# Adherence to the Colombian guideline on congenital toxoplasmosis

## TL;DR

This study assessed how well two hospitals in Medellin followed the Colombian guidelines for diagnosing and treating congenital and gestational toxoplasmosis between 2016 and 2020.

## Contribution

The study provides the first evaluation of adherence to the Colombian clinical guidelines for congenital and gestational toxoplasmosis in a real-world setting.

## Key findings

- Adherence to the guidelines varied, with high adherence observed in treating congenital toxoplasmosis (96.7%).
- Only 85.4% of cases included the recommended serology tests for gestational toxoplasmosis.
- Barriers to adherence included limited dissemination of guidelines and challenges in accessing diagnostic tools.

## Abstract

Congenital toxoplasmosis is associated with high morbidity and mortality in the neonatal period. Despite the existence of a Colombian clinical practice guideline for the diagnosis and treatment of gestational and congenital toxoplasmosis, adherence to its recommendations remains unknown.

To evaluate adherence to the Colombian clinical practice guidelines of congenital and gestational toxoplasmosis in two hospitals in Medellin during 2016-2020.

We conducted a descriptive study in children under one year of age with suspected or confirmed congenital toxoplasmosis, treated at two hospitals in Medellin between 2016 and 2020. We used proportion measures to assess adherence to the clinical practice guidelines recommendations.

Two hundred and forty-seven children were included; 17% had a confirmed congenital toxoplasmosis diagnosis. Adherence to the different clinical practice guidelines recommendations was variable. To diagnose gestational toxoplasmosis, immunoglobulins G and M serologies were ordered in 85.4% of the cases. Use of other diagnostic tests - depending on the clinical situation- ranged from 20 to 41.5%; amniocentesis was indicated in 42.9% of pregnant women, whereas IgM, IgG, and IgA were ordered for 50.6% of newborns. Spiramycin was prescribed to 68.8% of mothers diagnosed with gestational toxoplasmosis. Among patients diagnosed with congenital toxoplasmosis, 80.9% presented clinical manifestations; the most common were those of the central nervous system. The highest adherence to the clinical practice guidelines was observed for the treatment of congenital toxoplasmosis (96.7%).

Adherence to the recommendations of the Colombian clinical practice guidelines for congenital and gestational toxoplasmosis is variable, likely due to implementation barriers, such as limited dissemination, insufficient training or updates for healthcare personnel, and challenges in accessing diagnostic studies and ensuring follow-up. We recommend developing institutional and government policies to provide periodic updates to prenatal care and newborn care personnel.