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3. COVID-19 testing and reporting behaviours in England across different sociodemographic groups: a population-based study using testing data and data from community prevalence surveillance surveys

Author

Aguas, Ricardo, Amswych, Ma'ayan, Andersen-Waine, Billie, Bajaj, Sumali, Bimpong, Kweku, Bodley, Adam, Cantrell, Liberty, Chen, Siyu, Creswell, Richard, Dahal, Prabin, Dickinson, Sophie, Dittrich, Sabine, Evans, Tracy, Ferguson-Lewis, Angus, Franco, Caroline, Gao, Bo, Hounsell, Rachel, Kasim, Muhammad, Keene, Claire, Lambert, Ben, Mahmood, Umar, Mills, Melinda, Moldokmatova, Ainura, Molyneux, Sassy, Naidoo, Reshania, Ngwafor Anye, Randolph, Norman, Jared, Pan-Ngum, Wirichada, Pokharel, Sunil, Polner, Anastasiia, Rowe, Emily, Saralamba, Sompob, Shretta, Rima, Silal, Sheetal, Stepniewska, Kasia, L-H Tsui, Joseph, Voysey, Merryn, Wanat, Marta, White, Lisa J, Tsui, Joseph L-H, Kolade, Olumide, Nicholson, George, Lehmann, Brieuc, Hay, James A, Kraemer, Moritz U G, Donnelly, Christl A, Fowler, Tom, and Hopkins, Susan

Published
2024
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4. Modelling the COVID-19 pandemic in context: an international participatory approach

Author

Aguas, Ricardo, White, Lisa, Hupert, Nathaniel, Shretta, Rima, Pan-Ngum, Wirichada, Celhay, Olivier, Moldokmatova, Ainura, Arifi, Fatima, Mirzazadeh, Ali, Sharifi, Hamid, Adib, Keyrellous, Sahak, Mohammad Nadir, Franco, Caroline, Coutinho, Renato, Ariana, Proochista, Hancock, Penny, Kraenkel, Roberto A, Saralamba, Sompob, Luangasanatip, Nantasit, Silal, Sheetal Prakash, Norman, Jared, Hounsell, Rachel, Tun, Sai, Aung, Yu Nandar, Emmanuel, A Bakare, Getachew, Biniam, Adele, Sandra, Omoleke, Semeeh A, Zaman, Rashid U, Letchford, Nicholas, Parker, Daniel M, Pokharel, Sunil, Lata, Dipti, Chen, Siyu, Kyaw, Shwe Sin, Lubis, Inke ND, Alona, Ivana, Medina, John Robert C, Mercado, Chris Erwin G, Eybpoosh, Sana, Mamadu, Ibrahim, Marzouk, Manar, de Colombi, Nicole Feune, Suárez-Idueta, Lorena, Obando, Francisco, Freitas, Luzia, Klein, Michael G, Scales, David, Aizhan, Dooronbekova, Zhumalieva, Chynar, Estebesova, Aida, Mukambetov, Aibek, Ibragimov, Shamil, Kubatova, Aisuluu, Chanthavialy, Phetsavanh, Salim, Amel H, Venkatesan, Sudhir, Sarin, KC, Shrestha, Priyanka, Saeedzai, Sayed Ataullah, Hsieh, Jenny, Soukavong, Mick, Yunanda, Yuki, Harsono, Handoyo, Fariba, Mahnaz Hossain, Mabombo, Viviana, Advani, Nicole, Jabin, Nusrat, Naidoo, Reshania, Wattanasri, Parinda, Nwosu, Amen-Patrick, and Obiesie, Sopuruchukwu

Subjects
Health Services and Systems, Public Health, Health Sciences, Generic health relevance, Good Health and Well Being, COVID-19, Culture, Delivery of Health Care, Global Health, Health Policy, Humans, Internationality, Models, Theoretical, Pandemics, Research, SARS-CoV-2, Social Class, Uncertainty, health policy, respiratory infections, control strategies, SARS, CoMo Consortium, Health services and systems, Public health
Abstract

