SERO-PREVALENCE AND SOCIO-DEMOGRAPHY OF TOXOPLASMOSIS AMONG PREGNANT WOMEN ATTENDING ANTENATAL CLINIC OF STATE SPECIALIST HOSPITAL, MAIDUGURI

278 Nigerian Journal of Pharmaceutical and Biomedical Research Vol. 8 Issue.3 December, 2024. p-ISSN: 2579-1419 e-ISSN: 2814-1423 SERO-PREVALENCE AND SOCIO-DEMOGRAPHY OF TOXOPLASMOSIS AMONG PREGNANT WOMEN ATTENDING ANTENATAL CLINIC OF STATE SPECIALIST HOSPITAL, MAIDUGURI 1Askira, U. M., 1Balla, H.J., 2Kadaura, U.M., 1Tom, I.M., 3Zaman. A.A., 1Lawan A. U 1Department of Medical Laboratory Science, University of Maiduguri. 2Department of Medical Microbiology, Federal University of Health Science, Azare 3Department of Obstetrics and gynaecology, University of Maiduguri Teaching Hospital Corresponding author: e-mail; [email protected]. Phone: 07062842988 http://doi.org/10.55639/607.phar.10801.008 Abstract Toxoplasmosis is a parasitic infection that is widespread throughout the world. It is a serious public health hazard, pregnant women carry a significant risk of congenital toxoplasmosis, which can result in problematic pregnancy outcomes which include fetal losses and congenital malformations. The development of efficient toxoplasmosis control and preventive measures is hampered by the significant paucity of sero-epidemiological data on Toxoplasma gondii infection in Maiduguri, despite the impact of the disease worldwide. To determine the sero-prevalence and associated risk factors for T. gondii seropositivity among pregnant women who frequent prenatal clinics at Maiduguri Specialist Hospital in Borno State, was conducted. The study used an institutional-based survey and ran from October to November 2024. Obstetric history, socioeconomic traits, practices and knowledge regarding toxoplasma infection were gathered. A pre-tested survey was given to one hundred expectant mothers undergoing prenatal care. Each participant also had 4 ml of blood drawn, and One Step TOXO IgM/IgG test kits (Hanzhou Funworld Biotech Co., LTD.) were used to test the corresponding sera for T. gondii-specific IgG and IgM. SPSS version 29 was used to analyze the data. Interestingly, 88% of pregnant women who took part had never heard of toxoplasmosis. Contrary to expectations, the study found that among the 100 pregnant women whose serum samples were analyzed, there was a 2% seropositivity for T. gondii-specific IgG antibodies in their serum samples, and none of the subjects had any indications of T. gondii-specific IgM antibodies. This surprising finding calls into question the accepted wisdom on the prevalence of T. gondii in this community. Despite a 2% seroprevalence, the study revealed no signs of T. gondii infection in pregnant patients receiving prenatal treatment at Maiduguri Specialist Hospital, which was unexpected. While these results challenge prior assumptions, they underscore the importance of ongoing surveillance and the need to adapt prevention and control strategies based on the evolving epidemiological landscape. Further research and vigilance are essential to monitor and understand the dynamics of toxoplasmosis in different populations. Keywords: Toxoplasma gondii, Maiduguri, Pregnant women, IgG/IgM Introduction 279 The phylum Apicomplexa contains the obligatory intracellular parasite Toxoplasma gondii (T. gondii), the causative agent of toxoplasmosis. The intermediate hosts are humans and other warm-blooded animals, while the definitive hosts are felids, particularly cats (Kamal et al., 2015). The parasite is found all over the world, and variations in weather, reservoir hosts, and nutritional diets all affect the infection rate (Çetin and Çetin, 2017; Deng et al., 2018). Sources of infection include ingestion of raw and/or undercooked meats with the parasite tissue cysts, consumption of vegetables and water contaminated with sporulated oocyst discharged in the faeces of infected cats, direct contact with cats, and accidental ingestion of contaminated soil (Teimouri et al., 2020). In immunocompetent individuals, infection with T. gondii can remain asymptomatic in about 80% of cases. However, lymphadenopathy and flu-like symptoms may be observed. In immune-compromised patients, toxoplasmosis causes lifethreatening infections such as encephalitis, lethargy, ataxia, coma, pneumonia, chorioretinitis. The severity of the infection is related to a decrease in the levels of T cells and interferon gamma. Encephalitis toxoplasmosis has been implicated as the leading cause of death (Deng et al., 2018; Qamer et al., 2020; Tété-Bénissan et al., 2018). Congenital toxoplasmosis, in which women contract the disease just before or during pregnancy, is the most severe form of the illness. Pregnant women rarely have infection symptoms. However, foetopathies can result from primary infections in pregnant women that pass through the bloodplacenta barrier. Congenital infections can result in many visceral lesions, early birth, stillbirth, and spontaneous abortion (TétéBénissan et al., 2018). Depending on the severity of the