Expanding the volume of historical data on Antimicrobial resistance, use and consumption in the human health in Nepal: a CAPTURA undertaking

Abstract

Executive Summary: As part of the large Fleming Fund (FF) portfolio of grants funded by the Government of the United Kingdom and established as a response to the global problem of AMR, in 2019 the CAPTURA project was awarded with the specific objective of expanding the volume of historical data on antimicrobial resistance (AMR), consumption (AMC), and use (AMU) in the human health care sector across 12 countries in South and Southeast Asia, including Nepal. AMR context in Nepal AMR is a growing threat for Nepal with high level resistance to commonly used antimicrobials in the country. The AMR-National Action Plan (2018-2022) has identified several challenges to be addressed for achieving its objectives to guide various sectors to ensure a coherent, multi-sectoral approach towards combatting AMR. Nepal has a well-established AMR surveillance system, which is being expanded over time to incorporate new surveillance of emerging resistance and pathogens of interest for the country. Data generated through the network is routinely being shared within the country and externally different mechanisms.The government and private sector players provide Healthcare in Nepal. The Ministry of Health and Population (MoHP), along with multinational development agencies and external partners in the country, are working closely to upgrade the existing infrastructures and technologies to generate standardized quality data. In addition, they are also providing trainings to prepare future leaders to champion the AMR containment efforts. The authority to regulate production, import, sales and prescription of antimicrobials in the country lies with the Department of Drug Administration (DDA). The government has already made efforts to ban over-the-counter sales of antibiotics and their use in animal feed, and has been monitoring the import, production, and sales of antimicrobial agents. But, due to resource limitations, the endeavor has not been highly effective, and a large number of unregistered facilities selling drugs has posed a great challenge. Consolidated antimicrobial production, procurement, and distribution data is not available and there is an urgent need to collect it in a systematic way. With Nepal joining the GLASS-AMC,establishing a future data collection network following the GLASS methodology will enable the country to analyze, use, and share AMC data at both the local and global levels in the coming years. To generate data on antimicrobial use, antimicrobial audits are currently piloted with support from FF Country Grant and is planned to be extended across the country’s major hospitals. The continued collection of national AMR/C/U data will allow Nepal to further establish its national surveillance system as well as to implement evidence-based approaches for treating and managing infectious diseases, tracking AMR trends, and formulating AMR containment strategies. CAPTURA experience CAPTURA’s early engagement with the AMR stakeholders and subsequent effective coordination between the project team and the MoHP led to an expedited approval and work initiation. Although early progress was slowed down by the COVID-19 pandemic, CAPTURA was able to successfully achieve its objectives of identifying and assessing existing microbiology capacity, collecting and analyzing retrospective AMR data, and providing WHONET trainings to technical laboratory staff from both the human and animal health sectors. Further, a subset of AMU data was collected and analyzed as part of a piloting exercise.CAPTURA findings CAPTURA activities in Nepal have enabled capacity building within data management and analysis for future AMR and AMU surveillance efforts. In this report, we present a summary of findings from the scoping and analytical work conducted by CAPTURA in collaboration with the MoHP since 2019. The data content for this final report was selected after discussions with the CAPTURA in-country team and AMR stakeholders at the MoHP. Comprehensive analytical outputs and visualization tools will be shared with the National AMR program, QSRD, NPHL, and data owners before the closure of the project. The main utility of the retrospective data collected on AMR and AMU through the CAPTURA project in Nepal has been to identify the data sources and establish a preliminary data baseline. It is our hope that it can be a useful contribution to planning future investments in combatting AMR in Nepal and the Asian region.