The SARS-CoV-2 pandemic has had an unprecedented impact on multiple levels of society. Not only has the pandemic completely overwhelmed some health systems but it has also changed how scientific evidence is shared and increased the pace at which such evidence is published and consumed, by scientists, policymakers and the wider public. More significantly, the pandemic has created tremendous challenges for decision-makers, who have had to implement highly disruptive containment measures with very little empirical scientific evidence to support their decision-making process. Given this lack of data, predictive mathematical models have played an increasingly prominent role. In high-income countries, there is a long-standing history of established research groups advising policymakers, whereas a general lack of translational capacity has meant that mathematical models frequently remain inaccessible to policymakers in low-income and middle-income countries. Here, we describe a participatory approach to modelling that aims to circumvent this gap. Our approach involved the creation of an international group of infectious disease modellers and other public health experts, which culminated in the establishment of the COVID-19 Modelling (CoMo) Consortium. Here, we describe how the consortium was formed, the way it functions, the mathematical model used and, crucially, the high degree of engagement fostered between CoMo Consortium members and their respective local policymakers and ministries of health.

Published
2020

5. Transport properties of Methane, Ethane, Propane, and n-Butane in Water

Author

Pokharel, Sunil, Aryal, Narayan, Niraula, Bhakta Raj, Subedi, Arjun, and Adhikari, Narayan Prasad

Subjects
Physics - Chemical Physics, Condensed Matter - Materials Science
Abstract

In this work, we have estimated self diffusion coefficients along with the binary diffusion coefficients of mixtures of alkane (methane, ethane, propane and n-butane) in SPC/E water(H$_2$O). Molecular dynamics study of a binary mixture of alkane gas and SPC/E water, with alkane as solute and water as solvent, have been carried out at different temperatures ranging from 283.15 K to 333.15 K. We have taken a dilute solution of 3 alkane (methane, ethane, propane and n-butane) molecules and 971 water molecules in a system. The role of interaction in the structure of the constituents of the system as a function of temperature is studied with the help of the radial distribution function (RDF) and the coordination numbers. The self-diffusion coefficient of the constituents of the mixture was calculated by using mean square displacement (MSD) and the binary diffusion coefficients of alkane in water have been calculated by using Darken's relation. The results are then compared with the available experimental values. The values of self-diffusion coefficients of water from the present work come in good agreement with the experimental values within 9% error. The binary diffusion coefficients of ethane, methane, propane and n-butane agree with the previously reported experimental values. The dependence of the diffusion coefficients on temperature is approximated by Arrhenius-type exponential relationship., Comment: 12 pages, 14 figures

Published
2017

7. Mothers’ acceptability of using novel technology with video and audio recording during newborn resuscitation: A cross-sectional survey

Author

Kong, So Yeon Joyce, primary, Acharya, Ankit, additional, Basnet, Omkar, additional, Haaland, Solveig Haukås, additional, Gurung, Rejina, additional, Gomo, Øystein, additional, Ahlsson, Fredrik, additional, Meinich-Bache, Øyvind, additional, Axelin, Anna, additional, Basula, Yuba Nidhi, additional, Pokharel, Sunil Mani, additional, Subedi, Hira, additional, Myklebust, Helge, additional, and KC, Ashish, additional

Published
2024
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8. Mothers’ acceptability of using novel technology with video and audio recording during newborn resuscitation: A cross-sectional survey

Author

Kong, So Yeon Joyce, Acharya, Ankit, Basnet, Omkar, Haaland, Solveig Haukås, Gurung, Rejina, Gomo, Øystein, Ahlsson, Fredrik, Meinich-Bache, Øyvind, Axelin, Anna, Basula, Yuba Nidhi, Pokharel, Sunil Mani, Subedi, Hira, Myklebust, Helge, KC, Ashish, Kong, So Yeon Joyce, Acharya, Ankit, Basnet, Omkar, Haaland, Solveig Haukås, Gurung, Rejina, Gomo, Øystein, Ahlsson, Fredrik, Meinich-Bache, Øyvind, Axelin, Anna, Basula, Yuba Nidhi, Pokharel, Sunil Mani, Subedi, Hira, Myklebust, Helge, and KC, Ashish

