Unreliable and ingenuine results issued by clinical laboratories have serious consequences for the patients. Sigma metrics is a standardized tool for Quality assessment for test performance in a laboratory. To evaluate the performance of routine biochemistry laboratory at MMIMSR, Mullana in terms of Sigma metrics and Quality Goal Index. This cross sectional study evaluated performance of 14 routine chemistry parameters using retrospective Internal Quality Control data of two levels on Siemens Dimension Rxl from Feb to Jul 2019 for CV% and EQAS reports from CMC, Vellore for Bias%. Sigma metrics was calculated using total allowable error targets as per CLIA and Biological Variability database guidelines. For level-2 IQC; TG, Chol, ALP showed excellent performance with σ ​> ​6 while σ ​< ​3 was observed for AST, Total Protein, Glucose, BUN and ALT using CLIA guidelines while in IQC Level-3 poor performers were only BUN and ALT with Ca, TG and Chol showing σ ​> ​6. Further by using Biological Variability data guidelines; 10 parameters of IQC Level-2 and 5 of IQC level-3 were poor performers with σ ​< ​3. Sigma metrics is an excellent tool for performance analysis of tests performed in a clinical laboratory. Lack of precision in terms of CV% was seen for majority of the poor performers. Total allowable error targets using Biological Variability data revealed σ ​< ​3 for 10 parameters while using CLIA guidelines σ ​< ​3 was seen for only 5 parameters of IQC level-2.

Background: India accounted for 6% of global burden of malaria with 95% population residing in malaria endemic areas. However, Punjab is in the malaria elimination phase with annual parasite incidence (API) <1/1000 population. Objectives: We evaluated malaria surveillance system in Punjab using CDC’s updated guidelines for evaluating public health surveillance systems to provide recommendations for strengthening the existing system and to overcome the challenges in the path of malaria free Punjab. Methods: We chose two districts of Punjab, Amritsar (lowest API) and Mansa (highest API), interviewed stakeholders, and performed a retrospective desk review. We evaluated the overall usefulness of the system and assessed seven attributes at state, district, health facility, and village level during July–August 2020. Results: In Punjab, there was progressive decline in the malaria cases from 2,955 cases in 2009 to 1,140 in 2019 and no malaria deaths since 2011. Regarding various attributes, overall score for flexibility was good (85.9%); average for simplicity (77%), acceptability (74%), data quality (74%), and timeliness (70%); and poor for representativeness (59%) and stability (57%). Conclusions: Malaria surveillance system was useful in analyzing the trends of morbidity and mortality and for generating data to drive policy decisions. To improve stability, representativeness, and acceptability, surveillance staff should not be engaged in supplemental work, and reports from private sector must be ensured. Supportive supervision and regular trainings should be carried out regarding reporting formats, guidelines, and timely epidemiological investigations to improve timeliness, data quality, and simplicity.

Background: COVID-19 vaccination of the healthcare workers (HCWs) is a key priority in the fight against the SARS-CoV-2 pandemic. India launched its COVID-19 vaccination program in January 2021. We aimed to understand the trends in willingness to receive COVID-19 vaccines and its associated factors among HCWs in India.Methods: Using a repeated cross-sectional survey design, we collected information from HCWs in three critical time points: before (n = 937, October 2020), during (n = 1346, January 2021); and after (n = 812, May 2021) the introduction of COVID-19 vaccines in India. The third survey coincided with the peak of the second wave of COVID-19 pandemic in India.Findings: Of the study participants, 43.7, 60.2, and 73.2% were willing to receive COVID-19 vaccines during the first, second and third rounds of surveys, respectively. In multivariable logistic regression analysis, participants who trusted the health care system were more likely to report willingness to receive a COVID-19 vaccine; medical trust emerged as a significant factor in all the three rounds of surveys (First survey—aOR: 2.24, 95% CI: 1.67–2.99; Second survey—aOR: 3.38, 95% CI: 2.64-4.33; Third survey—aOR: 2.54, 95% CI: 1.65–3.91). Having confidence in domestic vaccines (Second survey—aOR: 2.21, 95% CI: 1.61–3.02; Third survey—aOR: 2.05, 95% CI: 1.24–3.37); and high perceived risk of contracting COVID-19 (Second survey—aOR: 1.48, 95% CI: 1.13–1.93; Third survey—aOR: 2.02, 95% CI: 1.31–3.13) were found to be associated with willingness to receive vaccines. Among socio-demographic characteristics, being married (aOR: 1.71, 95% CI: 1.08–2.71) and having high socio-economic status (aOR: 3.01, 95% CI: 1.65–5.51) emerged as significant factors associated with willingness to receive COVID-19 vaccines in the third round of the surveys.Interpretation: Willingness to receive COVID-19 vaccine increased with time, as the severity of the pandemic increased. To increase COVID-19 acceptance and coverage among HCWs, it is important to instill confidence in domestic vaccines and assist in accurate assessment of risk toward contracting COVID-19 infection.

