Links to Exploration step
Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Seroprevalence and determinants of toxoplasmosis in pregnant women attending antenatal clinic at the university teaching hospital, Lusaka, Zambia</title><author><name sortKey="Frimpong, Christiana" sort="Frimpong, Christiana" uniqKey="Frimpong C" first="Christiana" last="Frimpong">Christiana Frimpong</name><affiliation><nlm:aff id="Aff1">Department of Public Health, University of Zambia, School of Medicine, Lusaka, Zambia</nlm:aff></affiliation></author><author><name sortKey="Makasa, Mpundu" sort="Makasa, Mpundu" uniqKey="Makasa M" first="Mpundu" last="Makasa">Mpundu Makasa</name><affiliation><nlm:aff id="Aff1">Department of Public Health, University of Zambia, School of Medicine, Lusaka, Zambia</nlm:aff></affiliation></author><author><name sortKey="Sitali, Lungowe" sort="Sitali, Lungowe" uniqKey="Sitali L" first="Lungowe" last="Sitali">Lungowe Sitali</name><affiliation><nlm:aff id="Aff1">Department of Public Health, University of Zambia, School of Medicine, Lusaka, Zambia</nlm:aff></affiliation><affiliation><nlm:aff id="Aff2">Department of Biomedical Science, University of Zambia, School of Medicine, Lusaka, Zambia</nlm:aff></affiliation></author><author><name sortKey="Michelo, Charles" sort="Michelo, Charles" uniqKey="Michelo C" first="Charles" last="Michelo">Charles Michelo</name><affiliation><nlm:aff id="Aff1">Department of Public Health, University of Zambia, School of Medicine, Lusaka, Zambia</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">28056829</idno><idno type="pmc">5216584</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5216584</idno><idno type="RBID">PMC:5216584</idno><idno type="doi">10.1186/s12879-016-2133-7</idno><date when="2017">2017</date><idno type="wicri:Area/Pmc/Corpus">000623</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000623</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Seroprevalence and determinants of toxoplasmosis in pregnant women attending antenatal clinic at the university teaching hospital, Lusaka, Zambia</title><author><name sortKey="Frimpong, Christiana" sort="Frimpong, Christiana" uniqKey="Frimpong C" first="Christiana" last="Frimpong">Christiana Frimpong</name><affiliation><nlm:aff id="Aff1">Department of Public Health, University of Zambia, School of Medicine, Lusaka, Zambia</nlm:aff></affiliation></author><author><name sortKey="Makasa, Mpundu" sort="Makasa, Mpundu" uniqKey="Makasa M" first="Mpundu" last="Makasa">Mpundu Makasa</name><affiliation><nlm:aff id="Aff1">Department of Public Health, University of Zambia, School of Medicine, Lusaka, Zambia</nlm:aff></affiliation></author><author><name sortKey="Sitali, Lungowe" sort="Sitali, Lungowe" uniqKey="Sitali L" first="Lungowe" last="Sitali">Lungowe Sitali</name><affiliation><nlm:aff id="Aff1">Department of Public Health, University of Zambia, School of Medicine, Lusaka, Zambia</nlm:aff></affiliation><affiliation><nlm:aff id="Aff2">Department of Biomedical Science, University of Zambia, School of Medicine, Lusaka, Zambia</nlm:aff></affiliation></author><author><name sortKey="Michelo, Charles" sort="Michelo, Charles" uniqKey="Michelo C" first="Charles" last="Michelo">Charles Michelo</name><affiliation><nlm:aff id="Aff1">Department of Public Health, University of Zambia, School of Medicine, Lusaka, Zambia</nlm:aff></affiliation></author></analytic><series><title level="j">BMC Infectious Diseases</title><idno type="eISSN">1471-2334</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Toxoplasmosis is a neglected zoonotic disease which is prevalent among pregnant women especially in Africa. This study aimed to determine the seroprevalence and determinants of the disease among pregnant women attending antenatal clinic at the University Teaching Hospital (UTH).</p></sec><sec><title>Method</title><p>A cross-sectional study was employed where 411 pregnant women attending antenatal clinic at UTH were interviewed using closed ended questionnaires. Their blood was also tested for <italic>Toxoplasma gondii</italic> IgG and IgM antibodies using the OnSite Toxo IgG/IgM Combo Rapid test cassettes by CTK Biotech, Inc, USA.</p></sec><sec><title>Result</title><p>The overall seroprevalence of the infection (IgG) was 5.87%. There was no seropositive IgM result. Contact with cats showed 7.81 times the risk of contracting the infection in the pregnant women and being a farmer/being involved in construction work showed 15.5 times likelihood of contracting the infection. Socio-economic status of the pregnant women also presented an inverse relationship (showed association) with the infection graphically. However, though there were indications of association between contact with cats, employment type as well as socioeconomic status of the pregnant women with the infection, there was not enough evidence to suggest these factors as significant determining factors of <italic>Toxoplasma gondii</italic> infection in our study population.</p></sec><sec><title>Conclusion</title><p>There is a low prevalence of <italic>Toxoplasma gondii</italic> infection among pregnant women in Lusaka, Zambia. Screening for the infection among pregnant women can be done once or twice during pregnancy to help protect both mother and child from the disease. Health promotion among women of child bearing age on the subject is of immense importance in order to help curb the situation. Further studies especially that of case–control and cohort studies should be carried out in the country in order to better ascertain the extent of the condition nationwide.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Tenter, Am" uniqKey="Tenter A">AM Tenter</name></author><author><name sortKey="Heckeroth, Ar" uniqKey="Heckeroth A">AR Heckeroth</name></author><author><name sortKey="Weiss, Lm" uniqKey="Weiss L">LM Weiss</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hotez, Pj" uniqKey="Hotez P">PJ Hotez</name></author><author><name sortKey="Kamath, A" uniqKey="Kamath A">A Kamath</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kijlstra, A" uniqKey="Kijlstra A">A Kijlstra</name></author><author><name sortKey="Jongert, E" uniqKey="Jongert E">E Jongert</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mazigo, Hd" uniqKey="Mazigo H">HD Mazigo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Dubey, Jp" uniqKey="Dubey J">JP Dubey</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Elmore, Sa" uniqKey="Elmore S">SA Elmore</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Dubey, Jp" uniqKey="Dubey J">JP Dubey</name></author><author><name sortKey="Jones, Jl" uniqKey="Jones J">JL Jones</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lucas, Ao" uniqKey="Lucas A">AO Lucas</name></author><author><name sortKey="Gilles, Hm" uniqKey="Gilles H">HM Gilles</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Nissapatorn, V" uniqKey="Nissapatorn V">V Nissapatorn</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Singh, S" uniqKey="Singh S">S Singh</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Dubey, J" uniqKey="Dubey J">J Dubey</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Pappas, G" uniqKey="Pappas G">G Pappas</name></author><author><name sortKey="Roussos, N" uniqKey="Roussos N">N Roussos</name></author><author><name sortKey="Falagas, Me" uniqKey="Falagas M">ME Falagas</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Weiss, Lm" uniqKey="Weiss L">LM Weiss</name></author><author><name sortKey="Dubey, Jp" uniqKey="Dubey J">JP Dubey</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Remington, Js" uniqKey="Remington J">JS Remington</name></author><author><name sortKey="Thulliez, P" uniqKey="Thulliez P">P Thulliez</name></author><author><name sortKey="Montoya, Jg" uniqKey="Montoya J">JG Montoya</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wanachiwanawin, D" uniqKey="Wanachiwanawin D">D Wanachiwanawin</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Kistiah, K" uniqKey="Kistiah K">K Kistiah</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Flatt, A" uniqKey="Flatt A">A Flatt</name></author><author><name sortKey="Shetty, N" uniqKey="Shetty N">N Shetty</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nissapatorn, V" uniqKey="Nissapatorn V">V Nissapatorn</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mwambe, B" uniqKey="Mwambe B">B Mwambe</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sroka, S" uniqKey="Sroka S">S Sroka</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Boyer, Km" uniqKey="Boyer K">KM Boyer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cook, A" uniqKey="Cook A">A Cook</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Baril, L" uniqKey="Baril L">L Baril</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Jones, Jl" uniqKey="Jones J">JL Jones</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Berger, F" uniqKey="Berger F">F Berger</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nissapatorn, V" uniqKey="Nissapatorn V">V Nissapatorn</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Breugelmans, M" uniqKey="Breugelmans M">M Breugelmans</name></author><author><name