Abstract

Objective This study aims to assess the acceptability of a novel technology, MAchine Learning Application (MALA), among the mothers of newborns who required resuscitation. Setting This study took place at Bharatpur Hospital, which is the second-largest public referral hospital with 13 000 deliveries per year in Nepal. Design This is a cross-sectional survey. Data collection and analysis Data collection took place from January 21 to February 13, 2022. Self-administered questionnaires on acceptability (ranged 1–5 scale) were collected from participating mothers. The acceptability of the MALA system, which included video and audio recordings of the newborn resuscitation, was examined among mothers according to their age, parity, education level and technology use status using a stratified analysis. Results The median age of 21 mothers who completed the survey was 25 years (range 18–37). Among them, 11 mothers (52.4%) completed their bachelor’s or master’s level of education, 13 (61.9%) delivered first child, 14 (66.7%) owned a computer and 16 (76.2%) carried a smartphone. Overall acceptability was high that all participating mothers positively perceived the novel technology with video and audio recordings of the infant’s care during resuscitation. There was no statistical difference in mothers’ acceptability of MALA system, when stratified by mothers’ age, parity, or technology usage (p>0.05). When the acceptability of the technology was stratified by mothers’ education level (up to higher secondary level vs. bachelor’s level or higher), mothers with Bachelor’s degree or higher more strongly felt that they were comfortable with the infant’s care being video recorded (p = 0.026) and someone using a tablet when observing the infant’s care (p = 0.046). Compared with those without a computer (n = 7), mothers who had a computer at home (n = 14) more strongly agreed that they were comfortable with someone observing the resuscitation activity of their newborns (71.4% vs. 1

Published
2024
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9. COVID-19 testing and reporting behaviours in England across different sociodemographic groups: a population-based study using testing data and data from community prevalence surveillance surveys

Author

Bajaj, Sumali, Chen, Siyu, Creswell, Richard, Naidoo, Reshania, Tsui, Joseph L-H, Kolade, Olumide, Nicholson, George, Lehmann, Brieuc, Hay, James A, Kraemer, Moritz U G, Aguas, Ricardo, Donnelly, Christl A, Fowler, Tom, Hopkins, Susan, Cantrell, Liberty, Dahal, Prabin, White, Lisa J, Stepniewska, Kasia, Voysey, Merryn, Lambert, Ben, Aguas, Ricardo, Amswych, Ma'ayan, Andersen-Waine, Billie, Bajaj, Sumali, Bimpong, Kweku, Bodley, Adam, Cantrell, Liberty, Chen, Siyu, Creswell, Richard, Dahal, Prabin, Dickinson, Sophie, Dittrich, Sabine, Evans, Tracy, Ferguson-Lewis, Angus, Franco, Caroline, Gao, Bo, Hounsell, Rachel, Kasim, Muhammad, Keene, Claire, Lambert, Ben, Mahmood, Umar, Mills, Melinda, Moldokmatova, Ainura, Molyneux, Sassy, Naidoo, Reshania, Ngwafor Anye, Randolph, Norman, Jared, Pan-Ngum, Wirichada, Pokharel, Sunil, Polner, Anastasiia, Rowe, Emily, Saralamba, Sompob, Shretta, Rima, Silal, Sheetal, Stepniewska, Kasia, L-H Tsui, Joseph, Voysey, Merryn, Wanat, Marta, and White, Lisa J

Abstract

Understanding underlying mechanisms of heterogeneity in test-seeking and reporting behaviour during an infectious disease outbreak can help to protect vulnerable populations and guide equity-driven interventions. The COVID-19 pandemic probably exerted different stresses on individuals in different sociodemographic groups and ensuring fair access to and usage of COVID-19 tests was a crucial element of England's testing programme. We aimed to investigate the relationship between sociodemographic factors and COVID-19 testing behaviours in England during the COVID-19 pandemic.

