The national external quality assessment scheme for diagnostic medical parasitology in the Philippines, 2009-2015.

BACKGROUND: The Research Institute for Tropical Medicine (RITM)-National Reference Laboratory (NRL) for Malaria and Other Parasites, mandated by the Department of Health-Philippines (DOH), administers an annual Proficiency Test (PT) in diagnostic medical parasitology to clinical laboratories throughout the Philippines through the National External Quality Assessment Scheme (NEQAS). The PT in Parasitology aims to monitor and evaluate the capability of Philippine laboratories in the identification of blood and intestinal parasites, and the estimation of malaria parasite density in malaria-infected blood films. As of 2018, participation in the NEQAS is an annual requirement by the Department of Health-Health Facilities and Services Regulatory Bureau (DOH-HFSRB) for each clinical laboratory to obtain a license to operate. 

OBJECTIVE: This report aims to summarize the results of the PT for Parasitology and assess the performance of participating laboratories in malaria and fecal parasite microscopy from 2009 to 2015. 

METHODOLOGY: RITM-NRL oriented clinical laboratories in the NEQAS in 2008. Laboratories submitted their accomplished enrolment forms to RITM-NRL and paid fees to enroll in the PT in 2009 to 2015. Participating laboratories identified the species of malaria in blood films and the parasite/s in formalin-preserved fecal specimens. Estimation of parasite density in malaria blood films was performed as well. 

RESULTS: One thousand five hundred forty (1,540) laboratories participated from 2009 to 2015. Mean and median scores in all seven years were below the cut-off score of 80. Schistosoma japonicum was the most difficult to identify with only 7.7% of laboratories having correct identification result. Majority of participants from 2010 to 2014 gave malaria parasite density estimates outside the acceptable range. 

CONCLUSION: Most participating laboratories performed poorly in the proficiency tests over the last seven years. Training and refresher courses for laboratorians are recommended in order to address the poor performance in the laboratory diagnosis of parasitic infections, especially the endemic and uncommon ones, in the country.