The challenges and successes of implementing a sustainable antimicrobial resistance surveillance programme in Nepal
Open accessAbstract
Background: Antimicrobial resistance (AMR) is a major global public health concern and its surveillance is a fundamental tool for monitoring the development of AMR. In 1998, the Nepalese Ministry of Health (MOH) launched an Infectious Disease (ID) programme. The key components of the programme were to establish a surveillance programme for AMR and to develop awareness among physicians regarding AMR and rational drug usage in Nepal. Methods: An AMR surveillance programme was established and implemented by the Nepalese MOH in partnership with the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B) from 1998 to 2003. From 2004 to 2012, the programme was integrated and maintained as a core activity of the National Public Health Laboratory (NPHL) and resulted in an increased number of participating laboratories and pathogens brought under surveillance. The main strategies were to build national capacity on isolation, identification and AMR testing of bacterial pathogens, establish laboratory networking and an External Quality Assessment (EQA) programme, promote standardised recording and reporting of results, and to ensure timely analysis and dissemination of data for advocacy and national policy adaptations. The programme was initiated by nine participating laboratories performing AMR surveillance on Vibrio cholerae, Shigella spp., Streptococcus pneumoniae , Haemophilus influenzae, and Neisseria gonorrhoeae . Results: The number of participating laboratories was ultimately increased to 13 and the number of pathogens under surveillance was increased to seven ( Salmonella spp. was added to the surveillance programme in 2002 and extended spectrum β-lactamase producing Escherichia coli in 2011). From 1999 to 2012, data were available on 17,103 bacterial isolates. During the AMR programme, we observed changing trends in serovars/ species for Salmonella spp. , Shigella spp. and V. cholerae and changing AMR trend for all organisms. Notably, N. gonorrhoeae isolates demonstrated increasing resistance to ciprofloxacin. Additionally, the performance of the participating laboratories improved as shown by annual EQA data evaluation. Conclusions: This Nepalese AMR programme continues and serves as a model for sustainable surveillance of AMR monitoring in resource limited settings.
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- Authors
- Malla, S., Dumre, S. P., Shakya, G., Kansakar, P., Rai, B., Hossain, A., Nair, G. B., Albert, M. J., Sack, D., Baker, S., Rahman, M., & The Antimicrobial Resistance Surveillance Programme team, N.
- Affiliations
- Ministry of Health and Population (NP)
- International Centre for Diarrhoeal Disease Research (BD)
- Johns Hopkins University (US)
- Oxford University Clinical Research Unit (VN)
- Corresponding author
- Rahman, Motiur
- ORCID
- Venue
- BMC Public Health
- Published
- 2014-03-21
- Volume
- 14
- Issue
- 1
- Pages
- 269-269
- ISSN
- 1471-2458 (ISSN-L)
- PMC
- PMC4234382
- OpenAlex
- W2023681437
- Cited by
- 44
- References
- 15
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 10 · 2023: 6 · 2022: 9 · 2021: 3 · 2020: 3 · 2019: 3 · 2018: 1 · 2017: 2 · 2016: 5
- FWCI
- 1.95
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Public Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Greater South Information System
- Funders
- United States Agency for International Development
- Wellcome Trust (100087)
- Topics
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
- Life Sciences › Agricultural and Biological Sciences › Food Science › Salmonella and Campylobacter epidemiology
- Keywords
- antimicrobial resistance surveillance, Nepal, external quality assessment, capacity building, rational drug use, ciprofloxacin resistance, Neisseria gonorrhoeae, Salmonella, Shigella, Vibrio cholerae, Streptococcus pneumoniae, Haemophilus influenzae, extended-spectrum beta-lactamase, resource-limited settings, public health policy
- MeSH terms
- Anti-Bacterial Agents, beta-Lactamases, Developing Countries, Escherichia coli, Gram-Negative Bacteria, Gram-Positive Bacteria, Haemophilus influenzae, Health Policy, Humans, Laboratories, Neisseria gonorrhoeae, Nepal, Research Design, Salmonella, Shigella, Streptococcus pneumoniae, Vibrio cholerae, Program Evaluation, Drug Resistance, Bacterial
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