Published
2024
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10. A Practitioner’s Toolkit for Insulin Motivation in Adults with Type 1 and Type 2 Diabetes Mellitus: Evidence-Based Recommendations from an International Expert Panel

Author

Kalra, Sanjay, Bajaj, Sarita, Sharma, Surendra Kumar, Priya, Gagan, Baruah, Manash P., Sanyal, Debmalya, Das, Sambit, Chaudhury, Tirthankar, Gangopadhyay, Kalyan Kumar, Das, Ashok Kumar, Sethi, Bipin, Ayyar, Vageesh, Shaikh, Shehla, Shah, Parag, Jindal, Sushil, Deshmukh, Vaishali, Dave, Joel, Amod, Aslam, Joshi, Ansumali, Pokharel, Sunil, Pathan, Faruque, Afsana, Faria, Prasad, Indrajit, Murad, Moosa, Soelistijo, Soebagijo Adi, Purwoto, Johanes, Hussein, Zanariah, Horn, Lee Chung, Sahay, Rakesh, Somasundaram, Noel, Antonypillai, Charles, Sumanathilaka, Manilka, and Bulugahapitiya, Uditha

Published
2020
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11. Use of antimicrobials during the COVID-19 pandemic: A qualitative study among stakeholders in Nepal

Author

Dhungel, Binod, primary, Thapa Shrestha, Upendra, additional, Adhikari, Sanjib, additional, Adhikari, Nabaraj, additional, Bhattarai, Alisha, additional, Pokharel, Sunil, additional, Karkey, Abhilasha, additional, Limmathurotsakul, Direk, additional, Ghimire, Prakash, additional, Rijal, Komal Raj, additional, Cheah, Phaik Yeong, additional, Pell, Christopher, additional, and Adhikari, Bipin, additional

Published
2023
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17. Usability, acceptability and feasibility of a novel technology with visual guidance with video and audio recording during newborn resuscitation: a pilot study

Author

KC, Ashish, primary, Kong, So Yeon Joyce, additional, Basnet, Omkar, additional, Haaland, Solveig Haukås, additional, Bhattarai, Pratiksha, additional, Gomo, Øystein, additional, Gurung, Rejina, additional, Ahlsson, Fredrik, additional, Meinich-Bache, Øyvind, additional, Axelin, Anna, additional, Malla, Honey, additional, Basula, Yuba Nidhi, additional, Pathak, Om Krishna, additional, Pokharel, Sunil Mani, additional, Subedi, Hira, additional, and Myklebust, Helge, additional

Published
2022
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18. Bunch Length Measurements at the CEBAF Injector at 130 kV

Author

Pokharel, Sunil, Bruker, Max, Grames, Joseph, Hofler, Alicia, Kazimi, Reza, Krafft, Geoffrey, and Zhang, Shukui

Subjects
05: Beam Dynamics, Accelerator Physics
Abstract

In this work, we investigated the evolution in bunch length of beams through the CEBAF injector for low to high charge per bunch. Using the General Particle Tracer (GPT), we have simulated the beams through the beamline of the CEBAF injector and analyzed the beam to get the bunch lengths at the location of chopper. We performed these simulations with the existing injector using a 130 kV gun voltage. Finally, we describe measurements to validate these simulations. The measurements have been done using chopper scanning technique for two injector laser drive frequency modes: one with 500 MHz, and another with 250 MHz., Proceedings of the 5th North American Particle Accelerator Conference, NAPAC2022, Albuquerque, NM, USA

Published
2022
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20. Usability, acceptability and feasibility of a novel technology with visual guidance with video and audio recording during newborn resuscitation : a pilot study

Author

KC, Ashish, Kong, So Yeon Joyce, Basnet, Omkar, Haaland, Solveig Haukås, Bhattarai, Pratiksha, Gomo, Øystein, Gurung, Rejina, Ahlsson, Fredrik, Meinich-Bache, Øyvind, Axelin, Anna, Malla, Honey, Basula, Yuba Nidhi, Pathak, Om Krishna, Pokharel, Sunil Mani, Subedi, Hira, Myklebust, Helge, KC, Ashish, Kong, So Yeon Joyce, Basnet, Omkar, Haaland, Solveig Haukås, Bhattarai, Pratiksha, Gomo, Øystein, Gurung, Rejina, Ahlsson, Fredrik, Meinich-Bache, Øyvind, Axelin, Anna, Malla, Honey, Basula, Yuba Nidhi, Pathak, Om Krishna, Pokharel, Sunil Mani, Subedi, Hira, and Myklebust, Helge

