Open Access Highly Accessed Research article

The challenges and successes of implementing a sustainable antimicrobial resistance surveillance programme in Nepal

Sarala Malla1, Shyam Prakash Dumre12, Geeta Shakya1, Palpasa Kansakar1, Bhupraj Rai1, Anowar Hossain3, Gopinath Balakrish Nair34, M John Albert35, David Sack36, Stephen Baker7, Motiur Rahman37* and The Antimicrobial Resistance Surveillance Programme team, Nepal

Author Affiliations

1 National Public Health Laboratory, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal

2 Faculty of Allied Health Science, Tammasat University, Thailand, Thailand

3 International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh

4 Translational Health Science and Technology Institute, New Delhi, India

5 Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait

6 Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA

7 The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, 764 Vo Van Kiet Street, Ward 1, District 5, Ho Chi Minh City, Vietnam

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BMC Public Health 2014, 14:269  doi:10.1186/1471-2458-14-269

Published: 21 March 2014



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.


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.


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.


This Nepalese AMR programme continues and serves as a model for sustainable surveillance of AMR monitoring in resource limited settings.

Antimicrobial resistance surveillance; Nepal; Respiratory pathogens; Enteric pathogens; Sexually transmitted disease pathogens