Toxoplasmosis knowledge and preventive behavior among pregnant women in the city of Imperatriz, Maranhão, Brazil

Knowledge Gaps and Educational Opportunities in Congenital Toxoplasmosis: A Narrative Review of Brazilian and Global Perspectives

Congenital toxoplasmosis is a parasitic disease caused by the transmission of the protozoan Toxoplasma gondii during pregnancy that can potentially cause severe consequences for the fetus or neonates. The disease disproportionately impacts the global population and is generally correlated with the Human Development Index. Despite its prevalence, there are knowledge gaps among pregnant women and healthcare providers regarding the prevention, diagnosis, and treatment of this condition. This narrative review aimed to examine the current state of knowledge of toxoplasmosis among both groups, with a focus on exploring the Brazilian and global perspectives and highlighting opportunities for enhancing education and communication. A search was conducted across five databases, and 60 studies were selected (23 in Brazil and 37 worldwide). Quantitative analysis revealed that general knowledge of toxoplasmosis among pregnant women is notably poor, with 66% of Brazilian women and 72% of women worldwide lacking sufficient understanding. Among those with some knowledge, the most recognized association is with cats (46% in Brazil and 38% worldwide), followed by raw or undercooked meat (27% in Brazil and 25% worldwide), and improperly sanitized vegetables or water (15% in Brazil and 21% worldwide). Similarly, gaps in knowledge were found among healthcare providers. Difficulty with IgG avidity test interpretation is higher in Brazil (43%) compared to worldwide (18%). The most recognized association is with cats (66% in Brazil and 74% worldwide), followed by raw or undercooked meat (49% in Brazil and 70% worldwide), and improperly sanitized vegetables or water (31% in Brazil and 32% worldwide). These findings emphasize the need for tailored local and global public health educational initiatives to enhance knowledge of toxoplasmosis among pregnant women and healthcare providers.

Serosurvey of Toxoplasma gondii and Toxocara spp. co-infection in pregnant women in low-income areas of Brazil

Introduction

Despite human toxoplasmosis and toxocariasis having been listed among the top six most neglected parasitic zoonoses worldwide, presenting similar associated risk factors and transmission routes, few studies have been conducted in pregnant women and the consequences of concurrent infection remain to be fully established. Accordingly, the present study has serologically assessed the co-infection and associated risk factors for Toxoplasma gondii and Toxocara spp. in pregnant women, assisted by the public Unified National Health System (SUS) in southeastern Brazil.

Materials and Methods

Blood samples were collected and tested for IgG antibodies against Toxoplasma gondii by chemiluminescence immunoassay and against Toxocara spp. by enzyme-linked immunosorbent assay (ELISA). An epidemiological questionnaire was applied to gather socioeconomic information to assess the risk factors associated with seropositivity to toxocariasis/toxoplasmosis by univariate analysis followed by logistic regression.

Results

Overall, seropositivity was 69/280 (24.6, 95% CI: 19.96-30.01) for T. gondii and 56/280 (20.0, 95% CI: 15.73-25.08) for Toxocara spp. Co-infection was observed in 25/280 (8.9, 95% CI: 6.12-12.85) pregnant women, with increased odds (OR: 3.3, CI 95%: 1.77-6.14, p = 0.0002). Logistic regression revealed that a higher educational level (high school or college) significantly reduced the likelihood of co-infection seropositivity, owning cats increased the odds of toxocariasis, and older pregnant women presented significantly higher T. gondii seropositivity.

Conclusion

Co-infection herein highlights the importance of educational programs in the prevention of toxocariasis and toxoplasmosis in pregnant women and other high-risk populations.