Abstract

Objective: Inadequate adherence to resuscitation for non-crying infants will have poor outcome and thus rationalise a need for real-time guidance and quality improvement technology. This study assessed the usability, feasibility and acceptability of a novel technology of real-time visual guidance, with sound and video recording during resuscitation. Setting: A public hospital in Nepal. Design: A cross-sectional design. Intervention: The technology has an infant warmer with light, equipped with a tablet monitor, NeoBeat and upright bag and mask. The tablet records resuscitation activities, ventilation sound, heart rate and display time since birth. Healthcare providers (HCPs) were trained on the technology before piloting. Data collection and analysis: HCPs who had at least 8 weeks of experience using the technology completed a questionnaire on usability, feasibility and acceptability (ranged 1-5 scale). Overall usability score was calculated (ranged 1-100 scale). Results: Among the 30 HCPs, 25 consented to the study. The usability score was good with the mean score (SD) of 68.4% (10.4). In terms of feasibility, the participants perceived that they did not receive adequate support from the hospital administration for use of the technology, mean score (SD) of 2.44 (1.56). In terms of acceptability, the information provided in the monitor, that is, time elapsed from birth was easy to understand with mean score (SD) of 4.60 (0.76). Conclusion: The study demonstrates reasonable usability, feasibility and acceptability of a technological solution that records audio visual events during resuscitation and provides visual guidance to improve care.

Published
2022
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21. Health system preparedness for COVID-19 and its impacts on frontline health care workers in Nepal—implications for future epidemics:a qualitative study among frontline healthcare workers and policymakers

Author

Shrestha, Nipun, Mishra, Shiva Raj, Ghimire, Saruna, Gyawali, Bishal, Marahatta, Sujan Babu, Maskey, Smriti, Baral, Sushila, Yadav, Rakesh, Pokharel, Sunil, Ahikari, Bipin, Shrestha, Nipun, Mishra, Shiva Raj, Ghimire, Saruna, Gyawali, Bishal, Marahatta, Sujan Babu, Maskey, Smriti, Baral, Sushila, Yadav, Rakesh, Pokharel, Sunil, and Ahikari, Bipin

Abstract

Background: Rapidly growing coronavirus disease 2019 (COVID-19) pandemic has brought unprecedented challenges to the health system in Nepal. The main objective of this study was to explore the health system preparedness for COVID-19 and its impacts on frontline health-care workers in Nepal. Methods: Semi-structured interviews were conducted among 32 health-care workers who were involved in clinical care of COVID-19 patients and four policy-makers who were responsible for COVID-19 control and management at central and provincial level. Interviews were conducted through telephone or Internet-based tools such as Zoom and Skype. All interviews were audio-recorded, transcribed into English, and coded using inductive and deductive approaches. Results: Both health-care workers and policy-makers reported failure to initiate pre-emptive control measures at the early stages of the outbreak as the pivot in pandemic control. Although several measures were rolled out when cases started to appear, the overall health system preparedness was low. The poor governance, and coordination between three tiers of government was compounded by the inadequate personal protective equipment for health-care workers, insufficient isolation beds for patients, and poor engagement of the private sector. Frontline health-care workers experienced various degrees of stigma because of their profession and yet were able to maintain their motivation to continue serving patients. Conclusion: Preparedness for COVID-19 was affected by the poor coordination between three tiers of governance. Specifically, the lack of human resources, inadequate logistic chain management and laboratory facilities for testing COVID-19 appeared to have jeopardized the health system preparedness and escalated the pandemic in Nepal. Despite the poor preparedness, and health and safety concerns, health-care workers maintained their motivation. There is an urgent need for an effective coor

Published
2022

23. CEBAF Injector Model for K_{L} Beam Conditions

Author

Pokharel, Sunil, Bruker, Max, Grames, Joseph, Hofler, Alicia, Kazimi, Reza, Krafft, Geoffrey, and Zhang, Shukui

