Toxoplasma gondii seroprevalence among pregnant women in Africa: A systematic review and meta-analysis

BACKGROUND

Toxoplasmosis is a serious endemic zoonotic disease caused by the protozoan parasite Toxoplasma gondii. Toxoplasma infection during pregnancy can result in congenital transmission and serious fetal and neonatal complications. This systematic review and meta-analysis aimed to assess the pooled seroprevalence of T. gondii infection and its determinants among pregnant women in African countries.

METHODS

All articles reporting the seroprevalence of toxoplasmosis among pregnant women in African countries and published from 2010 to 2023 were searched using various databases. The pooled prevalence of toxoplasmosis was calculated using a random-effect model. The variation between the included studies was assessed using a funnel plot and I2 heterogeneity statistics. To identify the sources of heterogeneity, sub-group analysis was further conducted by country, diagnostic method, and sub-African region. The association of prevalence rates with the socio-economic level and geoclimatic parameters was also explored.

RESULTS

In total, 29,383 pregnant women from 60 articles were included for analysis. The pooled T. gondii seroprevalence was 42.89% with high heterogeneity (I2 = 99.4%, P < 0.001). Sub-group analysis revealed variation by country (ranging from 2.62% in Namibia to 80.28% in Congo), diagnostic method used (from 8.66% in studies using a rapid diagnostic test to 55.69% in those using an agglutination test), and sub-African region (from 4.14% in regions of Southern Africa to 53.96 in Central Africa). Cat ownership (OR = 1.58) and the consumption of raw meat (OR = 1.50) and raw vegetables (OR = 1.48) had a statistically significant combined effect on T. gondii seroprevalence. No association was found between T. gondii prevalence and the level of income of the country or geoclimatic parameters.

CONCLUSION

The prevalence of toxoplasmosis infection among pregnant women in Africa is high, particularly in Central and Eastern Africa. The determinants of prevalence are multifactorial. Therefore, efforts should be made to increase the awareness of women concerning the risk factors for toxoplasmosis.

Seroprevalence of Toxoplasma gondii IgG and IgM antibodies and associated risk factors among pregnant women consulted in three health centers in Dschang, Cameroon

Background

Toxoplasmosis is a zoonosis caused by Toxoplasma gondii, an obligate intracellular protozoan responsible for one of the most common congenital infections in the world. This study aimed to determine the seroprevalence and risk factors associated with toxoplasmosis in pregnant women consulted in three health centers in the city of Dschang.

Methods

This study was a cross-sectional study that was conducted, with a total of 242 participants. A questionnaire was administered after obtaining the free and informed consent of the participants. Blood sample was collected to assay IgG and IgM antibodies specific to Toxoplasma gondii using the enzyme-linked immunosorbent assay (ELISA) kit, and potential risk factors were evaluated with the administration questionnaire using a binary logistic regression model. Statistical significance was measured at P < 0.05.

Results

The overall seroprevalence of toxoplasmosis was 82.7%,with a seroprevalence of toxoplasma IgG of 62.8% (152), that of IgM at 11.6% (28) and that of IgG/IgM at 8.3% (20). The Saint Vincent Paul Hospital had a seroprevalence of 43.8% IgG and 8.7% IgM; followed by the Dschang District Hospital (11.6% IgG and 2.1% IgM). The seroprevalence of toxoplasma IgG (35.5%) and IgM (6.2%) was higher in multiparous pregnant women, and in the group of women who performed their first toxoplasmosis serology in the first trimester of pregnancy, 70 (28.9%), 9 (3.7%) respectively for IgG and IgM. The multivariate logistic regression analysis showed that the possession of a cat at home or its presence in the neighborhood, the consumption of undercooked or uncooked meat and having a history of blood transfusion were found to be statistically significant risk factors associated with toxoplasmosis seroprevalence among pregnant women.

Conclusion

The present study revealed a high seroprevalence of toxoplasmosis. Given this high seroprevalence, screening for toxoplasmosis in women of childbearing age should be encouraged.