Upregulation of IL-33, CCL2, and CXCL16 levels in Brazilian pregnant women infected by Toxoplasma gondii

Congenital toxoplasmosis can cause neurological and eye damage, behavioral alterations, or death in fetuses or babies born to Toxoplasma gondii-infected women. Several pieces of evidence suggest that socioeconomic, environmental, and inflammatory patterns linked to the maternal immune response partly drive the pathogenesis of this disease. However, immunoregulation induced by T. gondii infection during gestation is not completely understood. The aim of this study was to assess the association between T. gondii seropositivity and concentrations of plasma markers (CCL2, CXCL16, IL-17, and IL-33) in Brazilian pregnant women. Inflammatory markers were measured by immunoassays in the plasma of 131 pregnant women (13 to 46 years old). The prevalence of T. gondii infections was 45.8% (n = 60) in this population. The concentrations of CCL2, CXCL16, and IL-33 were higher in T. gondii-seropositive than in seronegative pregnant women, while the opposite was observed for IL-17 levels. In IgG+ women, a strong correlation between IL-17 and IL-33 (r = 0.7508, p = 0.0001) and a moderate correlation between CXCL16/IL-17 (r = 0.7319, p = 0.0001) and CXCL16/CCL2 (r = 0.3519, p = 0.0098) was observed. In uninfected women, a strong correlation was found between IL-17 and CXCL16 (r = 0.6779, p = 0.0001) but moderate between IL-17 and IL-33 (r = 0.4820, p = 0.0001). In summary, our data suggest that plasma upregulation of CCL2, CXCL16, and IL-33 might exert a potential protective role in the mother/fetus/parasite axis and, in addition, multiparous women are more likely to be infected with T. gondii than primiparous women.

Drinking water and the implications for gender equity and empowerment: A systematic review of qualitative and quantitative evidence

BACKGROUND

Safe drinking water is a fundamental human right, yet more than 785 million people do not have access to it. The burden of water management disproportionately falls on women and young girls, and they suffer the health, psychosocial, political, educational, and economic effects. While water conditions and disease outcomes have been widely studied, few studies have summarized the research on drinking water and implications for gender equity and empowerment (GEE).

METHODS

A systematic review of primary literature published between 1980 and 2019 was conducted on drinking water exposures and management and the implications for GEE. Ten databases were utilized (EMBASE, PubMed, Web of Science, Cochrane, ProQuest, Campbell, the British Library for Development Studies, SSRN, 3ie International Initiative for Impact Evaluation, and clinicaltrials.gov). Drinking water studies with an all-female cohort or disaggregated findings according to gender were included.

RESULTS

A total of 1280 studies were included. GEE outcomes were summarized in five areas: health, psychosocial stress, political power and decision-making, social-educational conditions, and economic and time-use conditions. Water quality exposures and implications for women's health dominated the literature reviewed. Women experienced higher rates of bladder cancer when exposed to arsenic, trihalomethanes, and chlorine in drinking water and higher rates of breast cancer due to arsenic, trichloroethylene, and disinfection byproducts in drinking water, compared to men. Women that were exposed to arsenic experienced higher incidence rates of anemia and adverse pregnancy outcomes compared to those that were not exposed. Water-related skin diseases were associated with increased levels of psychosocial stress and social ostracization among women. Women had fewer decision-making responsibilities, economic independence, and employment opportunities around water compared to men.

CONCLUSION

This systematic review confirms the interconnected nature of gender and WaSH outcomes. With growing attention directed towards gender equity and empowerment within WaSH, this analysis provides key insights to inform future research and policy.

A Cross-Sectional Study on the Association Between Risk Factors of Toxoplasmosis and One Health Knowledge in Pakistan

Toxoplasmosis is a zoonotic disease caused by Toxoplasma gondii, a protozoan that infects warm-blooded animals and humans. Approximately one third of the global population is infected by T. gondii. We conducted a cross-sectional study to assess the risk factors and One Health knowledge of toxoplasmosis in Rawalpindi and Islamabad, Pakistan. From July through December 2020, we collected data using questionnaires. The results showed that 60% of participants had heard or read about the disease, 23.3% of participants had no knowledge about the disease, and 16.8% participants were not sure about the disease. More than half of the participants (53.3%) reported that toxoplasmosis was caused by toxins, 5.3% reported that toxoplasmosis was an animal disease, 13.8% reported that toxoplasmosis was a human disease, 65.8% reported that it was both an animal and human disease, and 15.3% reported that it was neither an animal nor a human disease. Approximately 80.5% of participants reported that individuals acquired toxoplasmosis by changing cat litter. Our study findings revealed a low level of knowledge and awareness about toxoplasmosis among males. Therefore, there should be awareness programs to educate individuals about the risks of this deadly disease and to provide information on the major routes of transmission.