Subjects
MC5: Beam Dynamics and EM Fields, Accelerator Physics
Abstract

The Jefferson Lab KL experiment will run at the Continuous Electron Beam Accelerator Facility with a much lower bunch repetition rate (7.80 or 15.59 MHz) than nominally used (249.5 or 499 MHz). While the proposed average current of 2.5 - 5.0 muA is relatively low compared to the maximum CEBAF current of approximately 180 muA, the corresponding bunch charge is atypically high for CEBAF injector operation. In this work, we investigated the evolution and transmission of low-rep-rate, high-bunch-charge (0.32 to 0.64 pC) beams through the CEBAF injector. Using the commercial software General Particle Tracer, we have simulated and analyzed the beam characteristics for both values of bunch charge. We performed these simulations with the existing injector using a 130 kV gun voltage. We have calculated and measured the transmission as a function of the photocathode laser spot size and pulse length. We report on the findings of these simulations and optimum parameters for operating the experiment., Proceedings of the 13th International Particle Accelerator Conference, IPAC2022, Bangkok, Thailand

Published
2022
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24. Modeling a Nb₃Sn Cryounit in GPT at UITF

Author

Pokharel, Sunil, Hofler, Alicia, and Krafft, Geoffrey

Subjects
MC5: Beam Dynamics and EM Fields, Accelerator Physics
Abstract

Nb₃Sn is a prospective material for future superconducting RF (SRF) accelerator cavities. The material can achieve higher quality factors, higher temperature operation and potentially higher accelerating gradients (E_{acc} 96 MV/m) compared to conventional niobium. In this work, we performed modeling of the Upgraded Injector Test Facility (UITF) at Jefferson Lab utilizing newly constructed Nb₃Sn cavities. We studied the effects of the buncher cavity and varied the gun voltages from 200-500 keV. We have calibrated and optimized the SRF cavity gradients and phases for the Nb₃Sn five-cell cavities energy gains with the framework of General Particle Tracer (GPT). Our calculations show the beam goes cleanly through the unit. There is full energy gain out of the second SRF cavity but not from the first SRF cavity due to non-relativistic phase shifts., Proceedings of the 13th International Particle Accelerator Conference, IPAC2022, Bangkok, Thailand

Published
2022
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29. Health System Preparedness for COVID-19 and Its Impacts on Frontline Health-Care Workers in Nepal: A Qualitative Study Among Frontline Health-Care Workers and Policy-Makers.

Author

Shrestha, Nipun, Mishra, Shiva Raj, Ghimire, Saruna, Gyawali, Bishal, Marahatta, Sujan Babu, Maskey, Smriti, Baral, Sushila, Shrestha, Nilima, Yadav, Rakesh, Pokharel, Sunil, and Adhikari, Bipin

Subjects
COVID-19 pandemic, MEDICAL personnel
Abstract

Background: Rapidly growing coronavirus disease 2019 (COVID-19) pandemic has brought unprecedented challenges to the health system in Nepal. The main objective of this study was to explore the health system preparedness for COVID-19 and its impacts on frontline health-care workers in Nepal. Methods: Semi-structured interviews were conducted among 32 health-care workers who were involved in clinical care of COVID-19 patients and four policy-makers who were responsible for COVID-19 control and management at central and provincial level. Interviews were conducted through telephone or Internet-based tools such as Zoom and Skype. All interviews were audio-recorded, transcribed into English, and coded using inductive and deductive approaches. Results: Both health-care workers and policy-makers reported failure to initiate pre-emptive control measures at the early stages of the outbreak as the pivot in pandemic control. Although several measures were rolled out when cases started to appear, the overall health system preparedness was low. The poor governance, and coordination between three tiers of government was compounded by the inadequate personal protective equipment for health-care workers, insufficient isolation beds for patients, and poor engagement of the private sector. Frontline health-care workers experienced various degrees of stigma because of their profession and yet were able to maintain their motivation to continue serving patients. Conclusion: Preparedness for COVID-19 was affected by the poor coordination between three tiers of governance. Specifically, the lack of human resources, inadequate logistic chain management and laboratory facilities for testing COVID-19 appeared to have jeopardized the health system preparedness and escalated the pandemic in Nepal. Despite the poor preparedness, and health and safety concerns, health-care workers maintained their motivation. There is an urgent need for an effective coordination mechanism between various tiers of health structure (including private sector) in addition to incentivizing the health-care workers for the current and future pandemics. [ABSTRACT FROM AUTHOR]

