The flows and impasses of the Neonatal Screening Policy for congenital toxoplasmosis in the state of Pará

Abstract

Neonatal screening for congenital toxoplasmosis (CT) is an important tracking tool, recently implemented in the state of Pará, where there is a high prevalence of this disease. However, obstacles to complying with the protocols of this policy negatively impact the early management of reported cases. Thus, the objective of this study was to identify the main difficulties during the referral and outpatient follow-up of patients diagnosed with CT at the centralized referral service of the National Neonatal Screening Program (NNSP) in the state of Pará. This is an observational, descriptive, and retrospective study, conducted using data from physical medical records of patients with a confirmed diagnosis of CT followed up at the service since November 2024 to November 2025. The average time between birth-screening was 7.7 days; screening-confirmatory tests was: 43.9 days; and confirmatory tests-first consultation was 22.3 days. Among these 52 children confirmed with CT, 87% had less than one consultation per month with an infectious disease specialist. Among the multidisciplinary team members, there were no consultations with a neurologist, and 42% underwent speech therapy evaluation. The children came from 32 municipalities distributed throughout the state, with a predominance of cities outside the Belém Metropolitan Region. Travel to specialized care was a determining factor for 37 patients to also utilize the Out-of-Home Treatment (OBT) program, adding other obstacles in the care flow. Therefore, the study demonstrated delays and difficulties in the effectiveness of early diagnosis and timely initiation of treatment.