Establishment of an External Quality Assessment Scheme for Clinical Parasitology Diagnostics in India: Four years of experience (2022-2025)
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Introduction
Microscopy remains an important ‘catch all’ diagnostic tool for parasite detection in clinical settings. Although relatively low-cost in endemic settings, it requires sustained technical skills. To enhance microscopy-based diagnostic capabilities in India, a parasitology External Quality Assessment Scheme (EQAS) was launched in 2022.
Materials/Methods
An online survey was conducted to plan the diagnostics scope for a clinical parasitology EQAS in India. In the EQAS, well-characterized proficiency testing material was distributed biannually, with two challenges/cycle and scoring provided based on established criteria. After three years, an online feedback survey was conducted to evaluate the perceived effectiveness of the scheme.
Results
The diagnostic scope assessment (n=78 laboratories) indicated microscopy as the commonest technique for parasite identification (100%) and molecular diagnostics are sparsely available (3.8%). Of the eight PT cycles conducted, high competence (>80%) was observed for endemic parasites, Giardia duodenalis (90% in 2022 & 97% in 2025), Echinococcus granulosus (96%), Trichuris trichiura (95%), Taenia spp., (88.6%), Strongyloides stercoralis (87%), Hymenolepis nana (84%), Ascaris lumbricoides (82.6%), Cystoisospora belli (81%), and Cryptosporidium spp. (80%). Challenges noted were in the identification of uncommon or non-endemic parasites - Paracapillaria philippinensis (58%), Clonorchis sinensis (72%), Hymenolepis diminuta (63%) and in samples with two parasites, only 27% reported both accurately. Feedback survey indicated >95% satisfaction with reporting and educational materials among respondents, and 90% requesting for 3 PT cycles/year.
Conclusion
The parasitology EQAS program tailored for Indian laboratories led to measurable improvement in diagnostic performance, and participants’ feedback indicated a positive impact on parasitology diagnostics and education.