infection, T. gondii infections in infants and neonates can cause serious side effects such as intracranial calcification, blindness, mental retardation, and congenital malformations (microcephaly and hydrocephalus) (Çetin & Çetin, 2017; Tété-Bénissan et al., 2018; Varella et al., 2009). The diagnosis of toxoplasmosis is based on the detection of antibodies (IgM&IgG) in the serum or plasma of infected individuals using Enzyme Linked Immunosorbent Assay, dye test, immunofluorescent assays, and polymerase chain reaction. Others include culture, biopsy and imaging studies. Pregnant women worldwide have an IgM seroprevalence of 1.9% and an IgG seroprevalence of 32.9% for toxoplasmosis. The Western Pacific has the lowest incidence rate (11.2%) among the WHO regions, whereas the Americas have the highest at 45.2% (Bigna et al., 2020). Karshima and Karshima (2020) conducted a comprehensive review and meta-analysis of the seroprevalence of human T. gondii infection in Nigeria. They found that the overall prevalence was 32.92%, with a considerably higher pooled prevalence among pregnant women (40.25%). A seroprevalence of 76.63% among women in Osun, Nigeria, who are of childbearing age was also reported by Olarinde et al., (2022). In order to identify acutely infected women and those at risk for congenital transmission, this study aimed to ascertain and update the 280 prevalence of anti-toxoplasma IgM and IgG antibodies of pregnant women and their associated risks at State Specialist Hospital, Maiduguri, Nigeria. This was done to implement the proper clinical intervention. Materials and method Study Site The study was conducted in Specialist Hospital Maiduguri. Maiduguri is the capital and largest city of Borno State in northeastern Nigeria. The city sits along Ngadda River which disappears into the firkin swamps in the areas around Lake Chad. The climate is hot semi-arid, with highest recorded temperature of 47%. The population of the state is 4,171,104 (NPC 2007) Study Design: The research design is a facility-based cross-sectional study involving one-time sampling of pregnant women attending the study area. Study Population: The study population includes all pregnant women attending the study site who gave their informed consent. Inclusion Criteria: All pregnant women 16 years and above who gave consent to participate in *the study. Exclusion Criteria: Pregnant women below the age of 16 years and those who are not willing to participate in the study. Sampling: Random sampling from patient attending state specialist hospital Maiduguri was used for the study. Sample Size Calculation: The sample size was determined from using the prevalence rate of the study conducted by (Akubuilo et al., 2020) in Nigeria with overall seroprevalence of 11.7%, therefore, the minimum sample size at 95% confidence level was100. However, only 100 women voluntarily consented to participate in the study were enrolled. Ethical Consideration The protocol was approved by the Research and Ethics Review Committee of State Specialist Hospital Maiduguri (SSH/CEN/641/vol1/1/01/213). Before participating in the study, each participant provided written informed consent. To maintain confidentiality, data were analysed anonymously throughout the study. The serological results were only intended for research purposes and were not shared with the participants or physicians. Data Collection During the study, pregnant women who sought antenatal care at Specialist Hospital Maiduguri were eligible to participate voluntarily. Participants were consecutively sampled during antenatal care visits. Before enrollment, the study's purpose was explained, and those who agreed to participate were provided with written consent. Face-to-face interviews were conducted in a private room using pre-tested questionnaires translated into a language they understand. The questionnaires contained demographic data, obstetrics information, and knowledge of toxoplasmosis and exposure practices to T.gondii infections. The collected data included age, residence, education level, parity, gestational age, cat ownership, regular soil contact, consumption of under-cooked meat, consumption of raw vegetables, eating unwashed fruits, and water sources. 281 Sample Collection and Testing Four milliliters of venous whole blood was collected from the ante-cubital vein into EDTA containers. Blood was then centrifuged for 5 minutes at 3000 rpm. The plasma obtained was then screened for the presence of T. gondii IgM and IgG using One Step TOXO IgM/IgG test kits (Hanzhou Funworld Biotech Co., LTD.) according to the manufacturer’s instructions. Data Analysis Data collected was entered into raw data forms before entering it into an excel spreadsheet. Data analysis was carried out using IBM Statistical Package for Social Sciences (SPSS) version 29.0 windows. The outcome (dependant) variable is sero-status to Toxoplasma antibodies i.e., seropositive or seronegative while independent variables include age, occupation, eating