Vaccine hesitancy is of considerable concern as it threatens the great potential of a vaccine against COVID-19. This study aims to determine factors associated with community health workers’ willingness to participate in clinical trials of COVID-19 vaccine, and their vaccination intention, in India. A cross-sectional study was conducted among 377 community health workers using self-administered anonymous questionnaire during the lockdown periods in India. Participant's socio-demographics, willingness-to-participate in COVID-19 vaccine trials, intention to accept COVID-19 vaccine were recorded in a Likert scale. Data were analysed descriptively, and a multivariate logistic regression model was used to investigate factors associated with willingness to participate and accept the vaccine. Among 377 CHWs, 70 (19%) intended to participate in COVID-19 vaccine trial, 151 (40%) responded positively regarding their intention to get vaccinated. Those with knowledge on development of COVID-19 vaccine [aOR 3.05 (95% CI: 1.18–7.88), p = 0.021], and men [aOR 3.69 (95% CI: 1.51–8.97), p = 0.004] were more willing to participate in clinical-trial, while an undergraduate degree, and trust in domestic vaccines were identified as deterrents for the same. Perceiving COVID-19 as risk [aOR 2.31 (95% CI: 1.24–4.31), p = 0.009], and male gender [aOR 2.39 (95% CI: 1.17–4.88), p = 0.017] were factors associated with intention to get vaccinated. Respondents who had knowledge about COVID-19 virus were less likely to uptake the hypothetical vaccine [aOR 0.32 (95% CI: 0.12–0.88), p = 0.027]. Increasing knowledge regarding COVID-19 is not enough to improve vaccine acceptance rates. Targeted interventions addressing socio-demographic determinants related to COVID-19 vaccination should help improve acceptance.

In Punjab, first COVID-19 case was detected on March 5, 2020 followed by multiple clusters. Understanding the epidemiology of reported COVID-19 cases helps decision makers in planning future responses. We described the epidemiological patterns, laboratory surveillance and contact tracing of COVID-19 cases in Punjab. We analysed state's COVID-19 data from March–May 2020 to describe time, place and person distribution. We analysed the laboratory surveillance and contact tracing reports to calculate frequency of testing, sample positivity rate (PR) and contacts traced per case. A total of 2256 cases were reported from March–May 2020 (attack rate 75 cases/million and case fatality rate 2%). Attack rate was higher among males (81 cases/million males) and maximum affected age group was 60–69 years (164∙5 cases/million). Five of 22 districts reported almost half cases in May's first week. Mortality rate was highest among individuals >60 years (six deaths/million) and males (two deaths/million males). Of 45 deaths, 41 reported comorbidities [(hypertension (42%), diabetes (40%)]. COVID-19 testing increased from 46 samples/day (PR: 2%) in March's first week to 4000 samples/day (PR: 2∙5%) by May's end (2752 tests/million). Amritsar conducted 2035 tests/million (highest PR: 6∙5%) while Barnala conducted 4158 tests/million (lowest PR: 1%). For 2256 cases, 19,432 contacts were traced (nine contacts/case) with 11% positivity rate. COVID-19 in Punjab mostly affected males, >60 years of age and individuals with comorbid conditions. Many districts with less testing and contact tracing had higher positivity rate. We recommended to implement and ensure adequate testing and contact tracing in all the districts of Punjab.