The problem: Respiratory infections are among the leading causes of illness and death in children, particularly in regions where access to healthcare is limited. New and effective vaccines against bacterial respiratory infections have shifted the epidemiology towards more viral lower respiratory tract infections (LRTIs). These infections can lead to severe breathing difficulties and long-term complications like asthma or reduced lung function.  

Beyond the direct health impact, frequent illness can disrupt a child’s development and overall well-being. Factors such as air pollution, malnutrition, and inadequate vaccination can increase the risk. Moreover, missing diagnostics discriminating viral and bacterial causes of infection can contribute to overuse of antibiotics and fuel antibiotic resistance. Addressing this issue globally requires improved healthcare systems and innovative prevention and treatment options.  

In line with expert opinions, we have designed a clinical prospective study, C-LUNG, that will establish a state-of-the-art longitudinal biobank combined with clinical data of children with LRTIs to reveal the role of viral LRTIs in childhood as determinants of long-term lung disease in Nepal.  

Why Nepal and Dhulikhel Hospital: Nepal ranks among the countries with the highest global burden of childhood lower respiratory tract infections (LRTIs), both in terms of incidence and mortality. It also bears a significant burden of chronic lung disease. Despite this, there is limited research on the prevalence, risk factors, and clinical progression of common respiratory viruses in Nepali children with LRTIs. Compounding the challenge, molecular diagnostics to identify the causes of these infections is missing or not routinely used. 

Through C-LUNG, we aim to address these critical gaps. This initiative builds on a long-standing collaboration between researchers and clinicians at NTNU and St. Olav’s Hospital in Trondheim, Norway, and Dhulikhel Hospital, Kathmandu University Hospital (DHKUH), in Dhulikhel, Nepal. The collaboration agreement was formally sign in 2007 between the institsutions and have been developed further.

The principal investigators for the project have collaborated for a long time and Trude Helen Flo was a central person for establishment of a Molecular Diagnostic and Research Laboratory with equipment from NTNU/MH faculty in 2011, opened with a workshop on Molecular Methods with participants from DHKUH and other institutions in the region (Kathmandu valley). 

Pictures from the opening of the lab and the workshop.

The principal investigators for the project have collaborated for a long time. Kari Risnes was a central person for establishment of simulation training (2009) and introduction of triage and improved emergency services 2013-20.

Pictures from simulation training with personnel from St Olav and  Dhulikhel Hospital and regional work shop on pediatric viral RTI in 2009.