sortKey="Naessens, A" uniqKey="Naessens A">A Naessens</name></author><author><name sortKey="Foulon, W" uniqKey="Foulon W">W Foulon</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Sitoe, Spbl" uniqKey="Sitoe S">SPBL Sitoe</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Andiappan, H" uniqKey="Andiappan H">H Andiappan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ertug, S" uniqKey="Ertug S">S Ertug</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Shao, Er" uniqKey="Shao E">ER Shao</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Avelino, Mm" uniqKey="Avelino M">MM Avelino</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Jones, Jl" uniqKey="Jones J">JL Jones</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ogoina, D" uniqKey="Ogoina D">D Ogoina</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rosso, F" uniqKey="Rosso F">F Rosso</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">BMC Infect Dis</journal-id><journal-id journal-id-type="iso-abbrev">BMC Infect. Dis</journal-id><journal-title-group><journal-title>BMC Infectious Diseases</journal-title></journal-title-group><issn pub-type="epub">1471-2334</issn><publisher><publisher-name>BioMed Central</publisher-name><publisher-loc>London</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28056829</article-id><article-id pub-id-type="pmc">5216584</article-id><article-id pub-id-type="publisher-id">2133</article-id><article-id pub-id-type="doi">10.1186/s12879-016-2133-7</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group></article-categories><title-group><article-title>Seroprevalence and determinants of toxoplasmosis in pregnant women attending antenatal clinic at the university teaching hospital, Lusaka, Zambia</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Frimpong</surname><given-names>Christiana</given-names></name><address><email>Christy.frimpong@gmail.com</email></address><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Makasa</surname><given-names>Mpundu</given-names></name><address><email>cmakasa@yahoo.com</email></address><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Sitali</surname><given-names>Lungowe</given-names></name><address><email>lungowesitali@gmail.com</email></address><xref ref-type="aff" rid="Aff1">1</xref><xref ref-type="aff" rid="Aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Michelo</surname><given-names>Charles</given-names></name><address><email>ccmichelo@yahoo.com</email></address><xref ref-type="aff" rid="Aff1">1</xref></contrib><aff id="Aff1"><label>1</label>Department of Public Health, University of Zambia, School of Medicine, Lusaka, Zambia</aff><aff id="Aff2"><label>2</label>Department of Biomedical Science, University of Zambia, School of Medicine, Lusaka, Zambia</aff></contrib-group><pub-date pub-type="epub"><day>5</day><month>1</month><year>2017</year></pub-date><pub-date pub-type="pmc-release"><day>5</day><month>1</month><year>2017</year></pub-date><pub-date pub-type="collection"><year>2017</year></pub-date><volume>17</volume><elocation-id>10</elocation-id><history><date date-type="received"><day>5</day><month>8</month><year>2016</year></date><date date-type="accepted"><day>15</day><month>12</month><year>2016</year></date></history><permissions><copyright-statement>© The Author(s). 2017</copyright-statement><license license-type="OpenAccess"><license-p><bold>Open Access</bold>This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativecommons.org/publicdomain/zero/1.0/</ext-link>) applies to the data made available in this article, unless otherwise stated.</license-p></license></permissions><abstract id="Abs1"><sec><title>Background</title><p>Toxoplasmosis is a neglected zoonotic disease which is prevalent among pregnant women especially in Africa. This study aimed to determine the seroprevalence and determinants of the disease among pregnant women attending antenatal clinic at the University Teaching Hospital (UTH).</p></sec><sec><title>Method</title><p>A cross-sectional study was employed where 411 pregnant women attending antenatal clinic at UTH were interviewed using closed ended questionnaires. Their blood was also tested for <italic>Toxoplasma gondii</italic> IgG and IgM antibodies using the OnSite Toxo IgG/IgM Combo Rapid test cassettes by CTK Biotech, Inc, USA.</p></sec><sec><title>Result</title><p>The overall seroprevalence of the infection (IgG) was 5.87%. There was no seropositive IgM result. Contact with cats showed 7.81 times the risk of contracting the infection in the pregnant women and being a farmer/being involved in construction work showed 15.5 times likelihood of contracting the infection. Socio-economic status of the pregnant women also presented an inverse relationship (showed association) with the infection graphically. However, though there were indications of association between contact with cats, employment type as well as socioeconomic status of the pregnant women with the infection, there was not enough evidence to suggest these factors as significant determining factors of <italic>Toxoplasma gondii</italic> infection in our study population.</p></sec><sec><title>Conclusion</title><p>There is a low prevalence of <italic>Toxoplasma gondii</italic> infection among pregnant women in Lusaka, Zambia. Screening for the infection among pregnant women can be done once or twice during pregnancy to help protect both mother and child from the disease. Health promotion among women of child bearing age on the subject is of immense importance in order to help curb the situation. Further studies especially that of case–control and cohort studies should be carried out in the country in order to better ascertain the extent of the condition nationwide.</p></sec></abstract><kwd-group xml:lang="en"><title>Keywords</title><kwd>Determinants</kwd><kwd>Pregnant women</kwd><kwd>Seroprevalence</kwd><kwd>Toxoplasmosis</kwd><kwd>University teaching hospital (UTH)</kwd><kwd>Zambia</kwd></kwd-group><funding-group><award-group><funding-source><institution>Education, Audio-visual and Culture Executive Agency Project of the European Commission</institution></funding-source></award-group></funding-group><custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name><meta-value>© The Author(s) 2017</meta-value></custom-meta></custom-meta-group></article-meta></front><body><sec id="Sec1"><title>Background</title><p>Toxoplasmosis is a neglected zoonotic disease caused by a blood protozoan parasite called <italic>Toxoplasma gondii</italic> [<xref ref-type="bibr" rid="CR1">1</xref>–<xref ref-type="bibr" rid="CR4">4</xref>]. The organism is found worldwide and it infects nearly all warm-blooded animals including human beings [<xref ref-type="bibr" rid="CR5">5</xref>, <xref ref-type="bibr" rid="CR6">6</xref>]. Once human beings contract the infection, they remain infected for life [<xref ref-type="bibr" rid="CR7">7</xref>] hence, transmitting the disease vertically to their unborn babies [<xref ref-type="bibr" rid="CR8">8</xref>].</p><p>The life cycle of <italic>T. gondii</italic> constitutes the sexual reproduction component in both wild and domestic cats (definitive hosts) and the asexual component in all warm-blooded animals including human beings (intermediate hosts) [<xref ref-type="bibr" rid="CR9">9</xref>, <xref ref-type="bibr" rid="CR10">10</xref>] who get infected directly through handling contaminated cat litter boxes, meat and vegetables [<xref ref-type="bibr" rid="CR8">8</xref>], blood transfusion [<xref ref-type="bibr" rid="CR11">11</xref>] and organ transplants [<xref ref-type="bibr" rid="CR7">7</xref>, <xref ref-type="bibr" rid="CR10">10</xref>, <xref ref-type="bibr" rid="CR11">11</xref>] or indirectly through eating improperly cooked contaminated meat or vegetables [<xref ref-type="bibr" rid="CR8">8</xref>, <xref ref-type="bibr" rid="CR10">10</xref>]. Once in the human being, the organism lodges in the muscle tissues and then into the womb to infect the fetus; in the case of a pregnant woman [<xref ref-type="bibr" rid="CR10">10</xref>, <xref ref-type="bibr" rid="CR11">11</xref>]. <italic>Toxoplasma gondii</italic> is found commonly in the tissues of pigs, sheep and goats [<xref ref-type="bibr" rid="CR8">8</xref>, <xref ref-type="bibr" rid="CR10">10</xref>, <xref ref-type="bibr" rid="CR12">12</xref>] with prevalence of the disease ranging from 2.1-68% in swine, sows, cats, rats and mice [<xref ref-type="bibr" rid="CR12">12</xref>] and 39% in pigs, 26.8% in goats and 33.2% in sheep [<xref ref-type="bibr" rid="CR13">13</xref>].