Quality of clinical practice guidelines for gestational and congenital toxoplasmosis: A systematic review of the literature

Abstract

Objective: To evaluate the methodological quality and transparency of the clinical practice guidelines (CPGs) for the prevention, diagnosis, and treatment of gestational and congenital toxoplasmosis (CT). Methods: Systematic review of the literature on gestational and CT CPGs conducted in the MEDLINE, Embase, TripDatabase, Biblioteca Virtual en Salud databases and extensive manual searches in 19 CPG repositories. The characteristics of each of the guidelines were extracted using My AGREE PLUS on-line. Three reviewers assessed overall quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Results:The combined systematic review found 8651 citations. Of them 46 full texts were reviewed, and eight documents were finally included: four toxoplasmosis CPGs, three prenatal care CPGs that included recommendations on toxoplasmosis, and one pregnancy infection guideline that also included recommendations on toxoplasmosis.The AGREE II domains found to have the highest scores were 'clarity of presentation' (85%; [37%-100%]), followed by 'scope and purpose' (73%; [33%-98%]), and 'editorial independence' (51%; [3%-94%]); the domains with the lowest scores were 'rigour of development' (36%; [11%-79%]), 'stakeholder involvement' (34%;[24%-85%]), and 'applicability' (17%; [6%-83%]). The Colombian and Spanish-Agencia de Evaluaci on de Tecnologías Sanitarias de Andalucía (AETSA) CPGs had the highest global AGREE II scores. Absolute interrater agreement was good to excellent.Conclusion: Substantial quality variation was found among CPGs, which provided recommendations in accordance with the context of the disease in the corresponding country or region. Only two of the CPGs appraised obtained a good score and are classified as 'recommended'.

Toxoplasmosis: A Timeless Challenge for Pregnancy

“…[ 7 ]. The prevalence rates vary from region to region, and they reach as high as 90% in some parts of Africa and up to 60% in some parts of Europe [ 7 , 8 , 9 ]. However, data from Asia (including China and India) are limited on this topic [ 10 ].…”

Toxoplasmosis gestacional: desenlaces obstétricos y resultados perinatales en un hospital de referencia en Medellín, Colombia. 2015-2021. Un estudio descriptivo

“…Aunque no era el objetivo del estudio se identificó que la aplicación de la guía nacional para el diagnóstico y tratamiento de toxoplasmosis gestacional presentó dificultades y retrasos en el primer nivel de atención. Garantizar un control prenatal temprano y la adecuada implementación de las guías de manejo, es la mejor estrategia para una detección oportuna de riesgos y educación aplicada de la prevención primaria y secundaria en toxoplasmosis durante la gestación, tal como se demostró en un centro de referencia en el departamento de Quindío, Colombia, donde evidenciaron que al implementar las guías se aumentó significativamente el diagnóstico prenatal y por lo tanto el tratamiento y desenlaces materno perinatales favorables 5; sin embargo la aplicación de las guías presentan escasa adherencia como lo ha reportado Cabra-Bautista, et al quienes identificaron que, en el mundo hay una variación sustancial de calidad entre las guías de toxoplasmosis, las cuales brindan recomendaciones de acuerdo con el contexto de la enfermedad en el país o región correspondiente, con una aplicabilidad de solo el 17% (6%-83%) 19 .…”

“…La elaboración y difusión de la guía de atención integral para la prevención, detección temprana y tratamiento de las complicaciones del embarazo, parto y puerperio: sección "toxoplasmosis en el embarazo" en el año 2012 1 pretendía la estandarización nacional y fue un trabajo multidisciplinario muy grande, sin embargo, en esta valoración retrospectiva realizada se encontraron limitaciones para su aplicación. Se identificaron dificultades en el nivel primario de atención para el diagnóstico y la adecuada interpretación de las serologías y en la referencia oportuna al materno fetal, estas y otras limitaciones han sido valoradas previamente en cuanto a la aplicación de guías para toxoplasma en otros países 19,26,27 .…”

Quality and credibility of clinical practice guidelines recommendations for the management of neonatal hypoglycemia. A protocol for a systematic review and recommendations’ synthesis

“…Moreover, we will also use the two final assessment questions of the AGREE II tool, namely, the overall quality of CPGs and whether CPG can be recommended in practice, to define whether we would recommend the CPG to be used in clinical practice. Since no specific guidance or threshold has been established for this final assessment, we will use a modified approach of the criteria used by Cabra-Bautista et al [43] but using the rigor of development as the primary domain to consider. Therefore, a CPG will be 'recommended' if four (rigor of development being one of the domains) out of six domains score �60%; a CPG will be 'recommended with modifications' if it does not meet the criteria for being 'recommended' or 'not recommended'; and will be considered 'not recommended' when three out of six domain scores <30% or the domain three scores <60%.…”