raw or undercooked meat, eating raw or undercooked vegetables, owning a cat and cleaning the cat litter box. Descriptive statistics for each of the variables under study were presented in tables. The association between categorical variables was determined using the Chi-square test. A pvalue less or equal to 0.05 is considered statistically significant for all inferential analyses. Result A total of 100 pregnant women were enrolled. Table one shows the demographic characteristics of the respondents. A Large number of the respondents (29.0%) falls within 26-30 years. More than half (55%) of the participants had attained either Primary, Secondary or Tertiary institution (Figure 1). Table 1: Age distribution of Anti-toxoplasma IgG and IgM among pregnant women AGE No of TEST % No of POSITIVE % No of NEGATIVE % 0-15 0 0 0 0 0 0 16-20 16 16 0 0 16 16.3 21-25 26 26 1 1 25 25.5 26-30 29 29 0 0 29 29.6 31-35 18 18 1 1 17 17.4 36-40 11 11 0 0 11 11.2 41-45 0 0 0 0 0 0 >46 0 0 0 0 0 0 TOTAL 100 100 2 2 98 100 282 Figure1: Anti-Toxoplasma IgG and IgM Seropositive Across Education Level of Pregnant Women Table 2: Distribution of Anti-Toxoplasma IgG and IgM Positive with Place of Residence of Pregnant Women A total of 100 pregnant women were enrolled and the distribution of anti-toxoplasma IgG and IgM positive based on place of residence of the subject showed equal prevalence in both polo and Damboa road as shown in table 2. Place of residence Subject positive IgG positive IgG negative No % No % No % Polo 1 1 1 1 98 98 Damboa road 1 1 1 1 Total 2 2 2 2 98 98 45 6 34 15 20 0 0 0 5 10 15 20 25 30 35 40 45 50 NONE PRIMARY SECONDARY TERTIARY NO EXAM POSITIVE 283 Table: 3. Distribution of Anti-Toxoplasma IgG Positive with Occupation of Pregnant Women The distribution based on occupation have shown that unemployed women has the highest prevalence than employed women as shown in table 3 Occupation Subject positive IgG positive IgG negative No % No % No % Unemployed 2 2 2 2 98 98 Employed 0 0 0 0 Total 2 2 2 2 98 98 Table 4: Distribution of Anti-toxoplasma IgG and IgM based on Trimester The distribution on the bases of trimester have shown that second and third trimester has the parasite prevalence than the first trimester as shown in table 4. Trimester Subject Test IgG Positive IgG Negative IgM Positive IgM Negative No % No % No % No % No % First 13 13 0 0 13 13 0 0 13 13 Second 66 66 1 1 65 65 0 0 66 66 Third 21 21 1 1 20 20 0 0 21 21 Total 100 100 2 2 98 98 0 0 100 100 Table 5: Distribution of Anti-toxoplasma IgG and IgM based on Gravidae of pregnant women Primi and multi gravidae has the prevalence than secundi as shown in table 5 Gravidae Subject Test IgG Positive IgG Negative IgM Positive IgM Negative No % No % No % No % No % Primi 26 26 1 1 25 25 0 0 26 26 Secundi 26 26 0 0 26 26 0 0 26 26 Multi 48 48 1 1 47 47 0 0 48 48 Total 100 100 2 2 98 98 0 0 100 100 284 Discussion One parasitic infection that poses a serious threat to public health is toxoplasmosis. Understanding its sero-epidemiology is essential for creating efficient control and prevention plans, especially for high-risk populations like expectant mothers. Thus, the purpose of this study is to ascertain the prevalence of Toxoplasma gondii infection and to pinpoint risk variables that are linked to it in our local pregnant population. According to the results, 98 of the 100 samples examined with the One Step Toxo IgM/IgG quick test kit came out negative. On the other hand, two samples tested positive for IgG antibodies (2%). This investigation is consistent with one conducted in northwest Tanzania by Mwambe et al. (2013), which was unable to detect any cases of Toxoplasma gondii IgM seropositive. The absence of positive results in the Toxo IgM rapid test raises important considerations regarding the prevalence of toxoplasmosis among pregnant women in the study population. The negative results may suggest a low prevalence of Toxoplasma gondii infection among the pregnant women attending the antenatal clinic, at least during the time of the study. Geographical location, dietary habits, socioe conomic factors, and awareness levels amon g pregnant women are some of the factors th at may have contributed to the observed neg ative results. The results regarding age show ed that the infection rate was 1% for those a ged 21–25 and 31– 35, respectively, while those without formal education showed remarkable positivity and had the highest population in the study. The infection was more common among unempl oyed women (82.2 vs. 31.6%), which may h ave been caused by their interactions with d omestic pets at home and did not agree with the studies by Idris et al. (2015) who reported the prevalence among employed women with (75 vs. 25%, p = 0.025.) than among the unemployed. In conclusion, the study provides valuable insights into the seroprevalence of toxoplasmosis among pregnant women attending antenatal clinics in Borno State Specialist Hospital. 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