</p><p>A third of the global human population is believed to have had exposure with the organism and may have chronic infections [<xref ref-type="bibr" rid="CR14">14</xref>]. Most people who get infected remain asymptomatic until their immune system is weakened, which paves way for clinical conditions to set in [<xref ref-type="bibr" rid="CR15">15</xref>]. The infection is said to range from being asymptomatic to overt disease and can actually cause outbreaks [<xref ref-type="bibr" rid="CR7">7</xref>, <xref ref-type="bibr" rid="CR13">13</xref>, <xref ref-type="bibr" rid="CR16">16</xref>]. Toxoplasmosis is particularly grave in pregnant women who get infected during gestation, congenitally infected fetuses and newborns, immunocompromised patients, and people with chorioretinitis [<xref ref-type="bibr" rid="CR17">17</xref>]. In pregnant women, vertical transmission of the infection during the first trimester is critical and causes severe clinical conditions in the fetus, whereas third trimester infections have rapid transmission rate of parasites to fetuses, hence causing higher incidence of disease in the baby [<xref ref-type="bibr" rid="CR11">11</xref>, <xref ref-type="bibr" rid="CR16">16</xref>]. Some general clinical manifestations of the infection are ocular disease, lymphadenopathy (most common), encephalitis and generalized infection in immunocompromised people [<xref ref-type="bibr" rid="CR15">15</xref>, <xref ref-type="bibr" rid="CR18">18</xref>]. It causes spontaneous abortion of fetuses as well as stillbirths [<xref ref-type="bibr" rid="CR16">16</xref>]. Surviving babies on the other hand develop neurological diseases such as epileptic seizures, choroidoretinitis, hydrocephalus, intra-cerebral calcification, mental retardation and deafness at a stage in their lifetime [<xref ref-type="bibr" rid="CR11">11</xref>, <xref ref-type="bibr" rid="CR16">16</xref>, <xref ref-type="bibr" rid="CR17">17</xref>].</p><p>Toxoplasmosis in pregnant women varies geographically. There are reports of 3.7% in Korea [<xref ref-type="bibr" rid="CR19">19</xref>], 6.4% in South Africa [<xref ref-type="bibr" rid="CR20">20</xref>], 17.3% in London [<xref ref-type="bibr" rid="CR21">21</xref>], 24.1% in Saudi Arabia [<xref ref-type="bibr" rid="CR19">19</xref>], 28.3% in Thailand [<xref ref-type="bibr" rid="CR22">22</xref>], 30.9% in Tanzania [<xref ref-type="bibr" rid="CR23">23</xref>], 68.6% in Brazil [<xref ref-type="bibr" rid="CR24">24</xref>] and 92.5% in Ghana [<xref ref-type="bibr" rid="CR13">13</xref>].</p><p>Some factors associated with toxoplasmosis in pregnancy include, eating undercooked or cured meat (meat with preservatives such as salt, nitrates or sugar added) [<xref ref-type="bibr" rid="CR25">25</xref>–<xref ref-type="bibr" rid="CR27">27</xref>], having a pet cat [<xref ref-type="bibr" rid="CR25">25</xref>, <xref ref-type="bibr" rid="CR27">27</xref>], contact with soil [<xref ref-type="bibr" rid="CR26">26</xref>], educational level and occupation [<xref ref-type="bibr" rid="CR28">28</xref>, <xref ref-type="bibr" rid="CR29">29</xref>], age and crowded conditions [<xref ref-type="bibr" rid="CR28">28</xref>], being foreign born / race [<xref ref-type="bibr" rid="CR28">28</xref>, <xref ref-type="bibr" rid="CR30">30</xref>], Parity [<xref ref-type="bibr" rid="CR30">30</xref>] and eating raw vegetables [<xref ref-type="bibr" rid="CR27">27</xref>].</p><p>Screening is very vital in detecting this infection [<xref ref-type="bibr" rid="CR18">18</xref>, <xref ref-type="bibr" rid="CR31">31</xref>], as it has proven to be in France and Austria through the implementation of routine monthly screening of pregnant women for the disease. This has as well provided enough serological data on the disease in these two countries [<xref ref-type="bibr" rid="CR11">11</xref>, <xref ref-type="bibr" rid="CR32">32</xref>].</p><p>The exact burden of Toxoplasmosis in pregnancy in Zambia is unknown and this is so because screening for <italic>Toxoplasma gondii</italic> in pregnant women is not routinely done in the country. Meanwhile, the Burden of the disease is reported to be generally severe in Immune compromised populations such as pregnant women and HIV patients [<xref ref-type="bibr" rid="CR18">18</xref>]. This makes it difficult to detect and protect unborn babies from transplacental infections which bring about congenital Toxoplasmosis. As a result of this, babies, infants and children may suffer from disease conditions and complications and even death, which on the other hand could have been prevented. Compounding the situation further has been the lack of information on the determinants of the disease here in the country.</p><p>This study asks the question; ‘what is the prevalence of and factors associated with Toxoplasmosis among pregnant women attending antenatal clinic at the University Teaching Hospital (UTH) in Lusaka, Zambia? And therefore aimed to determine the prevalence and explore these factors.</p><p>In addition to providing the prevalence of <italic>Toxoplasma gondii</italic> infection in the referral hospital and to shed light on possible determining factors of the disease in the country, this study also set out to set the foundation for further studies to be carried out in this area. These will further create avenue for management and treatment of this disease in this population.</p></sec><sec id="Sec2"><title>Methods</title><sec id="Sec3"><title>Study design</title><p>This was a cross-sectional study carried out at the national referral hospital - University Teaching Hospital (UTH), (15.4323° S, 28.3137° E), in Lusaka, the capital city of Zambia, from August to October 2015. The study consisted of all women at all stages of pregnancy. Women who did not consent to participate were not included in the study. This study employed estimation for simple proportion to calculate the sample size. The total sample size was 411, with a response rate of 80% using a prevalence of 31% from Tanzania, according to Mwambe et al. The first participant was randomly picked, after which every third consenting pregnant woman was interviewed and tested for the infection. There were 84 women in their first trimester, 134 in their second trimester and 192 in their third trimester. Of the 411 participants, 68 were HIV positive, 338 were HIV negative and 5 statuses were unknown.</p><p>Structured interviews with structured closed-ended questionnaires were used. The questionnaire was developed from information reviewed in literature. It gathered information on socio-demographic factors (Age, marital status, level of education, income; which is the money that comes in/a person makes in a month etc.), behavioral (‘eating meat’; which means eating meat and meat products, ‘length of cooking meat’; which is the number of minutes meat is cooked, ‘contact with cats’ which is ownership/a level of handling cats or cat liter, drinking unpasteurized milk is drinking raw fresh milk from the cattle), obstetrical (Parity is the number of times a woman has given birth, gestational age which is the stage of pregnancy in trimesters) and co-infection (HIV status) of the women. The women were not tested for HIV in this study but rather their HIV status was obtained with consent from their patient files. In addition to the questionnaire, blood samples were obtained for blood analysis for <italic>T. gondii</italic> infection. About 2mls of blood from the blood drawn from the women by the hospital for routine blood tests, was taken and used for the testing. For the pregnant women who were not undergoing routine blood testing by the hospital, about 2mls of venous blood was drawn from them as well and tested for the <italic>Toxoplasma</italic> infection. The OnSite Toxo IgG/IgM Combo Rapid test cassettes (a lateral flow chromatographic immunoassay) manufactured by the CTK Biotech Inc., San Diego, USA, were used in the laboratory to detect the presence of the anti-<italic>Toxoplasma</italic> antibodies in the blood samples, following manufacturer’s instructions.</p></sec><sec id="Sec4"><title>Data analysis</title><p>The data was analysed using STATA version 12 (StataCorp, Texas, USA). The quantile-quantile (Q-Q) plot was used to check normality of the continuous variable ‘age’ before it was categorized. The data was normally distributed hence, mean age and standard deviation was recorded. Chi-square test was used to determine associations between the infection and characteristics of the pregnant women through cross-tabulations, but where appropriate, the Fishers exact test was used instead of Chi-square test. Generalized linear model for binary outcome (in this case Toxoplasma infection present or absent), reporting odds ratios was used for univariate analysis. Significant variables obtained from univariate analysis together with priori for the study was put in the final model for multivariable analysis [<xref ref-type="bibr" rid="CR20">20</xref>]. The corresponding odds ratios, confidence intervals and <italic>p</italic>-values (<italic>p</italic> < 0.05 was considered statistically significant) were recorded at 95% confidence interval. A new variable ‘socio-economic status’, was created out of all variables (income, residence, employment type and education) indicative of socio-economic status in our study and plotted against Toxoplasma infection in a graph.