Assessment of Current Dengue Diagnostic Practices Across Health Facilities in Bagmati Province
Background
Dengue is one of the fastest-growing mosquito-borne viral infections worldwide, with an estimated 390 million infections occurring annually. More than 70% of the global burden is concentrated in Asia and Latin America, but outbreaks are increasingly being reported in Africa. The spread of Aedes aegypti and Aedes albopictus mosquitoes, rapid urbanization, climate change, and increased mobility of populations have contributed to the wider expansion of dengue into both endemic and previously non-endemic regions.
Despite its growing burden, dengue diagnosis remains a major challenge. The clinical presentation of dengue is often non-specific and overlaps with other febrile illnesses such as malaria, chikungunya, influenza, and typhoid fever. In the absence of reliable laboratory confirmation, misdiagnosis can result in inappropriate treatment, delayed detection of severe cases, and misuse of antibiotics (a driver of antimicrobial resistance (AMR)). To address this, WHO recommends laboratory confirmation of all suspected dengue cases – using antigen detection (NS1 RDTs/ELISA), IgM/IgG serology, or molecular assays (RT-PCR).
However, in most LMICs, there is limited evidence on the availability, affordability, and uptake of available dengue diagnostic tools. Experiences from malaria diagnostics have shown that even after global policy shifts, diagnostic access in LMICs, particularly in the private sector, remains inconsistent. Understanding the dengue diagnostics market is therefore critical for strengthening health systems, ensuring equitable access to testing, and improving outbreak preparedness.
Nepal Context
Nepal has witnessed a rapid rise in dengue cases since the first outbreak recorded in 2010, with subsequent large nationwide epidemics recorded in 2019 and 2022. The disease, once limited to the southern, lowland Terai region, has now expanded to hill and mountain districts, demonstrating the changing epidemiology of dengue in the country. Laboratory capacity for dengue testing is concentrated in urban centers and tertiary hospitals, while peripheral facilities often rely on clinical diagnosis or limited use of RDTs. In the private sector, diagnostic services are expanding but remain largely unregulated, with variable pricing and uncertain quality.
Given Nepal’s increasing dengue burden, its mix of public and private health service providers, and its vulnerability to large outbreaks, the country provides an important setting to assess the current state of dengue diagnostics. This study will provide evidence to help close a current knowledge gap by documenting baseline availability, pricing, and barriers to dengue diagnostic access in Nepal, while also generating evidence relevant to other LMICs facing similar challenges.
Objectives
- To generate observational data on the current state of dengue diagnostics availability in public and private health sectors in Nepal.
- To assess the types of available diagnostic tests in use (NS1 antigen, IgM/IgG serology, ELISA, PCR) and their distribution across facilities.
- To assess manufacturer and regulatory approval status of diagnostic products.
- To establish baseline evidence on the availability and cost of dengue diagnostics to support national policy formulation and resource planning.
Methods
A nationally representative, cross-sectional, cluster-based survey will be conducted across all seven provinces of Nepal in two phases. The survey will target the following levels of the health system:
- Public hospitals and health facilities at central, provincial, and district levels.
- Private sector institutions, including hospitals, clinics, and diagnostic laboratories.
- Community-level providers, such as pharmacies and drug shops, where diagnostic services are available.
Nepal comprises seven provinces—Koshi, Madhesh, Bagmati, Gandaki, Lumbini, Karnali, and Sudurpashchim – each with varying laboratory capacities. While some provinces have well-established laboratories, others include remote districts with limited diagnostic infrastructure.
Phase 1: The initial phase will be implemented in Bagmati Province, which includes 13 districts.
Phase 2: The survey will be expanded to cover the remaining six provinces in subsequent phases.
Eligibility criteria:
Outlets will be eligible if they currently provide dengue diagnostic services or have done so in the past 1 year.
Data collection:
Structured questionnaires will be used to capture information on:
- Availability and types of dengue diagnostic tests.
- Manufacturers and brands of available products.
- Pricing of diagnostics in public and private sectors.
- Procurement sources, supply chain reliability, and stock-out frequency.
Expected Results
- A comprehensive overview of dengue diagnostic test availability and use across public and private sectors in Nepal.
- Identification of gaps in diagnostic access and need especially in peripheral facilities and private outlets.
- Documentation of patient-level costs and variations in pricing across providers.
- Insights into supply chain and market challenges, including dependence on imported products.
- Preliminary insights into how the availability and affordability of diagnostics may influence case management practices, highlighting areas where further research could assess the direct impact of diagnostic access on quality of care, rational use of medicines, and patient outcomes.
Study team;
Dr. Janak Thapa, Ms. Pragya Pokharel, Mr. Sushant Luitel, and Dr. Jyotshna Sapkota
Duration: January 2026- July 2026