Implementing Pulse Oximetry Screening for Critical Congenital Heart Disease in São Tomé and Príncipe: Lessons from a Pilot Programme

Pulse oximetry (POX) screening improves early detection of critical congenital heart disease (CCHD) but has rarely been implemented in newborn care in sub-Saharan Africa. We introduced POX screening at São Tomé and Príncipe’s main maternity unit, integrating staff training and a simplified screening algorithm. Six CCHD diagnoses were documented at the maternity unit after positive screens, two in already symptomatic infants. Screening coverage is unknown and screen-negative infants were not systematically followed up, so sensitivity cannot be determined and missed cases cannot be excluded. Staff interviews identified workforce shortages, equipment limitations, difficulties interpreting the algorithm, caregiver reluctance to delay discharge, and inconsistent documentation. Training was reinforced, caregiver materials and wrap-type neonatal probes were introduced, and the maternity informatic system was adapted. POX screening was delivered within routine care, but reliable documentation and post-discharge follow-up are needed before coverage or accuracy can be assessed.