</p></sec></sec><sec id="Sec5"><title>Results</title><p>Data from 411 pregnant women were obtained and analysed for this study. Most of the pregnant women (59.6%) were in the age group of 25-34years. A greater number (51.7%) of them had up to secondary education and 66.6% worked in the employment category as professionals/administrative work. Most of the women (42.3%) lived in low cost residential areas which imply highly dense settlements, 64.5% of them had no children and 16.8% were HIV positive (Table <xref rid="Tab1" ref-type="table">1</xref>). Twenty-four of the pregnant women out of the 411 who participated in the study were reactive to <italic>Toxoplasma gondii</italic> IgG antibodies, which represented an overall seroprevalence of 5.87% of the total number of pregnant women who attend antenatal clinic at the university teaching hospital. None of these pregnant women were reactive to <italic>Toxoplasma gondii</italic> IgM antibodies.<table-wrap id="Tab1"><label>Table 1</label><caption><p>Prevalence and Factors Associated with Toxoplasma gondii Infection</p></caption><table frame="hsides" rules="groups"><thead><tr><th colspan="3"></th><th colspan="3">UNIVARITE ANALYSIS</th><th colspan="3">MULTIVARIABLE ANALYSIS</th></tr><tr><th>Characteristics</th><th>Response (%) n</th><th>Prevalence (%), category total (n)</th><th>OR</th><th>95% CI</th><th><italic>P</italic>-VALUE</th><th>OR</th><th>95% CI</th><th><italic>P</italic>-VALUE</th></tr></thead><tbody><tr><td colspan="9">SOCIO-DEMOGRAHIC</td></tr><tr><td colspan="9">AGE IN YEARS</td></tr><tr><td> 15-24</td><td>(18.7) 77</td><td>11.7 (77)</td><td>3.11</td><td>1.21-7.96</td><td>0.02</td><td>0.11</td><td>0.00-7.41</td><td>0.30</td></tr><tr><td> 25-34</td><td>(59.6) 245</td><td>4.08 (245)</td><td>1.00</td><td>1.00</td><td>1.00</td><td>1.00</td><td>1.00</td><td>1.00</td></tr><tr><td> 35-49</td><td>(21.7) 89</td><td>5.62 (89)</td><td>1.40</td><td>0.46-4.21</td><td>0.55</td><td>1.91</td><td>0.25-14.7</td><td>0.53</td></tr><tr><td colspan="9">LEVEL OF EDUCATION</td></tr><tr><td> Up to secondary*</td><td>(51.7) 209</td><td>6.22 (209)</td><td>1.00</td><td>1.00</td><td>1.00</td><td>0.60</td><td>0.10-3.57</td><td>0.57</td></tr><tr><td> Tertiary</td><td>(48.3) 195</td><td>4.62 (195)</td><td>0.73</td><td>0.30-1.75</td><td>0.48</td><td>1.00</td><td>1.00</td><td>1.00</td></tr><tr><td colspan="9">MARITAL STATUS</td></tr><tr><td> Married</td><td>(88.3) 361</td><td>4.99 (361)</td><td>1.00</td><td>1.00</td><td>1.00</td><td>1.46</td><td>0.01-271</td><td>0.89</td></tr><tr><td> Never been married</td><td>(5.38) 22</td><td>18.2 (22)</td><td>3.46</td><td>1.08-11.1</td><td>0.04</td><td>10.9</td><td>0.06-1955</td><td>0.37</td></tr><tr><td> Divorced/Widowed</td><td>(6.36) 26</td><td>7.69 (26)</td><td>1.91</td><td>0.41-8.79</td><td>0.41</td><td>1.00</td><td>1.00</td><td>1.00</td></tr><tr><td colspan="9">EMPLOYED</td></tr><tr><td> In Employment</td><td>(62.7) 257</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td> Unemployed</td><td>(37.3) 153</td><td></td><td></td><td></td><td></td><td></td><td></td><td></td></tr><tr><td colspan="9">EMPLOYMENT TYPE</td></tr><tr><td> Farming and construction</td><td>(2.7) 7</td><td>28.6 (7)</td><td>8.97</td><td>1.47-54.6</td><td>0.02</td><td>15.5</td><td>0.23-1019</td><td>0.20</td></tr><tr><td> Professional/Administrative</td><td>(63.6) 164</td><td>6.90 (87)</td><td>1.66</td><td>0.54-5.11</td><td>0.38</td><td>0.71</td><td>0.08-6.02</td><td>0.75</td></tr><tr><td> Trading/other businesses</td><td>(33.7) 87</td><td>4.27 (164)</td><td>1.00</td><td>1.00</td><td>1.00</td><td>1.00</td><td>1.00</td><td>1.00</td></tr><tr><td colspan="9">INCOME</td></tr><tr><td> Below K3000</td><td>(37.6) 94</td><td>10.64 (94)</td><td>3.13</td><td>0.95-10.3</td><td>0.06</td><td></td><td></td><td></td></tr><tr><td> Between K3000 and K5000</td><td>(43.6) 109</td><td>3.67 (109)</td><td>1.0</td><td>1.00</td><td>1.00</td><td></td><td></td><td></td></tr><tr><td> Above K5000</td><td>(18.8) 47</td><td>2.13 (47)</td><td>0.57</td><td>0.06-5.25</td><td>0.62</td><td></td><td></td><td></td></tr><tr><td colspan="9">RESIDENCE</td></tr><tr><td> High cost residential area</td><td>(18.5) 76</td><td>3.95 (76)</td><td>0.94</td><td>0.23-0.13</td><td>0.93</td><td>2.84</td><td>0.20-39.3</td><td>0.44</td></tr><tr><td> Medium cost residential area</td><td>(39.2) 161</td><td>3.73 (161)</td><td>2.30</td><td>0.64-8.18</td><td>0.20</td><td>0.40</td><td>0.03-5.77</td><td>0.50</td></tr><tr><td> Low cost residential area</td><td>(42.3) 174</td><td>8.62 (174)</td><td>1.0</td><td>1.00</td><td>1.00</td><td>1.00</td><td>1.00</td><td>1.00</td></tr><tr><td colspan="9">OBSTETRICAL FACTORS</td></tr><tr><td colspan="9">GESTATIONAL AGE</td></tr><tr><td> First Trimester</td><td>(20.5) 84</td><td>3.57 (84)</td><td>0.68</td><td>0.18-2.53</td><td>0.56</td><td></td><td></td><td></td></tr><tr><td> Second Trimester</td><td>(32.6) 134</td><td>8.21 (134)</td><td>1.64</td><td>0.68-4.00</td><td>0.28</td><td></td><td></td><td></td></tr><tr><td> Third Trimester</td><td>(47.0) 192</td><td>5.18 (193)</td><td>1.0</td><td>1.00</td><td>1.00</td><td></td><td></td><td></td></tr><tr><td colspan="9">PARITY</td></tr><tr><td> No child (first pregnancy)</td><td>(64.5) 262</td><td>4.62 (262)</td><td>1.77</td><td>0.23-13.9</td><td>0.59</td><td></td><td></td><td></td></tr><tr><td> One child</td><td>(29.3) 119</td><td>9.09 (119)</td><td>0.83</td><td>0.09-7.80</td><td>0.87</td><td></td><td></td><td></td></tr><tr><td> Two and above</td><td>(6.16) 25</td><td>3.47 (25)</td><td>1.0</td><td>1.00</td><td>1.00</td><td></td><td></td><td></td></tr><tr><td colspan="9">BEHAVORIAL/LIFESTYLE FACTORS</td></tr><tr><td colspan="9">CONTACT WITH CATS</td></tr><tr><td> Yes</td><td>(10.0) 41</td><td>7.32 (41)</td><td>1.31</td><td>0.37-4.59</td><td>0.68</td><td>7.81</td><td>0.99-61.8</td><td>0.05</td></tr><tr><td> No</td><td>(90.0) 369</td><td>5.69 (369)</td><td>1.0</td><td>1.00</td><td>1.00</td><td>1.00</td><td>1.00</td><td>1.00</td></tr><tr><td colspan="9">CONTACT WITH DOGS</td></tr><tr><td> Yes</td><td>(22.2) 91</td><td>6.59 (91)</td><td>1.18</td><td>0.45-3.07</td><td>0.73</td><td></td><td></td><td></td></tr><tr><td> No</td><td>(77.8) 319</td><td>5.64 (319)</td><td>1.00</td><td>1.00</td><td>1.00</td><td></td><td></td><td></td></tr><tr><td colspan="9">EATING MEAT</td></tr><tr><td> Yes</td><td>(97.6) 401</td><td>5.99 (401)</td><td>1.00</td><td>1.00</td><td>1.00</td><td></td><td></td><td></td></tr><tr><td> No</td><td>(2.43) 10</td><td>0 (10)</td><td>2.65*10-<sup>06</sup></td><td>0</td><td>0.99</td><td></td><td></td><td></td></tr><tr><td colspan="9">LENGTH OF COOKING MEET</td></tr><tr><td> Under 30 min</td><td>(12.6) 49</td><td>4.08 (49)</td><td>0.62</td><td>0.14-2.82</td><td>0.54</td><td></td><td></td><td></td></tr><tr><td> Within 30 to 60 min</td><td>(55.9) 218</td><td>6.42 (218)</td><td>1.00</td><td>1.00</td><td>1.00</td><td></td><td></td><td></td></tr><tr><td> Within 60 to 120 min</td><td>(18.0) 70</td><td>4.29 (70)</td><td>0.65</td><td>0.18-2.34</td><td>0.51</td><td></td><td></td><td></td></tr><tr><td> Over 120 min</td><td>(13.6) 53</td><td>3.77 (53)</td><td>0.57</td><td>0.13-2.60</td><td>0.47</td><td></td><td></td><td></td></tr><tr><td colspan="9">EATING CURED MEAT</td></tr><tr><td> Yes</td><td>(87.0) 347</td><td>5.19 (347)</td><td>1.00</td><td>1.00</td><td>1.00</td><td>1.00</td><td>0.02-43.6</td><td>1.00</td></tr><tr><td> No</td><td>(13.0) 52</td><td>11.5 (52)</td><td>2.38</td><td>0.90-6.32</td><td>0.08</td><td>1.00</td><td>1.00</td><td>1.00</td></tr><tr><td colspan="9">EATING RAW VEGETABLES</td></tr><tr><td> Yes</td><td>(81.3) 334</td><td>5.69 (334)</td><td>1.00</td><td>1.00</td><td>1.00</td><td></td><td></td><td></td></tr><tr><td> No</td><td>(18.7) 77</td><td>6.49 (77)</td><td>1.15</td><td>−4160-0.04</td><td>0.79</td><td></td><td></td><td></td></tr><tr><td colspan="9">DRINKING UNPASTEURIZED MILK</td></tr><tr><td> Yes</td><td>(8.76) 36</td><td>8.33 (36)</td><td>1.53</td><td>0.43-5.41</td><td>0.51</td><td></td><td></td><td></td></tr><tr><td> No</td><td>(91.2) 375</td><td>5.60 (375)</td><td>1.00</td><td>1.00</td><td>1.00</td><td></td><td></td><td></td></tr><tr><td colspan="9">CO-INFECTION</td></tr><tr><td colspan="9">HIV STATUS</td></tr><tr><td> Positive</td><td>(16.8) 69</td><td>8.70 (69)</td><td>1.69</td><td>0.65-4.43</td><td>0.28</td><td>0.39</td><td>0.04-3.47</td><td>0.40</td></tr><tr><td> Negative</td><td>(82.2) 338</td><td>5.33 (338)</td><td>1.0</td><td>1.00</td><td>1.00</td><td>1.00</td><td>1.00</td><td>1.00</td></tr></tbody></table><table-wrap-foot><p>Associations were calculated with Chi-square, and Fisher’s exact test where appropriate, whereas GLM for binary outcome reporting odds ratios was used for the univariate analysis</p><p>* = the category ‘two and above’ was created because the participants who had three to eight (maximum) children were few hence were not very comparable</p><p>Variables, ‘eating meat’, parity, ‘length of cooking meat’, ‘drinking unpasteurised milk’ and income were omitted in the final model due to their small numbers</p></table-wrap-foot></table-wrap></p><sec id="Sec6"><title>Determinants of toxoplasmosis</title><p>In univariate analysis, age category 15–24 years showed significance to the infection with 3.11 times the likelihood of contracting the infection among this age group as compared to the older groups. Those who had never been married also showed significance, with 3.5 times risk of the disease. Employment type and income, both being characteristic of socio-economic status, also exhibited 8.97 times and 3.13 times the risk of contracting the infection respectively (Table <xref rid="Tab1" ref-type="table">1</xref>).