Clinical Factors Among Health-Care Providers Affecting the Diagnosis of Pulmonary Paragonimiasis in Basilan, Philippines: A 2006 Baseline Study Revisited

Basilan was identified as a new endemic focus for human paragonimiasis in 1992, yet hospital-confirmed cases declined sharply over the following decade without clarity on whether this reflected true epidemiological change or diagnostic failure. Objectives: This study, conducted in 2006 and not previously published, examined the clinical factors affecting the diagnosis of pulmonary paragonimiasis in Basilan: physician knowledge competency, medical technologists' diagnostic skills, hospital diagnostic capability, and rural health unit (RHU) recognition and referral practices. Design: Analytical, cross-sectional study. Participants and sampling: Twelve physicians, eleven medical technologists, and two RHU midwives (N = 25) enrolled through total enumeration of all eligible personnel in four major hospitals and two RHUs in paragonimiasis-endemic municipalities. Instruments: Three parallel problem-based, criterion-referenced multiple-choice examinations, validated by laboratory and public health specialists and pretested before administration. Statistical tools: Frequency and percentage, mean, standard deviation, University of Calgary item analysis against a computed Minimum Passing Level (MPL), the KR-20 coefficient, and the chi-square test with the Fisher-Freeman-Halton exact test; hospital capability was assessed against World Health Organization (WHO, 1996) laboratory standardization criteria. Results: For SOP 1, 8 of 11 medical technologists (73%) reached the MPL, but only 7 of 11 (64%) passed items requiring direct identification of Paragonimus ova. For SOP 2, only 4 of 12 physicians (33%) reached the MPL, failing most often in paraclinical test selection (10/12) and preventive medicine (9/12). For SOP 3, all four hospitals met the WHO benchmarks assessed. For SOP 4, both RHU midwives recognized and appropriately referred a simulated case and had conducted community education on raw crab consumption. Conclusion: Physician underrecognition, rather than laboratory or hospital capacity, was the most likely point of breakdown, suggesting that the apparent decline in reported paragonimiasis reflected underdiagnosis rather than disease elimination, a finding still relevant to paragonimiasis-tuberculosis surveillance in the region.