# A descriptive study on feasibility of nasopharyngeal and oropharyngeal swab collection from pediatric research participants in Cebu, Philippines

## TL;DR

This study explores the challenges of collecting nasal and throat swabs from children in Cebu, Philippines, finding that fear, discomfort, and perceived lack of necessity are major barriers.

## Contribution

The study provides insights into the feasibility and acceptability of swab collection for respiratory virus surveillance among pediatric populations in a specific regional context.

## Key findings

- Only 16.1% of participants agreed to undergo NPS/OPS collection, all from the community-based study.
- Fear or discomfort was cited as a reason for refusal by 20.5% of participants.
- None of the hospital-based participants agreed to NPS/OPS collection.

## Abstract

Nasopharyngeal (NPS) and oropharyngeal (OPS) swab collection are vital in the diagnosis and surveillance of respiratory viruses. However, the acceptability of these procedures among children remains a challenge.

We conducted a descriptive study using data from two pediatric observational studies in Cebu, Philippines (July 2021–October 2022). One was a community-based study, involving febrile adolescents aged 13–19 years, and the other was a hospital-based study, involving febrile children aged 1 month to <5 years. Both studies aimed to collect NPS/OPS samples for respiratory pathogen testing, including SARS-CoV-2, influenza A/B, and respiratory syncytial virus. We described reasons for refusal of NPS/OPS collection obtained from parents or guardians who were approached for participation in these studies.

Among 180 children enrolled from study sites in Bogo and Balamban Cebu, 134 (74.4%) were from the community-based study and 46 (25.6%) from the hospital-based study. Twenty-nine (29/180; 16.1%) agreed to undergo NPS/OPS collection—all of whom were from the community-based study. None of the hospital-based participants agreed to undergo NPS/OPS collection as part of their participation in the study. Among the 151/180 (83.90%) participants who refused the research swab collection, 41 (27.2%) declined due to a prior swab, 31 (20.5%) cited fear or discomfort, and 28 (18.5%) felt it was unnecessary at the time.

NPS/OPS collection was less acceptable in both community and hospital settings, unless mandated by local authorities based on the experience during the COVID-19 pandemic. Prior swabbing, procedural discomfort, and perceived lack of necessity were key barriers, especially among younger children and their caregivers.