External quality assessment in African clinical laboratories: A systematic review and meta-analysis.

Objectives: External quality assessment (EQA) helps evaluate and improve the quality of laboratory testing by providing unbiased reviews. The study aimed to synthesize pooled EQA performance of clinical laboratories across the African region.

Methods: The review was registered in PROSPERO (CRD42024562987) and reported based on the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. An extensive search was employed using the PubMed, Scopus, Cochrane, and Embase databases as well as gray literature. After duplicates were removed, the remaining articles were evaluated based on title, abstract, and full text. Methodologic quality was assessed using the JBI critical appraisal checklist. Random effects meta-analysis was used to estimate the pooled performance of EQA at 95% CIs. In addition, the I2 statistic was used to assess heterogeneity, and a funnel plot along with Egger regression were employed to evaluate publication bias. Trim and fill analysis was also performed to adjust the publication bias.

Results: From an electronic database search, a total of 622 articles were retrieved. Of these, 17 articles met the inclusion criteria, encompassing a total sample size of 4509 participating laboratories. In this study, the overall pooled performance of EQA in the African region was 71.25% (95% CI, 63.12-79.39). The result indicated statistically significant heterogeneity (I2 = 96.36). The funnel plot displayed an asymmetrical distribution of the studies, and Egger regression revealed significant publication bias (P = .002).

Conclusions: The findings revealed that the pooled EQA performance of laboratories in Africa did not meet the typical standard of 80%, indicating a need for continuous improvement. We suggest conducting further studies to gain better insights.