Published
2022
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30. Health System Preparedness for COVID-19 and Its Impacts on Frontline Health-Care Workers in Nepal: A Qualitative Study Among Frontline Health-Care Workers and Policy-Makers

Author

Shrestha, Nipun, primary, Mishra, Shiva Raj, additional, Ghimire, Saruna, additional, Gyawali, Bishal, additional, Marahatta, Sujan Babu, additional, Maskey, Smriti, additional, Baral, Sushila, additional, Shrestha, Nilima, additional, Yadav, Rakesh, additional, Pokharel, Sunil, additional, and Adhikari, Bipin, additional

Published
2021
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31. Why do people purchase antibiotics over-the-counter? A qualitative study with patients, clinicians and dispensers in central, eastern and western Nepal

Author

Adhikari, Bipin, primary, Pokharel, Sunil, additional, Raut, Shristi, additional, Adhikari, Janak, additional, Thapa, Suman, additional, Paudel, Kumar, additional, G C, Narayan, additional, Neupane, Sandesh, additional, Neupane, Sanjeev Raj, additional, Yadav, Rakesh, additional, Shrestha, Sirapa, additional, Rijal, Komal Raj, additional, Marahatta, Sujan B, additional, Cheah, Phaik Yeong, additional, and Pell, Christopher, additional

Published
2021
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34. Trimethoprim-sulfamethoxazole Versus Azithromycin for the Treatment of Undifferentiated Febrile Illness in Nepal: A Double-blind, Randomized, Placebo-controlled Trial

Author

Giri, Abhishek, primary, Karkey, Abhilasha, additional, Dangol, Sabina, additional, Arjyal, Amit, additional, Pokharel, Sunil, additional, Rijal, Samita, additional, Gajurel, Damodar, additional, Sharma, Rabi, additional, Lamsal, Kamal, additional, Shrestha, Pradip, additional, Prajapati, Gayatri, additional, Pathak, Saruna, additional, Shrestha, Sita Ram, additional, K.C, Raj Kumar, additional, Pandey, Sujata, additional, Thapa, Abishkar, additional, Shrestha, Nistha, additional, Thapa, Raj Kumar, additional, Poudyal, Buddhi, additional, Phuong, Dung Nguyen Thi, additional, Baker, Stephen, additional, Kestelyn, Evelyne, additional, Geskus, Ronald, additional, Thwaites, Guy, additional, and Basnyat, Buddha, additional

Published
2020
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38. Trimethoprim-sulfamethoxazole Versus Azithromycin for the Treatment of Undifferentiated Febrile Illness in Nepal: A Double-blind, Randomized, Placebo-controlled Trial.

Author

Giri, Abhishek, Karkey, Abhilasha, Dangol, Sabina, Arjyal, Amit, Pokharel, Sunil, Rijal, Samita, Gajurel, Damodar, Sharma, Rabi, Lamsal, Kamal, Shrestha, Pradip, Prajapati, Gayatri, Pathak, Saruna, Shrestha, Sita Ram, K. C., Raj Kumar, Pandey, Sujata, Thapa, Abishkar, Shrestha, Nistha, Thapa, Raj Kumar, Poudyal, Buddhi, and Dung Nguyen Thi Phuong