</p><p>At multivariable analysis, there was no significant outcome, but for employment type and contact with cats which showed association with the infection with 15.5 times and 7.81 times the risk of the infection in the pregnant women respectively (Table <xref rid="Tab1" ref-type="table">1</xref>).</p></sec></sec><sec id="Sec7"><title>Discussion</title><p>This study has shown that the overall seroprevalence of <italic>Toxoplasma gondii</italic> infection among pregnant women attending antenatal clinic at UTH is 5.87% and that ‘contact with cats’, ‘employment type’ and socio-economic status are associated with the infection.</p><p>Though there are studies with comparatively low seroprevalence of the infection in pregnant women such as in the United Kingdom, 9%, [<xref ref-type="bibr" rid="CR19">19</xref>], South Africa, 6.4%, [<xref ref-type="bibr" rid="CR23">23</xref>] and Korea, 3.7%, [<xref ref-type="bibr" rid="CR19">19</xref>], seroprevalence in this current study is quite low. This is in comparison with results from other studies in the region such as 18.7% in Mozambique [<xref ref-type="bibr" rid="CR33">33</xref>], 30.9% in Tanzania [<xref ref-type="bibr" rid="CR22">22</xref>] and 92.5% in Ghana [<xref ref-type="bibr" rid="CR13">13</xref>]. Globally, 24.1% in Saudi Arabia, [<xref ref-type="bibr" rid="CR19">19</xref>], 28.3% in Southern Thailand [<xref ref-type="bibr" rid="CR24">24</xref>] and 17.3% in London [<xref ref-type="bibr" rid="CR20">20</xref>]. Nonetheless, we find of epidemiological importance the low prevalence and agree with the statements by Kistiah that “A low prevalence means that more previously unexposed people are at risk of acquiring an acute infection, which may cause congenital disease in pregnant women, or which, in reactivation form may ultimately be life-threatening in HIV/AIDS patients” [<xref ref-type="bibr" rid="CR23">23</xref>] and by Andiappan that, “The seroprevalence may vary in a global view, but the risk of this parasitic infection in human populations, especially in pregnant women, still holds a great interest” [<xref ref-type="bibr" rid="CR34">34</xref>]. So though the prevalence turned out to be low, it is still of medical importance.</p><p>There was no IgM result found in this study. Some studies found IgM antibodies [<xref ref-type="bibr" rid="CR13">13</xref>, <xref ref-type="bibr" rid="CR20">20</xref>, <xref ref-type="bibr" rid="CR23">23</xref>], whereas other studies consistent with this study did not find [<xref ref-type="bibr" rid="CR22">22</xref>, <xref ref-type="bibr" rid="CR33">33</xref>, <xref ref-type="bibr" rid="CR35">35</xref>]. Most studies report mainly no or few IgM antibodies as compared to IgG. The ELISA method which detects early IgM infections even within the first two weeks of infection seems to be the most appropriate for discovering IgM antibodies [<xref ref-type="bibr" rid="CR16">16</xref>].</p><p>Cats are believed to be the main carriers and transmitters of <italic>T. gondii</italic> infection to man [<xref ref-type="bibr" rid="CR9">9</xref>] and some studies have established that they are significantly associated with Toxoplasmosis [<xref ref-type="bibr" rid="CR13">13</xref>, <xref ref-type="bibr" rid="CR27">27</xref>]. However, this study did not establish significant association between the infection and ‘contact with cats’ and this is consistent with reports established elsewhere [<xref ref-type="bibr" rid="CR20">20</xref>, <xref ref-type="bibr" rid="CR22">22</xref>, <xref ref-type="bibr" rid="CR26">26</xref>, <xref ref-type="bibr" rid="CR30">30</xref>, <xref ref-type="bibr" rid="CR35">35</xref>]. Albeit, the risk of contracting the infection where there is ‘contact with cats’ in this study was found to be 7.81 times more than where there is no contact with cats. It is important however to mention, that the risk of contracting <italic>Toxoplasma gondii</italic> from cats is as a result of the way or extent of handling the cat litter and not necessarily simple contact with cats [<xref ref-type="bibr" rid="CR22">22</xref>, <xref ref-type="bibr" rid="CR36">36</xref>]. More so, excretion of oocysts (which are infective) by infected cats lasts only few weeks [<xref ref-type="bibr" rid="CR26">26</xref>]. These we believe are the reasons for the non-significance which was found in this current study as well as the other studies which shared same results.</p><p>Eating meat and eating undercooked meat were not significantly associated with Toxoplasmosis in our study. Some studies have reported that eating undercooked meat is a determining factor of Toxoplasmosis [<xref ref-type="bibr" rid="CR20">20</xref>, <xref ref-type="bibr" rid="CR25">25</xref>–<xref ref-type="bibr" rid="CR27">27</xref>], but the divergent result of this current study turns to concur with other studies [<xref ref-type="bibr" rid="CR30">30</xref>, <xref ref-type="bibr" rid="CR35">35</xref>], which did not find ‘eating undercooked meat’ to be significantly associated with Toxoplasmosis. One reason for this disparity arises from the different types of meat that are investigated into in the various studies [<xref ref-type="bibr" rid="CR37">37</xref>]: This current study investigated beef, mutton, chevon, chicken, pork and ‘others’ which comprised bush meat or game meat. Again, the varying prevalence of the disease in food producing animals in the various affected regions plays a significant role in the infection in man [<xref ref-type="bibr" rid="CR14">14</xref>]. The different hygienic conditions under which meat is kept and handled before consumption is also a contributing factor to this [<xref ref-type="bibr" rid="CR38">38</xref>]. What's more, the definition of undercooked meat may differ among these studies due to different settings such as culture and preference, under which these studies were carried out. This study considered undercooked meat to be meat cooked in less than thirty minutes. This is not a documented universal standard: Undercooked meat in some European countries refers to raw meat which still has blood in it and this is uncommon in our setting. It is unclear however, the criteria other studies used to define undercooked meat. This could be the reason why this variable did not come out as an important determining factor of the infection in this study.</p><p>Prevalence of <italic>Toxoplasma gondii</italic> infection among HIV positive pregnant women was higher than that in HIV negative ones in this study. This difference was not statistically significant but is consistent with results from other reported studies [<xref ref-type="bibr" rid="CR17">17</xref>, <xref ref-type="bibr" rid="CR33">33</xref>, <xref ref-type="bibr" rid="CR39">39</xref>]. Two studies however report significant association between these two groups [<xref ref-type="bibr" rid="CR17">17</xref>, <xref ref-type="bibr" rid="CR33">33</xref>]. According to one current study, one of the reasons for the non-significance could be as a result of the Anti-Retroviral Therapy (ART) which some of the HIV positive pregnant women were taking [<xref ref-type="bibr" rid="CR36">36</xref>]. Nonetheless, another study compared the prevalence of the infection in HIV- Toxoplasmosis co-infected individuals on ART and HIV- Toxoplasmosis co-infected individuals not on ART and found no significant association between the two groups [<xref ref-type="bibr" rid="CR39">39</xref>]. It is however unclear the reason for these results.</p><p>‘Farming/ construction under ‘Employment type’ was found to have association with the infection. This category showed 15.5 times the likelihood of contracting the infection as compared to trading/other businesses and professional/administration which had a reduced risk of the infection. Some studies reported significant association with soil related occupation [<xref ref-type="bibr" rid="CR28">28</xref>], ‘being a labourer’ [<xref ref-type="bibr" rid="CR34">34</xref>], ‘employed/business women’ as compared to ‘peasants’ [<xref ref-type="bibr" rid="CR22">22</xref>] as well as weak association with ‘working with animals’ [<xref ref-type="bibr" rid="CR26">26</xref>]. Some other studies also found ‘occupation’ to have no association with the infection at all [<xref ref-type="bibr" rid="CR19">19</xref>, <xref ref-type="bibr" rid="CR36">36</xref>]. There is an extent of diversity when it comes to ‘occupation’, as different studies investigate different economic activities under this term and others do not specify exactly which activities investigated.</p><p>There was increased risk of the infection with increase in age as was reported elsewhere [<xref ref-type="bibr" rid="CR22">22</xref>, <xref ref-type="bibr" rid="CR28">28</xref>, <xref ref-type="bibr" rid="CR35">35</xref>] and these studies found this association to be significant. However, consistent with our study’s finding, some studies did not establish significant association between the two [<xref ref-type="bibr" rid="CR13">13</xref>, <xref ref-type="bibr" rid="CR39">39</xref>]. Age appears to be associated with the infection because time of exposure increases as one gets older [<xref ref-type="bibr" rid="CR35">35</xref>]. Age alone is neither sufficient no necessary for the infection to occur.