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

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Quality Assessment of an Antimicrobial Resistance Surveillance System in a Province of Nepal Tropical Medicine and Infectious Disease Article Quality Assessment of an Antimicrobial Resistance Surveillance System in a Province of Nepal Jyoti Acharya 1,* , Maria Zolfo 2 , Wendemagegn Enbiale 3,4, Khine Wut Yee Kyaw 5 , Meika Bhattachan 6, Nisha Rijal 1, Anjana Shrestha 1, Basudha Shrestha 7, Surendra Kumar Madhup 8, Bijendra Raj Raghubanshi 9 , Hari Prasad Kattel 10, Piyush Rajbhandari 11 , Parmananda Bhandari 12, Subhash Thakur 13, Saroj Sharma 14, Dipendra Raman Singh 15 and Runa Jha 1 1 National Public Health Laboratory, Kathmandu 44600, Nepal; [email protected] (N.R.); [email protected] (A.S.); [email protected] (R.J.) 2 Institute of Tropical Medicine, 2000 Antwerp, Belgium; [email protected] 3 Department of Dermatology and Venereology, BahirDar University, 1996 Bahir Dar, Ethiopia; [email protected] 4 Amsterdam UMC, Academic Medical Centre, Department of Dermatology, Amsterdam Institute for Infection and Immunity (AI&I), University of Amsterdam, 7057 Amsterdam, The Netherlands 5 International Union against Tuberculosis and Lung Disease, Paris, France and International Union against Tuberculosis and Lung Disease, Mandalay 11061, Myanmar; [email protected] 6 World Health Organization, Health Emergencies Unit, Kathmandu 44700, Nepal; [email protected] 7 Kathmandu Model Hospital, Kathmandu 44600, Nepal; [email protected] Citation: Acharya, J.; Zolfo, M.; 8 Dhulikhel Hospital, Dhulikhel 45200, Nepal; [email protected] Enbiale, W.; Kyaw, K.W.Y.; 9 KIST Medical College Teaching Hospital, Lalitpur 44700, Nepal; [email protected] Bhattachan, M.; Rijal, N.; Shrestha, A.; 10 Tribhuwan University Teaching Hospital, Kathmandu 44600, Nepal; [email protected] 11 Shrestha, B.; Madhup, S.K.; Patan Hospital, Patan Academy of Health Sciences, Lalitpur 44700, Nepal; [email protected] 12 Raghubanshi, B.R.; et al. Quality Sukraraj Tropical and Infectious Disease Hospital, Kathmandu 44600, Nepal; [email protected] Assessment of an Antimicrobial 13 Paropakar Maternity and Women’s Hospital, Kathmandu 44600, Nepal; [email protected] Resistance Surveillance System in a 14 Kanti Children’s Hospital, Kathmandu 44600, Nepal; [email protected] Province of Nepal. Trop. Med. Infect. 15 Quality Standard and Regulation Division, Ministry of Health and Population, Kathmandu 44600, Nepal; Dis. 2021, 6, 60. https://doi.org/ [email protected] 10.3390/tropicalmed6020060 * Correspondence: [email protected]; Tel.: +977-9841292279 Academic Editors: Olga Perovic, Abstract: Antimicrobial resistance (AMR) is a global problem, and Nepal is no exception. Countries Tom Decroo and Chakaya are expected to report annually to the World Health Organization on their AMR surveillance progress Muhwa Jeremiah 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 Received: 2 March 2021 Accepted: 8 April 2021 3 of Nepal for completeness, consistency, and timeliness and examined barriers for non-reporting Published: 23 April 2021 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 Publisher’s Note: MDPI stays neutral representatives at the five reporting and four non-reporting sites. Among the 1584 records from with regard to jurisdictional claims in the reporting sites assessed for consistency and completeness, 77–92% were consistent and 88–100% published maps and institutional affil- were complete, with inter-site variation. Data from two sites were received by the 15th day of iations. 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. Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. Keywords: Global Antimicrobial Resistance Surveillance System (GLASS); reference laboratory; This article is an open access article NPHL; SORT IT; operational research distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). Trop. Med. Infect. Dis. 2021, 6, 60. https://doi.org/10.3390/tropicalmed6020060 https://www.mdpi.com/journal/tropicalmed Trop. Med. Infect. Dis. 2021, 6, 60 2 of 13 1. Introduction The increasing prevalence of antimicrobial resistance (AMR) is a global public health threat, recognized by the World Health Organization (WHO) member states and the World Health Assembly as a priority area for global action [1].The AMR Global Action Plan (GAP), introduced by the WHO in 2015, has provided guidance to countries in tackling antibiotic resistance, with microbiological surveillance as a