalis ◽

Molecular Testing ◽

Resource Limited Settings ◽

Syphilis Infection ◽

Syndromic Management ◽

Sexually Transmitted ◽

Factors Associated ◽

Resource Limited ◽

The Cost ◽

Low Prevalence

ABSTRACT The sexually transmitted infections (STIs) chlamydia (CT) and gonorrhea (NG) are often asymptomatic in women and undetected by syndromic management, leading to complications such as pelvic inflammatory disease, infertility, and ectopic pregnancy. Molecular testing, such as the GeneXpert CT/NG assay, is highly sensitive, but cost restraints preclude implementation of these technologies in resource-limited settings. Pooled testing is one strategy to reduce the cost per sample, but the extent of savings depends on disease prevalence. The current study describes a pooling strategy based on identification of sociodemographic and laboratory factors associated with CT/NG prevalence in a high-risk cohort of Zambian female sex workers and single mothers conducted from 2016 to 2019. Factors associated with testing positive for CT/NG via logistic regression modeling included city, younger age, lower education, long-acting reversible contraception usage, Trichomonas vaginalis infection, bacterial vaginosis, and incident syphilis infection. Based on these factors, the study population was stratified into high-, intermediate-, and low-prevalence subgroups and tested accordingly—individually, pools of 3, or pools of 4, respectively. The cost per sample was reduced from $18 to as low as $9.43 in the low-prevalence subgroup. The checklist tool and pooling approach described can be used in a variety of treatment algorithms to lower the cost per sample and increase access to molecular STI screening. This is particularly valuable in resource-limited settings to detect and treat asymptomatic CT/NG infections missed by traditional syndromic management.

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Caring for Children With Life-Limiting Illness in Bloemfontein, South Africa: Challenging the Assumptions of the ‘Good Death’

OMEGA - Journal of Death and Dying ◽

10.1177/0030222820944099 ◽

2020 ◽

pp. 003022282094409

Author(s):

Callie Daniels-Howell

Keyword(s):

Hospice Care ◽

Meaning Making ◽

Good Death ◽

Resource Limited Settings ◽

High Resource ◽

Resource Limited ◽

Resource Setting ◽

Alternate Forms ◽

Open Discussion ◽

And Control

Theories of good death focused on acceptance, control, and meaning-making inform adult palliative care in high-resource settings. As children’s palliative and hospice care (CPHC) develops in resource-limited settings, critical conceptualisations of a good death for children across these diverse settings are unknown. Assessed against high-resource setting tenets of good death from carer perspectives, results suggest: carer agency is limited; advanced discussion of death does not occur; distress results from multiple burdens; basic survival is prioritised; physical pain is not an emphasised experience; and carers publicly accept death quickly while private grief continues. Hegemonic conceptions of ‘good death’ for children do not occur in contexts where agency is constrained and discussing death is taboo, limiting open discussion, acceptance, and control of dying experiences. Alternate forms of discourse and good death could still occur. Critical, grounded conceptualisations of good death in individual resource-limited settings should occur in advance of CPHC development to effectively relieve expansive suffering in these contexts.

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