</p><p>Our study further demonstrated no significant association with gestational age as reported in other studies [<xref ref-type="bibr" rid="CR13">13</xref>, <xref ref-type="bibr" rid="CR36">36</xref>] but higher infections were found with the second and third trimesters of both HIV positive and HIV negative pregnant women.</p><p>This study found that there was an association between <italic>Toxoplasma gondii</italic> infection and the socio-economic status of pregnant women. Highest infections where found among pregnant women with low socio-economic status as compared to those with high socio-economic status (see Fig. <xref rid="Fig1" ref-type="fig">1</xref>). This was in line with other studies’s findings [<xref ref-type="bibr" rid="CR21">21</xref>, <xref ref-type="bibr" rid="CR34">34</xref>, <xref ref-type="bibr" rid="CR40">40</xref>]. This could be due to pregnant women of low socio-economic status being more prone to live and work in highly dense areas with poor sanitary conditions as was realised in this study, lack good education and may lack knowledge on good hygienic practices in general.<fig id="Fig1"><label>Fig. 1</label><caption><p>A Graph showing the relationship between <italic>Toxoplasma gondii</italic> infection and Socio-economic status of Study Participants</p></caption><graphic xlink:href="12879_2016_2133_Fig1_HTML" id="MO1"></graphic></fig></p><sec id="Sec8"><title>Limitations and strengths of the study</title><p>The results of this study cannot be generalised to the entire population in Zambia due to the fact that the study was carried out only in pregnant women in Lusaka. Furthermore, though a negative test result indicates absence of the infection, it does not rule out possibility of exposure to or with the infection. Again, some specimen containing unusually high titer of heterophile antibodies or rheumatoid factor may affect the expected results.</p><p>Though these limitations exist, our study is the first of its kind done in pregnant women in UTH and in the country at large and it was carefully and accurately carried out following all necessary precautions. The study population was also a true susceptible population where Toxoplasmosis is concerned, hence the need for the study.</p></sec></sec><sec id="Sec9"><title>Conclusion</title><p>There is low prevalence of <italic>T. gondii</italic> infection among pregnant women attending antenatal clinic in UTH, Lusaka, Zambia, with a prevalence of 5.87%. Contact with cats, employment type and socio-economic status have association with <italic>Toxoplasma</italic> infection.</p><p>The low prevalence in this investigated area could be due to the fact that fewer women own or have contact with cats and also that farming / construction is not an activity greatly engaged in by most women in the urban city, Lusaka.</p><sec id="Sec10"><title>Recommendations</title><p>Toxoplasmosis screening can be carried out twice (during first and third trimesters) or at least once (during first trimesters) for every pregnant woman, in hospitals. We recommend this because as highlighted early in this study, vertical transmission of the infection during the first trimester is critical and causes severe clinical conditions in the fetus, and third trimester infections have rapid transmission rate of parasites to fetuses, hence causing higher incidence of disease. This when practised, will help save the lives of both mother and child. Health promotion among women of childbearing age is also of immense importance in order to create awareness of the disease in this group and help curb it. In as much as we have given a good picture of the infection among pregnant women in Lusaka, we recommend that more robust studies such as cohort and case–control studies be carried out in the country in order to better ascertain the extent of the condition nationwide.</p></sec></sec></body><back><glossary><title>Abbreviations</title><def-list><def-item><term>AIDS</term><def><p>Acquired immune deficiency syndrome</p></def></def-item><def-item><term>ANC</term><def><p>Antenatal care</p></def></def-item><def-item><term>CI</term><def><p>Confidence interval</p></def></def-item><def-item><term>CNS</term><def><p>Central nervous system</p></def></def-item><def-item><term>GLM</term><def><p>Generalised linear model</p></def></def-item><def-item><term>HIV</term><def><p>Human immunodeficiency virus</p></def></def-item><def-item><term>IgG</term><def><p>Immunoglobulin G</p></def></def-item><def-item><term>IgM</term><def><p>Immunoglobulin M</p></def></def-item><def-item><term>SAG2</term><def><p>Surface antigen 2 gene</p></def></def-item><def-item><term><italic>T. gondii</italic></term><def><p><italic>Toxoplasma gondii</italic></p></def></def-item><def-item><term>UNZA</term><def><p>University of Zambia</p></def></def-item><def-item><term>US</term><def><p>United States</p></def></def-item><def-item><term>UTH</term><def><p>University teaching hospital</p></def></def-item></def-list></glossary><ack><title>Acknowledgements</title><p>The Authors thank the Education, Audio-visual and Culture Executive Agency Project of the European Commission that made it possible to conduct this study through the Intra-ACP (Africa, Caribbean & Pacific) Scholarship scheme. Also, to Mr. John Chisoso for helping in the conception of the study, obtaining test kits and materials for the laboratory work as well as supervising the laboratory work. Our gratitude to the entire department of Public Health for their selfless contributions.</p><sec id="FPar1"><title>Availability of data and materials</title><p>The dataset is available upon request.</p></sec><sec id="FPar2"><title>Authors’ contributions</title><p>CF conceived and designed the study, collected and analysed data and drafted the manuscript. CM, MM and LS all supervised, coordinated and provided guidance during the designing and drafting of the manuscript. All authors have read and approved this manuscript for publication.</p></sec><sec id="FPar3"><title>Competing interests</title><p>The Authors declare that they have no competing interests.</p></sec><sec id="FPar4"><title>Consent for publication</title><p>Not applicable.</p></sec><sec id="FPar5"><title>Consent to participate</title><p>The procedures and risk in this study were explained thoroughly to participants after which they signed an informed consent. All participants answered the closed ended questionnaires and had their blood tested for Toxoplasmosis. Those who had reactive results to the test where referred to doctors in the hospital.</p></sec><sec id="FPar6"><title>Ethics approval and consent to participate</title><p>Ethical approval was given by the Excellence in Research Ethics and Science (ERES Converge IRB) with Ref. No. 2015-June-013. Permission was also given from the Hospital Management to allow the study to take place at the maternity wing (BO2) of the hospital.</p></sec></ack><ref-list id="Bib1"><title>References</title><ref id="CR1"><label>1.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Tenter</surname><given-names>AM</given-names></name><name><surname>Heckeroth</surname><given-names>AR</given-names></name><name><surname>Weiss</surname><given-names>LM</given-names></name></person-group><article-title>Toxoplasma gondii: from animals to humans</article-title><source>Int J Parasitol</source><year>2000</year><volume>30</volume><issue>12</issue><fpage>1217</fpage><lpage>1258</lpage><pub-id pub-id-type="doi">10.1016/S0020-7519(00)00124-7</pub-id><pub-id pub-id-type="pmid">11113252</pub-id></element-citation></ref><ref id="CR2"><label>2.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hotez</surname><given-names>PJ</given-names></name><name><surname>Kamath</surname><given-names>A</given-names></name></person-group><article-title>Neglected tropical diseases in sub-Saharan Africa: review of their prevalence, distribution, and disease burden</article-title><source>PLoS Negl Trop Dis</source><year>2009</year><volume>3</volume><issue>8</issue><fpage>e412</fpage><pub-id pub-id-type="doi">10.1371/journal.pntd.0000412</pub-id><pub-id pub-id-type="pmid">19707588</pub-id></element-citation></ref><ref id="CR3"><label>3.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kijlstra</surname><given-names>A</given-names></name><name><surname>Jongert</surname><given-names>E</given-names></name></person-group><article-title>Toxoplasma-safe meat: close to reality?</article-title><source>Trends Parasitol</source><year>2009</year><volume>25</volume><issue>1</issue><fpage>18</fpage><lpage>22</lpage><pub-id pub-id-type="doi">10.1016/j.pt.2008.09.008</pub-id><pub-id pub-id-type="pmid">18951847</pub-id></element-citation></ref><ref id="CR4"><label>4.