Investigator(s)
| WHO Technical Officer |
Saugat shrestha World Health Organization (WHO) Country Office Nepal Saugat shrestha 
|
| Principal Investigator |
Sreska Shrestha National Public Health Laboratory (NPHL) Sreska Shrestha
|
Title(s) and abstract
| Scientific title | Performance and implementation of a newly piloted External Quality Assessment Scheme (EQAS) compared to the existing EQAS in AMR sentinel surveillance laboratories, Kathmandu, Nepal during 2025-2026 |
| Public title | Performance and implementation of a newly piloted EQAS in AMR sentinel surveillance laboratories in Nepal |
| Background | The global burden of AMR is immense, and AMR surveillance is a key strategy to address this growing public health threat. Surveillance enables the detection of resistance patterns, trends, and outbreaks at national and international levels. EQAS, which assess laboratory performance and provide structured feedback, are essential to maintaining high laboratory standards, and EQAS performance is a core indicator of AMR surveillance data quality. In Nepal, the NPHL coordinates EQAS for all AMR sentinel surveillance sites. Although EQAS has been implemented for over two decades, the existing programme has faced several limitations, including limited organism diversity, a scoring system unable to differentiate minor from major errors, lack of in-depth performance analysis, and absence of a digital platform. In 2025, NPHL piloted a new EQAS in five sentinel sites in Kathmandu, incorporating genetically characterised and internationally validated bacterial strains, an improved scoring and reporting system, a web-based tracking platform, and enhanced mechanisms for timely feedback and corrective action. |
| Objectives | The study aims to (i) compare the newly piloted EQAS with the existing programme in five AMR sentinel sites in Kathmandu in terms of timeliness, correct bacterial identification, AST, and total laboratory scores; and (ii) explore the feasibility, acceptability, and operational challenges of implementing the new EQAS. |
| Study Methods | This is an explanatory mixed-methods study using IDIs and FGDs. Five EQAS cycles from the existing programme and three cycles from the new EQAS conducted during 2025–2026 will be reviewed. Quantitative findings will inform the qualitative interview guides. The qualitative component will include eight IDIs with laboratory focal persons and NPHL officers, and two FGDs with laboratory technicians from five piloted and five non-piloted sentinel sites in the same province. The final number of interviews and discussions will be guided by thematic saturation. |
| Expected outcomes and use of results | The study will generate robust programmatic evidence on comparative EQAS performance and implementation. Results will inform NPHL and and the MOHP on whether the new EQAS should be adopted, modified, or scaled up nationally, thereby strengthening AMR surveillance quality in Nepal. |
| Keywords | AMR, EQAS, Laboratory, Nepal, AST |
Research Details
| Student research | No |
| Start Date | 31-Dec-2025 |
| End Date | 31-Dec-2026 |
| Key Implementing Institution | National Public Health Laboratory |
| Multi-country research | No |
| Nationwide research | Yes |
| Research Domain(s) | Communicable Disease Research |
| Research field(s) | |
| Involves human subjects | Yes |
| Operational Research | |
| Data Collection | Primary and secondary data |
| Proposal reviewed by other Committee | Final decision available |