Investigator(s)
| WHO Technical Officer |
Saugat shrestha World Health Organization (WHO) Country Office Nepal Saugat shrestha 
|
| Principal Investigator |
Bal Krishna Awal National Public Health Laboratory, Kathmandu, Nepal Bal Krishna Awal
|
Title(s) and abstract
| Scientific title | Completeness and Timeliness of Identification and Testing of ‘Severe Acute Respiratory Infection’ (SARI) cases for Influenza at 15 virological surveillance sites of Nepal: A mixed-methods study |
| Public title | Completeness and Timeliness of Identification and Testing of SARI cases in Nepal |
| Background | Influenza remains a major global health burden. Low- and middle-income countries, including Nepal, face disproportionate challenges due to limited diagnostic capacity and constrained health systems. Severe Acute Respiratory Infection (SARI), defined by WHO as acute respiratory infection with fever and cough of less than 10 days requiring hospitalization, is a key syndrome for influenza surveillance. Timely identification and testing of SARI cases are critical for outbreak detection, guiding interventions, and informing vaccine policy. Nepal’s National Influenza Centre (NIC) at the National Public Health Laboratory (NPHL) coordinates influenza virological surveillance through a network of 15 sentinel sites, linked either directly to NPHL or to Provincial Public Health Laboratories (PPHL). Despite this, anecdotal evidence suggests gaps in identifying and testing SARI cases, with incomplete sampling and delays in reporting. |
| Objectives | General Objective: To evaluate the extent of identification and testing of patients with SARI for influenza at 15 virological surveillance sites in Nepal, and to understand enablers, challenges, and potential solutions. Specific Objectives: 1. Among inpatients at all 15 influenza virological surveillance sites in Nepal during February 2026, to assess the a. Proportion meeting the SARI case definition, and among them, proportion tested and confirmed positive for influenza b. Median time intervals between dates of admission, sample collection, testing and reporting results up to subtyping (influenza A) /lineage (Influenza B). 2. To explore the enablers, challenges and solutions in identification and testing of SARI cases from the perspective of health care providers and focal points at NPHL and PPHL. |
| Study Methods | An explanatory mixed-methods design will be used. The quantitative phase involves a cohort of all inpatients admitted during February 2026, a peak influenza month. Data will be extracted from admission/discharge registers and laboratory databases. A sample size of 1,535 SARI cases is anticipated (census approach). Variables include demographics, diagnoses, testing status, and timelines. Data will be captured electronically via EpiCollect5, cleaned, and analyzed in Stata. Key indicators will be stratified by site, laboratory linkage, age, and gender, with statistical tests applied to assess differences. The qualitative phase will follow, using purposive sampling of 4–6 sentinel sites representing high and low performers. Approximately 20 interviews with clinicians, nurses, laboratory staff, medical recorders, and focal points at PPHL/NPHL will be conducted, after obtaining written informed consent. Interviews will explore operational challenges, enablers, and proposed solutions. Transcripts will be analyzed using descriptive content analysis, guided by COREQ standards. |
| Expected outcomes and use of results | The study will generate evidence on the completeness and timeliness of SARI case identification and influenza testing. By integrating quantitative findings with qualitative insights, it will highlight systemic gaps and practical solutions. Results will inform national strategies to strengthen surveillance, improve data quality, and enhance pandemic preparedness. Ultimately, the research aims to bridge policy and practice, ensuring Nepal’s influenza surveillance system is robust, responsive, and sustainable. |
| Keywords | Influenza, Nepal, SARI, NISN, case definition, completeness |
Research Details
| Student research | No |
| Start Date | 09-Feb-2026 |
| End Date | 31-Dec-2026 |
| Key Implementing Institution | National Influenza Centre-National Public Health Laboratory |
| Multi-country research | No |
| Nationwide research | Yes |
| Research Domain(s) | Communicable Disease Research |
| Research field(s) | Infectious Disease |
| Involves human subjects | Yes |
| Operational Research | |
| Data Collection | Primary and secondary data |
| Proposal reviewed by other Committee | Final decision available |