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Mazigo</surname><given-names>HD</given-names></name><etal></etal></person-group><article-title>Epilepsy and tropical parasitic infections in Sub-Saharan Africa: a review</article-title><source>Tanzan J Health Res</source><year>2013</year><volume>15</volume><issue>2</issue><fpage>102</fpage><lpage>19</lpage><pub-id pub-id-type="doi">10.4314/thrb.v15i2.5</pub-id><pub-id pub-id-type="pmid">26591716</pub-id></element-citation></ref><ref id="CR5"><label>5.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Dubey</surname><given-names>JP</given-names></name></person-group><article-title>The history of Toxoplasma gondii—the first 100 years</article-title><source>J Eukaryot Microbiol</source><year>2008</year><volume>55</volume><issue>6</issue><fpage>467</fpage><lpage>475</lpage><pub-id pub-id-type="doi">10.1111/j.1550-7408.2008.00345.x</pub-id><pub-id pub-id-type="pmid">19120791</pub-id></element-citation></ref><ref id="CR6"><label>6.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Elmore</surname><given-names>SA</given-names></name><etal></etal></person-group><article-title>Toxoplasma gondii: epidemiology, feline clinical aspects, and prevention</article-title><source>Trends Parasitol</source><year>2010</year><volume>26</volume><issue>4</issue><fpage>190</fpage><lpage>196</lpage><pub-id pub-id-type="doi">10.1016/j.pt.2010.01.009</pub-id><pub-id pub-id-type="pmid">20202907</pub-id></element-citation></ref><ref id="CR7"><label>7.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Dubey</surname><given-names>JP</given-names></name><name><surname>Jones</surname><given-names>JL</given-names></name></person-group><article-title>Toxoplasma gondii infection in humans and animals in the United States</article-title><source>Int J Parasitol</source><year>2008</year><volume>38</volume><issue>11</issue><fpage>1257</fpage><lpage>1278</lpage><pub-id pub-id-type="doi">10.1016/j.ijpara.2008.03.007</pub-id><pub-id pub-id-type="pmid">18508057</pub-id></element-citation></ref><ref id="CR8"><label>8.</label><element-citation publication-type="book"><person-group person-group-type="author"><name><surname>Lucas</surname><given-names>AO</given-names></name><name><surname>Gilles</surname><given-names>HM</given-names></name></person-group><source>Lucas and Gilles Short Textbook of Public Health Medicine for the Tropics</source><year>2005</year><edition>Fourth ed</edition><publisher-loc>New York</publisher-loc><publisher-name>Oxford University Press, New York</publisher-name></element-citation></ref><ref id="CR9"><label>9.</label><mixed-citation publication-type="other">Weiss LM, Kim K, Toxoplasma gondii: the model apicomplexan. Perspectives and methods. Academic Press; 2011.</mixed-citation></ref><ref id="CR10"><label>10.</label><element-citation publication-type="book"><person-group person-group-type="author"><name><surname>Nissapatorn</surname><given-names>V</given-names></name></person-group><person-group person-group-type="editor"><name><surname>Zajac</surname><given-names>V</given-names></name></person-group><article-title>Toxoplasmosis in HIV/AIDS patients: a living legacy</article-title><source>Microbes, Viruses and Parasites in AIDS Process</source><year>2009</year><fpage>307</fpage><lpage>352</lpage></element-citation></ref><ref id="CR11"><label>11.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Singh</surname><given-names>S</given-names></name></person-group><article-title>Mother-to-child transmission and diagnosis of Toxoplasma gondii infection during pregnancy</article-title><source>Indian J Med Microbiol</source><year>2003</year><volume>21</volume><issue>2</issue><fpage>69</fpage><pub-id pub-id-type="pmid">17642985</pub-id></element-citation></ref><ref id="CR12"><label>12.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Dubey</surname><given-names>J</given-names></name></person-group><article-title>Strategies to reduce transmission of Toxoplasma gondii to animals and humans</article-title><source>Vet Parasitol</source><year>1996</year><volume>64</volume><issue>1</issue><fpage>65</fpage><lpage>70</lpage><pub-id pub-id-type="doi">10.1016/0304-4017(96)00961-2</pub-id><pub-id pub-id-type="pmid">8893464</pub-id></element-citation></ref><ref id="CR13"><label>13.</label><mixed-citation publication-type="other">Ayi I, et al., Sero-epidemiology of toxoplasmosis amongst pregnant women in the greater Accra region of Ghana. Ghana Med J, 2009. 43(3).</mixed-citation></ref><ref id="CR14"><label>14.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Pappas</surname><given-names>G</given-names></name><name><surname>Roussos</surname><given-names>N</given-names></name><name><surname>Falagas</surname><given-names>ME</given-names></name></person-group><article-title>Toxoplasmosis snapshots: global status of Toxoplasma gondii seroprevalence and implications for pregnancy and congenital toxoplasmosis</article-title><source>Int J Parasitol</source><year>2009</year><volume>39</volume><issue>12</issue><fpage>1385</fpage><lpage>1394</lpage><pub-id pub-id-type="doi">10.1016/j.ijpara.2009.04.003</pub-id><pub-id pub-id-type="pmid">19433092</pub-id></element-citation></ref><ref id="CR15"><label>15.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Weiss</surname><given-names>LM</given-names></name><name><surname>Dubey</surname><given-names>JP</given-names></name></person-group><article-title>Toxoplasmosis: A history of clinical observations</article-title><source>Int J Parasitol</source><year>2009</year><volume>39</volume><issue>8</issue><fpage>895</fpage><lpage>901</lpage><pub-id pub-id-type="doi">10.1016/j.ijpara.2009.02.004</pub-id><pub-id pub-id-type="pmid">19217908</pub-id></element-citation></ref><ref id="CR16"><label>16.</label><mixed-citation publication-type="other">Van kessell, K.A. and D.A. Eschenbach. Toxoplasmosis In Pregnancy. 2014 2014 [cited 2015 22nd April]; Available from: <ext-link ext-link-type="uri" xlink:href="http://www.glowm.com/section_view/heading/Toxoplasmosis%20in%20Pregnancy/item/187">www.glowm.com/section_view/heading/Toxoplasmosis%20in%20Pregnancy/item/187</ext-link>.</mixed-citation></ref><ref id="CR17"><label>17.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Remington</surname><given-names>JS</given-names></name><name><surname>Thulliez</surname><given-names>P</given-names></name><name><surname>Montoya</surname><given-names>JG</given-names></name></person-group><article-title>Recent developments for diagnosis of toxoplasmosis</article-title><source>J Clin Microbiol</source><year>2004</year><volume>42</volume><issue>3</issue><fpage>941</fpage><lpage>945</lpage><pub-id pub-id-type="doi">10.1128/JCM.42.3.941-945.2004</pub-id><pub-id pub-id-type="pmid">15004036</pub-id></element-citation></ref><ref id="CR18"><label>18.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wanachiwanawin</surname><given-names>D</given-names></name><etal></etal></person-group><article-title>Toxoplasma gondii antibodies in HIV and non-HIV infected Thai pregnant women</article-title><source>Asian Pac J Allergy Immunol</source><year>2001</year><volume>19</volume><issue>4</issue><fpage>291</fpage><lpage>294</lpage><pub-id pub-id-type="pmid">12009080</pub-id></element-citation></ref><ref id="CR19"><label>19.</label><mixed-citation publication-type="other">Aqeely H, et al. Seroepidemiology of Toxoplasma gondii amongst Pregnant Women in Jazan Province, Saudi Arabia. J Trop Med. 2014;2014.</mixed-citation></ref><ref id="CR20"><label>20.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kistiah</surname><given-names>K</given-names></name><etal></etal></person-group><article-title>Seroprevalence of Toxoplasma gondii infection in HIV-positive and HIV-negative subjects in Gauteng, South Africa</article-title><source>S Afr J Epidemiol Infect</source><year>2011</year><volume>26</volume><issue>4</issue><fpage>225</fpage><lpage>228</lpage></element-citation></ref><ref id="CR21"><label>21.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Flatt</surname><given-names>A</given-names></name><name><surname>Shetty</surname><given-names>N</given-names></name></person-group><article-title>Seroprevalence and risk factors for toxoplasmosis among antenatal women in London: a re-examination of risk in an ethnically diverse population</article-title><source>Eur J Public Health</source><year>2013</year><volume>23</volume><issue>4</issue><fpage>648</fpage><lpage>652</lpage><pub-id pub-id-type="doi">10.1093/eurpub/cks075</pub-id><pub-id pub-id-type="pmid">22696530</pub-id></element-citation></ref><ref id="CR22"><label>22.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Nissapatorn</surname><given-names>V</given-names></name><etal></etal></person-group><article-title>Toxoplasmosis-serological evidence and associated risk factors among pregnant women in southern Thailand</article-title><source>AmJTrop Med Hyg</source><year>2011</year><volume>85</volume><issue>2</issue><fpage>243</fpage><lpage>247</lpage><pub-id pub-id-type="doi">10.4269/ajtmh.2011.10-0633</pub-id></element-citation></ref><ref id="CR23"><label>23.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Mwambe</surname><given-names>B</given-names></name><etal></etal></person-group><article-title>Sero-prevalence and factors associated with Toxoplasma gondii infection among pregnant women attending antenatal care in Mwanza, Tanzania</article-title><source>Parasit Vectors</source><year>2013</year><volume>6</volume><fpage>222</fpage><pub-id pub-id-type="doi">10.1186/1756-3305-6-222</pub-id><pub-id pub-id-type="pmid">23915834</pub-id></element-citation></ref><ref id="CR24"><label>24.