An analytical study on the awareness and practice relating toxoplasmosis among pregnant women in Casablanca, Morocco

BACKGROUND

Although toxoplasmosis is asymptomatic in most cases among pregnant women, it may cause newborn abortions and birth defects if the infection occurs during pregnancy. Therefore, raising awareness and promoting good practices of pregnant women towards toxoplasmosis disease is essential to avoid infection during pregnancy. The aim of this cross-sectional study is to assess toxoplasmosis awareness and its risk-related behavior pregnant women who attended public health centers in one of the biggest Moroccan cities: Casablanca.

METHODS

A structured questionnaire was used to collect data including socio-demographics data, awareness of etiology, modes of transmission and preventive practices towards toxoplasmosis.

RESULTS

This study survey showed that among 390 pregnant women interviewed, 41.2% reported having heard or read information regarding toxoplasmosis. Only 8.1% of them knew that toxoplasmosis is a parasitic disease caused by Toxoplasma gondii, and 13.7% of those who gave a correct answer were aware that the host of toxoplasmosis is cats. There is a significant statistical association between age, level of education and profession of pregnant women and toxoplasmosis awareness. Despite of the majority of the interviewed pregnant women had had effective preventive practices towards toxoplasmosis, 17.4% of pregnant women were convinced that Toxoplasmosis can transmit to the fetus and 14.3% stated it is asymptomatic in most cases.

CONCLUSION

This study highlights the low level of knowledge and awareness of toxoplasmosis among pregnant women in Casablanca/Morocco. Therefore, a special education program targeting all women during their reproductive age is necessary.

Toxoplasmosis and knowledge: what do the Italian women know about?

Toxoplasmosis is a worldwide zoonotic infectious disease caused by Toxoplasma gondii. This infection is estimated to affect about a third of the world's population. The aim of this study was to evaluate the knowledge of Italian women about toxoplasmosis and its forms of transmission, clinical manifestations, diagnosis and prevention through two different modalities (e-research and traditional research). In a cross-sectional study, 808 Italian women were interviewed, using a self-administered questionnaire, through two different modalities: an e-research or web survey and a traditional paper research and 84% reported to have heard about toxoplasmosis, but from most of the sample, it resulted that the knowledge of the protozoan disease was superficial and incomplete.The assessment of the dimensionality related to the toxoplasmosis knowledge's instrument showed that the scale is composed by two stable and reliable factors which explain 58.6% of the variance: (a) the basic knowledge (α = 0.83), which explains the 45.2% of the variance and (b) the specialist knowledge (α = 0.71), which explains the 13.4% of the variance. The variance and the multiple linear regression data analysis showed significant predictors of correct basic knowledge of toxoplasmosis: the highest age, the highest degree of study, to have previously contracted illness or to know someone who had contracted it, to be working or to be housewives. In conclusion, this study showed limited awareness of toxoplasmosis and suggested the implementation of effective education and learning programs. The results also showed that online data collection, in academic research, might be a valid alternative to more traditional (paper-and-pencil) surveys.

Ciência & Saúde Coletiva - 25 years: contributions to pregnancy, delivery, and childhood studies

We reviewed the scientific production on maternal health and the health of children under ten years of age, published in Journal Ciência & Saúde Coletiva during the last 25 years, focusing on quantitative studies. The authors' characteristics, populations under study, thematic areas, and methodology are described. A total of 170 publications were identified and grouped into 12 major themes. Pregnancy, delivery, and puerperium were the subject of 47 studies, followed by child anthropometric assessments (29), breastfeeding (24), and mortality (13). The selected publications represented 3.5% of the total original papers published by the Journal since its creation in 1996 and about 5% of the publications in the 2015-2020 period. The primary data sources were health service records, information systems, and population surveys. The cross-sectional design was used in 113 of the 170 articles, and 70% covered only one municipality. The Southeast and Northeast Regions of Brazil were the target of most studies, and the North Region was the least represented. The publications reflect the complexity of maternal and child health themes, with a particular focus on the importance of the Unified Health System and showing how open access data can contribute to public health research.