Seroprevalence of anti-Toxoplasma gondii IgM antibody and risk factors among pregnant and non-pregnant women referred to health centers of Khyber Pakhtunkhwa, Pakistan

Abstract

Background: Intracellular parasite Toxoplasma gondii which causes toxoplasmosis in humans is a common parasite. It infects one third of the world’s population. Infection is normally asymptomatic in most adults, some people, especially women in early pregnancy, may experience serious complications. Toxoplasmosis is not reported very often and its prevalence is estimated based on regional studies. In Pakistan, few studies have been carried out in different parts of the country which show quite high prevalence. The aim of this study was to evaluate the seroprevalence of anti-Toxoplasma gondii IgM antibodies in women of childbearing age and associated risk factors referred to different health centers of Khyber Pakhtunkhwa, Pakistan. Serological test by Enzyme Linked Immunosorbent Assay (ELISA) for the detection of anti- Toxoplasma IgM antibodies was carried out to address the associated risk factors which possess potential burden socially and economically. Methods: A total of 423 respondents between the age group 18 and >40 years were included in our study. Subjects were pregnant and non-pregnant ladies from the different districts of Khyber Pakhtunkhwa province, Pakistan Many factors were analyzed such as pregnancy status of women, age group, gestation period, profession and the residency of the respondent. Highly sensitive and specific sero-diagnostic technique, Enzyme-linked immunosorbent assay (ELISA) was used to detect anti- Toxoplasma IgM antibodies from the blood sera. Chisquare test and Odd ratios (OR) were used to analyze the data. Simple logistic regression analysis was performed to find association between seroprevalence of anti-Toxoplasma IgM antibodies and associated risk factors. Results: Different outcomes were seen, in all the study an effort was made to evaluate and compare the seroprevalence with already reported seroprevalence. The overall seroprevalence was found 56.26% with highest seropositivity in Mansehra 55 (13.0%), followed by Abbottabad 51 (12.0%), Batagram 43 (10.1), Peshawar 43 (10.1%) and lowest in Haripur district 35 (8.27%). Statistically a significant association was observed among the five districts of Khyber Pakhtunkhwa ( χ2=9.982, p=0.045).The prevalence rate was higher in pregnant women 34.70% (147) as compared to the non-pregnant women 18.6% (79). A statistically significant association was observed between the pregnancy status and the seropositivity (χ2=27.06, p=0.001). Among different age groups the highest seroprevalence was observed at 25-29 years of age group n=58 (42%) followed by 20-24 years of age group n=51 (36.9%), 30-34 years of age group n=15 (10.86%) , 35-39,15-19 years of age group Chapter # 1 2 n=11 (7.97%) and the least prevalence was at age group >40 years of age group n=3 (2%) among the pregnant women .Whereas in non-pregnant ladies highest seroprevalence was observed at age group >40 years (41.4%) n=29 followed by 25-29 years (18.57%), 30-34 years (14.28%), 20-24 years (12.85%), 35-39 years (10%) and the lowest prevalence was observed in age group 15-19 (2%) years. Statistically non signification association was found among different age groups of suspected women of child bearing age (χ2=2.099, p=0.842). Among three trimesters of gestation period highest seroprevalence was observed at 3rd trimester 33.20% n=88 followed by 2nd trimester 17.7% n=47 and lowest at 1st trimester 4.90% n=13. In our study when trimester factor was analyzed non-significant association was observed (χ2=3.432, p=0.185).When profession factor was analyzed higher seroprevalence was found among housewives 29.53% followed by teachers 16.54%, students 8.4% and other working ladies including nurses 3.87% and lowest in bankers 2.42%.Statistical nonsignificant association was the outcome of the profession factor (χ2=6.10, p=0.227) Conclusion: Compared to the already reported seroprevalence, in our study we noted the increase in the seroprevalence among the women of childbearing age population. The study showed that pregnant women are more infected and are at great risk of being infected with drastic outcomes as the vertical transmission of the parasite can result in defective outcomes in the foetus. Through our investigation we came to conclusion that there is a much need of public awareness regarding the disease transmission and life cycle of the parasite. There is a need of timely screening of the suspected people especially the pregnant women population, they should be facilitated at the health centers with proper detection techniques so that the higher prevalence can be controlled in time, in this regard serological screening is important to reduce the risk of congenital transmission. Further studies are needed to evaluate whether this trend is same throughout the country or is just localized to this province.