Abstract

Background. Azithromycin and trimethoprim-sulfamethoxazole (SXT) are widely used to treat undifferentiated febrile illness (UFI). We hypothesized that azithromycin is superior to SXT for UFI treatment, but the drugs are noninferior to each other for culture-confirmed enteric fever treatment. Methods. We conducted a double-blind, randomized, placebo-controlled trial of azithromycin (20 mg/kg/day) or SXT (trimethoprim 10 mg/kg/day plus sulfamethoxazole 50 mg/kg/day) orally for 7 days for UFI treatment in Nepal. We enrolled patients >2 years and <65 years of age presenting to 2 Kathmandu hospitals with temperature ≥38.0°C for ≥4 days without localizing signs. The primary endpoint was fever clearance time (FCT); secondary endpoints were treatment failure and adverse events. Results. From June 2016 to May 2019, we randomized 326 participants (163 in each arm); 87 (26.7%) had blood culture–confirmed enteric fever. In all participants, the median FCT was 2.7 days (95% confidence interval [CI], 2.6–3.3 days) in the SXT arm and 2.1 days (95% CI, 1.6–3.2 days) in the azithromycin arm (hazard ratio [HR], 1.25 [95% CI, .99–1.58]; P = .059). The HR of treatment failures by 28 days between azithromycin and SXT was 0.62 (95% CI, .37–1.05; P = .073). Planned subgroup analysis showed that azithromycin resulted in faster FCT in those with sterile blood cultures and fewer relapses in culture-confirmed enteric fever. Nausea, vomiting, constipation, and headache were more common in the SXT arm. Conclusions. Despite similar FCT and treatment failure in the 2 arms, significantly fewer complications and relapses make azithromycin a better choice for empirical treatment of UFI in Nepal. [ABSTRACT FROM AUTHOR]

Published
2021
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45. Algorithm in the Diagnosis of Febrile Illness Using Pathogen-specific Rapid Diagnostic Tests.

Author

Pokharel, Sunil, White, Lisa J, Aguas, Ricardo, Celhay, Olivier, Pellé, Karell G, and Dittrich, Sabine

Subjects
*DIAGNOSIS of fever, *RAPID diagnostic tests, *DISEASE prevalence, *ROUTINE diagnostic tests, *SENSITIVITY & specificity (Statistics), *ALGORITHMS
Abstract

Background In the absence of proper guidelines and algorithms, available rapid diagnostic tests (RDTs) for common acute undifferentiated febrile illnesses are often used inappropriately. Methods Using prevalence data of 5 common febrile illnesses from India and Cambodia, and performance characteristics (sensitivity and specificity) of relevant pathogen-specific RDTs, we used a mathematical model to predict the probability of correct identification of each disease when diagnostic testing occurs either simultaneously or sequentially in various algorithms. We developed a web-based application of the model so as to visualize and compare output diagnostic algorithms when different disease prevalence and test performance characteristics are introduced. Results Diagnostic algorithms with appropriate sequential testing predicted correct identification of etiology in 74% and 89% of patients in India and Cambodia, respectively, compared with 46% and 49% with simultaneous testing. The optimally performing sequential diagnostic algorithms differed in India and Cambodia due to varying disease prevalence. Conclusions Simultaneous testing is not appropriate for the diagnosis of acute undifferentiated febrile illnesses with presently available tests, which should deter the unsupervised use of multiplex diagnostic tests. The implementation of adaptive algorithms can predict better diagnosis and add value to the available RDTs. The web application of the model can serve as a tool to identify the optimal diagnostic algorithm in different epidemiological settings, while taking into account the local epidemiological variables and accuracy of available tests. [ABSTRACT FROM AUTHOR]

Published
2020
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50. Co-trimoxazole versus azithromycin for the treatment of undifferentiated febrile illness in Nepal: study protocol for a randomized controlled trial

Author

Pokharel, Sunil, primary, Basnyat, Buddha, additional, Arjyal, Amit, additional, Mahat, Saruna Pathak, additional, KC, Raj Kumar, additional, Bhuju, Abhusani, additional, Poudyal, Buddhi, additional, Kestelyn, Evelyne, additional, Shrestha, Ritu, additional, Phuong, Dung Nguyen Thi, additional, Thapa, Rajkumar, additional, Karki, Manan, additional, Dongol, Sabina, additional, Karkey, Abhilasha, additional, Wolbers, Marcel, additional, Baker, Stephen, additional, and Thwaites, Guy, additional

Published
2017
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