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sroka</surname><given-names>S</given-names></name><etal></etal></person-group><article-title>Prevalence and risk factors of toxoplasmosis among pregnant women in Fortaleza, Northeastern Brazil</article-title><source>AmJTrop Med Hyg</source><year>2010</year><volume>83</volume><issue>3</issue><fpage>528</fpage><lpage>533</lpage><pub-id pub-id-type="doi">10.4269/ajtmh.2010.10-0082</pub-id></element-citation></ref><ref id="CR25"><label>25.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Boyer</surname><given-names>KM</given-names></name><etal></etal></person-group><article-title>Risk factors for Toxoplasma gondii infection in mothers of infants with congenital toxoplasmosis: implications for prenatal management and screening</article-title><source>Am J Obstet Gynecol</source><year>2005</year><volume>192</volume><issue>2</issue><fpage>564</fpage><lpage>571</lpage><pub-id pub-id-type="doi">10.1016/j.ajog.2004.07.031</pub-id><pub-id pub-id-type="pmid">15696004</pub-id></element-citation></ref><ref id="CR26"><label>26.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Cook</surname><given-names>A</given-names></name><etal></etal></person-group><article-title>Sources of toxoplasma infection in pregnant women: European multicentre case–control studyCommentary: Congenital toxoplasmosis—further thought for food</article-title><source>BMJ</source><year>2000</year><volume>321</volume><issue>7254</issue><fpage>142</fpage><lpage>147</lpage><pub-id pub-id-type="doi">10.1136/bmj.321.7254.142</pub-id><pub-id pub-id-type="pmid">10894691</pub-id></element-citation></ref><ref id="CR27"><label>27.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Baril</surname><given-names>L</given-names></name><etal></etal></person-group><article-title>Risk factors for Toxoplasma infection in pregnancy: a case–control study in France</article-title><source>Scand J Infect Dis</source><year>1999</year><volume>31</volume><issue>3</issue><fpage>305</fpage><lpage>309</lpage><pub-id pub-id-type="doi">10.1080/00365549950163626</pub-id><pub-id pub-id-type="pmid">10482062</pub-id></element-citation></ref><ref id="CR28"><label>28.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Jones</surname><given-names>JL</given-names></name><etal></etal></person-group><article-title>Toxoplasma gondii infection in the United States: seroprevalence and risk factors</article-title><source>Am J Epidemiol</source><year>2001</year><volume>154</volume><issue>4</issue><fpage>357</fpage><lpage>365</lpage><pub-id pub-id-type="doi">10.1093/aje/154.4.357</pub-id><pub-id pub-id-type="pmid">11495859</pub-id></element-citation></ref><ref id="CR29"><label>29.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Berger</surname><given-names>F</given-names></name><etal></etal></person-group><article-title>Toxoplasmosis among pregnant women in France: risk factors and change of prevalence between 1995 and 2003</article-title><source>Rev Epidemiol Sante Publique</source><year>2009</year><volume>57</volume><issue>4</issue><fpage>241</fpage><lpage>248</lpage><pub-id pub-id-type="doi">10.1016/j.respe.2009.03.006</pub-id><pub-id pub-id-type="pmid">19577390</pub-id></element-citation></ref><ref id="CR30"><label>30.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Nissapatorn</surname><given-names>V</given-names></name><etal></etal></person-group><article-title>Toxoplasmosis: prevalence and risk factors</article-title><source>J Obstet Gynecol</source><year>2003</year><volume>23</volume><issue>6</issue><fpage>618</fpage><lpage>624</lpage><pub-id pub-id-type="doi">10.1080/01443610310001604376</pub-id><pub-id pub-id-type="pmid">14617462</pub-id></element-citation></ref><ref id="CR31"><label>31.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Breugelmans</surname><given-names>M</given-names></name><name><surname>Naessens</surname><given-names>A</given-names></name><name><surname>Foulon</surname><given-names>W</given-names></name></person-group><article-title>Prevention of toxoplasmosis during pregnancy–an epidemiologic survey over 22 consecutive years</article-title><source>J Perinat Med</source><year>2004</year><volume>32</volume><issue>3</issue><fpage>211</fpage><lpage>214</lpage><pub-id pub-id-type="doi">10.1515/JPM.2004.039</pub-id><pub-id pub-id-type="pmid">15188792</pub-id></element-citation></ref><ref id="CR32"><label>32.</label><mixed-citation publication-type="other">Wong, S.-Y. and J.S. Remington, Toxoplasmosis in pregnancy. Clin Infect Dis, 1994: p. 853–861.</mixed-citation></ref><ref id="CR33"><label>33.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sitoe</surname><given-names>SPBL</given-names></name><etal></etal></person-group><article-title>Preliminary report of HIV and Toxoplasma gondii occurrence in pregnant women from Mozambique</article-title><source>Rev Inst Med Trop Sao Paulo</source><year>2010</year><volume>52</volume><issue>6</issue><fpage>291</fpage><lpage>295</lpage><pub-id pub-id-type="pmid">21225211</pub-id></element-citation></ref><ref id="CR34"><label>34.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Andiappan</surname><given-names>H</given-names></name><etal></etal></person-group><article-title>Toxoplasma infection in pregnant women: a current status in Songklanagarind hospital, southern Thailand</article-title><source>Parasit Vectors</source><year>2014</year><volume>7</volume><fpage>239</fpage><pub-id pub-id-type="doi">10.1186/1756-3305-7-239</pub-id><pub-id pub-id-type="pmid">24886651</pub-id></element-citation></ref><ref id="CR35"><label>35.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ertug</surname><given-names>S</given-names></name><etal></etal></person-group><article-title>Seroprevalence and risk factors for toxoplasma infection among pregnant women in Aydin province, Turkey</article-title><source>BMC Public Health</source><year>2005</year><volume>5</volume><issue>1</issue><fpage>66</fpage><pub-id pub-id-type="doi">10.1186/1471-2458-5-66</pub-id><pub-id pub-id-type="pmid">15958156</pub-id></element-citation></ref><ref id="CR36"><label>36.</label><element-citation publication-type="book"><person-group person-group-type="author"><name><surname>Shao</surname><given-names>ER</given-names></name><etal></etal></person-group><article-title>Sero-Prevalence and Factors Associated with Toxoplasma Gondii Infection among Pregnant Women Attending Antenatal Care in the Referral Hospital in Tanzania: Cross Sectional Study</article-title><source>Annals of Clinical and Laboratory Research</source><year>2015</year></element-citation></ref><ref id="CR37"><label>37.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Avelino</surname><given-names>MM</given-names></name><etal></etal></person-group><article-title>Risk factors for Toxoplasma gondii infection in women of childbearing age</article-title><source>Braz J Infect Dis</source><year>2004</year><volume>8</volume><issue>2</issue><fpage>164</fpage><lpage>174</lpage><pub-id pub-id-type="doi">10.1590/S1413-86702004000200007</pub-id><pub-id pub-id-type="pmid">15361995</pub-id></element-citation></ref><ref id="CR38"><label>38.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Jones</surname><given-names>JL</given-names></name><etal></etal></person-group><article-title>Toxoplasma gondii infection in the United States, 1999–2004, decline from the prior decade</article-title><source>AmJTrop Med Hyg</source><year>2007</year><volume>77</volume><issue>3</issue><fpage>405</fpage><lpage>410</lpage></element-citation></ref><ref id="CR39"><label>39.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ogoina</surname><given-names>D</given-names></name><etal></etal></person-group><article-title>Seroprevalence of IgM and IgG Antibodies to Toxoplasma infection in healthy and HIV-positive adults from Northern Nigeria</article-title><source>J Infect Dev Ctries</source><year>2013</year><volume>7</volume><issue>05</issue><fpage>398</fpage><lpage>403</lpage><pub-id pub-id-type="doi">10.3855/jidc.2797</pub-id><pub-id pub-id-type="pmid">23669429</pub-id></element-citation></ref><ref id="CR40"><label>40.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Rosso</surname><given-names>F</given-names></name><etal></etal></person-group><article-title>Prevalence of infection with Toxoplasma gondii among pregnant women in Cali, Colombia, South America</article-title><source>AmJTrop Med Hyg</source><year>2008</year><volume>78</volume><issue>3</issue><fpage>504</fpage><lpage>508</lpage></element-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Sante/explor/SidaSubSaharaV1/Data/Pmc/Corpus
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 000623 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd -nk 000623 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Wicri/Sante
|area= SidaSubSaharaV1
|flux= Pmc
|étape= Corpus
|type= RBID
|clé=
|texte=
}}
| This area was generated with Dilib version V0.6.32. |  |