key action [2]. AMR surveillance is important for revealing patterns, trends, and outbreaks of resis- tant microorganisms at the national and international levels [3]. Data from this surveillance allow policymakers and health care providers to introduce evidence-based standards and regulations and to make appropriate decisions about antibiotic prescribing [4]. Countries are expected to report annually to the WHO regarding their progress on AMR data using the Global Antimicrobial Resistance Surveillance System (GLASS). The GLASS-AMR platform collects aggregated data on the frequency of antimicrobial resistance among high-priority pathogens that cause acute infections in humans, namely, Escherichia coli, Klebsiella pneumoniae, Salmonella spp., Shigella spp., Acinetobacter spp., Streptococcus pneumoniae, Staphylococcus aureus, and Neisseria gonorrhoeae. These pathogens are the most commonly identified in hospital-acquired and community-acquired infections, and treatment is becoming increasingly difficult because of high rates of AMR. Moreover, some of the selected bacteria included in the GLASS are present in non-human animals and the food supply. The data for the GLASS are collected at the national level and enable countries to share comparable and validated data worldwide to drive national, regional, and global actions in reducing the AMR burden [5]. Other than AMR data, the GLASS also is a repository of information about the status of national AMR surveillance systems, including the presence of a National Reference Laboratory (NRL), National Coordinating Centre (NCC), and National Action Plan (NAP) from enrolled countries. By April 2020, 91 countries and territories had enrolled in the GLASS, and 66 countries submit AMR data reports [5]. Laboratory-based surveillance systems require resources, facilities, training, and a central public health reference laboratory for quality assurance [6]. The Ministry of Health and Population in Nepal, with the participation of various multi-sectoral stakeholders, has drafted an NAP for AMR in line with the GAP and, in 2017, designated the National Public Health Laboratory (NPHL) as the NRL and NCC for Nepal. The NPHL initiated a laboratory-based AMR surveillance about two decades ago, with nine sentinel sites [7], which has now expanded to 21 sites country-wide. Ten of these sites are situated in Province 3, one of the most populous provinces in Nepal [8]. The NPHL receives AMR data from the surveillance sites and is responsible for collating and combining the data before submission to the GLASS. The completeness, consistency, and frequency of data reporting vary among surveillance sites, with some sending the information monthly, others quarterly, and others only sporadically. The NPHL has adhered to the GLASS initiative and began to submit data to the platform in 2017 [9]. The aim of this study was to assess and verify the AMR surveillance laboratory data reported to the GLASS from five AMR “reporting” surveillance sites and to use a basic infrastructure assessment to identify barriers to submission for four “non-reporting” sites, all in Nepal’s Province 3. To our knowledge, this work represents the first such assessment of the quality of AMR data submitted through a surveillance system in Nepal. 2. Materials and Methods 2.1. Study Design This is a cross-sectional descriptive study using secondary AMR data collection and a structured questionnaire. Trop. Med. Infect. Dis. 2021, 6, 60 3 of 13 2.2. Settings 2.2.1. General Setting Nepal is a landlocked country in Asia with a population of around 30 million. The country consists of seven self-governing provinces with 77 administrative districts and 753 local self-governing bodies. Province 3 (presently Bagmati Pradesh) represents 22% of the total country population. Moreover, it has the highest number of microbiological surveillance sites (10 out of the total 21 surveillance sites in the country), which are easily accessible and are larger sites with a relatively high volume of AMR data. For these reasons, we selected them for this study. 2.2.2. Specific Setting The NPHL is the national reference laboratory responsible for monitoring, supervis- ing, capacity-strengthening, and providing an external quality assessment (EQA) of all microbiological surveillance sites in the country. The NPHL took on the responsibility of reporting to the GLASS in 2017, when only one site submitted complete data, which was not
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