Seroprevalence of Gestational and Neonatal Toxoplasmosis as well as Risk Factors in Yaoundé, Cameroon

Background. Toxoplasmosis, caused by Toxoplasma gondii in pregnant women, is a significant public health problem due to risk of mother to child transmission. The aim of the study was to determine the seroprevalence of toxoplasmosis in pregnant women and corresponding cord blood among women attending Biyem-Assi and CASS Nkoldongo hospitals in Yaoundé, Cameroon. Methods. An institutional based cross-sectional study was conducted between June 2019 and May 2020 on 300 pregnant women from late second trimester to third trimester. A total of 259 cord blood samples were collected at birth from these women. Toxoplasma gondii-specific IgG and IgM antibodies in maternal and cord blood were detected using the Toxoplasma Enzyme Immunosorbent Assay kit, and potential risk factors captured through questionnaire were identified using binary logistic regression model. Statistical significance was measured at $P<0.05$ . Results. The overall seroprevalence of gestational and neonatal toxoplasmosis was 80% and 88%, respectively. IgG seropositivity was 72.7%, IgM only was 1.3% and cooccurrence of IgG/IgM was 6% amongst pregnant women. Out of 259 newborn cord bloods, 72.2% were positive for IgG only, 8.9% for IgM only, and 23.9% for both IgG/IgM. Pregnant women 15-24 years ( $\text{AOR}=4.6$ , $P=0.011$ ) and women with primary level of education ( $\text{AOR}=3.9$ , $P=0.042$ ) were significantly at risk of infection with Toxoplasma gondii. Conclusion. Gestational and neonatal toxoplasmosis appears to be more common with higher risk of infection in younger women and less educated women. Hence, these findings will serve as baseline data for further investigations on mother to child transmission of toxoplasmosis in Yaoundé and the need for reinforcement of pregnant women toxoplasmosis-related health measures.

Risk factors associated with seropositivity for Toxoplasma gondii in population-based studies among immunocompromised patients (pregnant women, HIV patients and children) in West African countries, Cameroon and Gabon: a meta-analysis

Toxoplasmosis in immunocompromised individuals can be life threatening. The information needed for proper control and management strategies in endemic West African countries is lacking, hence a systematic review and meta-analysis were performed. This study aimed to determine the seroprevalence of anti-Toxoplasma gondii among pregnant women, HIV/AIDs and children in West Africa, Cameroon and Gabon. The epidemiology of the disease published between 1984 and 2019 using PubMed, Web of Science, Ovid MEDLINE, AJOL and Google Scholar databases were identified. Studies that met the inclusion criteria of Toxoplasma gondii infections under the preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist were analysed. A total of 58 eligible studies were selected for meta-analysis. These studies considered 18,674 hosts and an overall pooled seroprevalence of anti-T. gondii antibodies were 45.4, 39.0 and 29.5% for pregnant women, HIV/AIDS patients and children, respectively. Pooled seroprevalence was highest in Gabon and lowest in Mali for pregnant women while highest levels of seropositivity for anti-T. gondii antibodies for HIV/AIDS individuals and children were both observed in Ghana. The major risk factors associated with anti-T. gondii seropositivity were gravida status, contact with cats, consumption of raw vegetables and /fruits, age and CD4 counts. More studies are needed to determine seroconversion rate. Improved sensitization among immunocompromised patients on T. gondii and its risk factors will be an efficient method to reducing the prevalence of the disease. One Health interventions involving transdisciplinary, integrative research and capacity building are necessary to address the problem of toxoplasmosis in West Africa.

Toxoplasmosis in pregnancy: a neglected bane but a serious threat in Nigeria

Toxoplasmosis is a global health threat in which occurrence in pregnant women poses grave consequences to fetal wellbeing. Studies on prenatal Toxoplasma gondii infection are generally limited in sub-Saharan African countries, including Nigeria. The risk of transmission of toxoplasmosis is very high in Nigeria due to the favourable climatic conditions and prevailing behavioural and socio-economic factors that could aid transmission. Currently, there are no systematic and organized procedures for diagnosis and treatment of maternal toxoplasmosis in Nigeria. These conditions forecast possible unabated transmission in many areas and exponential impact on associated adverse events of the disease during pregnancy. This paper highlights the importance of early diagnosis and treatment during pregnancy which may forestall subsequent development of infection in children delivered by infected mothers. Inclusion of toxoplasmosis control policy in the routine antenatal care of pregnant women is therefore strongly recommended.