Seroprevalence and Associated Risk Factors for Toxoplasma Gondii Among HIV Positive Pregnant Women Attending Antenatal Clinics in Uasin Gishu County - Kenya.
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Abstract Toxoplasma gondii is an intracellular Apicomplexan protozoan parasite that infects humans who ingest raw or undercooked meat or congenitally by trans-placental transmission. Immunocompromised patients are at risk of contracting T. gondii which can be fatal if not promptly treated. This study determined the seroprevalence of T. gondii and its associated risk factors among HIV infected pregnant women. We enrolled pregnant, HIV positive women aged 18 years and above from the antenatal clinics of Academic Model Providing Access to Healthcare Program (AMPATH) centers within Uasin Gishu County, Kenya. Blood samples from the women were collected aseptically, transported to the immunology laboratory and screened for anti-T. gondii IgG antibodies using the enzyme linked immunosorbent assay (ELISA) technique. Participant sociodemographic, clinical and risk factor data were collected using a structured questionnaire. Descriptive and inferential data analysis was conducted using Stata Version 11.2. Chi-square test was used to determine the association between seropositivity and various risk factors with a p-value ≤ 0.05 considered statistically significant. Logistic regression analysis was conducted for significant variables at the bivariate level. Of the 102 women enrolled, ___(46%) had T. gondii IgG antibodies. __ (27%) were aware of T. gondii transmission mechanisms and boiled water prior to consumption, 98% washed their hands during food preparation and after visiting the toilet, while 39.2% kept cats in their homesteads. __ (41.2%) were in their second trimester of pregnancy and ___(19%) had a history of abortion. Women aged 25–30 years had nearly five-fold significant risk (RR = 4.840 [95% CI; 0.699–23.297, p = 0.017) of having a T. gondii infection compared to their counterparts. Additional infection risks were seen among women who did not treat water were (RR = 2.801 [95% CI; 1.00-7.851]) and practiced farming (RR = 9.950 [95% CI; 0.691–8.197]). In conclusion, T. gondii is a highly prevalent pathogen among HIV infected pregnant women receiving antenatal care at AMPATH clinics in Uasin Gishu county. This study also highlights age, lack of water treatment and farming practices as significant risk factors for infection. There is need to institute risk reduction measures of factors associated with T. gondii infection. These include encouraging adequate cooking food to safe temperatures, avoiding direct contact with potentially infected soil or cat litter and treating water before use.
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Maureen Kurere, Charles Mwandawiro, John M. Kagira, Simon Karanja This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4659431/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Toxoplasma gondii is an intracellular Apicomplexan protozoan parasite that infects humans who ingest raw or undercooked meat or congenitally by trans-placental transmission. Immunocompromised patients are at risk of contracting T. gondii which can be fatal if not promptly treated. This study determined the seroprevalence of T. gondii and its associated risk factors among HIV infected pregnant women. We enrolled pregnant, HIV positive women aged 18 years and above from the antenatal clinics of Academic Model Providing Access to Healthcare Program (AMPATH) centers within Uasin Gishu County, Kenya. Blood samples from the women were collected aseptically, transported to the immunology laboratory and screened for anti- T. gondii IgG antibodies using the enzyme linked immunosorbent assay (ELISA) technique. Participant sociodemographic, clinical and risk factor data were collected using a structured questionnaire. Descriptive and inferential data analysis was conducted using Stata Version 11.2. Chi-square test was used to determine the association between seropositivity and various risk factors with a p-value ≤ 0.05 considered statistically significant. Logistic regression analysis was conducted for significant variables at the bivariate level. Of the 102 women enrolled, ___(46%) had T. gondii IgG antibodies. __ (27%) were aware of T. gondii transmission mechanisms and boiled water prior to consumption, 98% washed their hands during food preparation and after visiting the toilet, while 39.2% kept cats in their homesteads. __ (41.2%) were in their second trimester of pregnancy and ___(19%) had a history of abortion. Women aged 25–30 years had nearly five-fold significant risk (RR = 4.840 [95% CI; 0.699–23.297, p = 0.017) of having a T. gondii infection compared to their counterparts. Additional infection risks were seen among women who did not treat water were (RR = 2.801 [95% CI; 1.00-7.851]) and practiced farming (RR = 9.950 [95% CI; 0.691–8.197]). In conclusion, T. gondii is a highly prevalent pathogen among HIV infected pregnant women receiving antenatal care at AMPATH clinics in Uasin Gishu county. This study also highlights age, lack of water treatment and farming practices as significant risk factors for infection. There is need to institute risk reduction measures of factors associated with T. gondii infection. These include encouraging adequate cooking food to safe temperatures, avoiding direct contact with potentially infected soil or cat litter and treating water before use. Parasitology Toxoplasma gondii seroprevalence pregnancy HIV AMPATH Uasin Gishu County Western Kenya Introduction Toxoplasmosis, a disease associated with Toxoplasma gondii , a parasitic zoonotic infection, is a major cause of morbidity among both humans and animals. The causative pathogen, T. gondii , is an intracellular Apicomplexan protozoan parasite capable of infecting almost any cell type. This characteristic makes T. gondii one of the most ‘successful’ protozoan parasites on earth. In its life cycle, cats act as the definitive hosts while human beings the intermediate hosts 1 – 3 . The infection pathway for humans includes ingesting raw or undercooked meat, cat-shed oocysts left on contaminated soil, food and water, as well as through vertical (transplacental) transmission of tachyzoites. Although the clinical disease is seen in few cases, it is more serious among infected pregnant women and immune-compromised patients. Toxoplasmosis presents as an asymptomatic disease during the first few weeks after exposure, which could be followed by mild flu-like illness 4 – 6 . However, among the immunocompromised, such as HIV infected individuals or pregnant women, it is symptomatic causing serious illness that could be fatal 7 . Some of those infected could have encephalitis that present with neurological symptoms, affects the heart, liver, inner part of the ears and eyes 8 . Due to lack of systematically planned reporting of T. gondii infections, there is limited data from majority of the sub-Saharan African countries. For instance, from the findings of a study conducted in South Africa, the seroprevalence of T. gondii was estimated at 20% in a cohort of immune competent individuals (Samra et al. , 2007). Additionally, in a generalized cohort, the seroprevalence was estimated at 6.4% 9 . In a study conducted among immunocompromised individuals who were occupationally exposed to livestock (as abattoir or animal health workers and livestock keepers in Tanzania, the estimated prevalence of T. gondii was 45.7% 10 . In Uganda 11 , the estimated prevalence of T. gondii was 27% and between 32% 12 and 39.1% 13 (among slaughter house workers) in Kenya. In a number of studies reviewing the incidences of T. gondii among at risk HIV infected pregnant women and those within the reproductive age group 14 – 16 ,, the seroprevalence of T.gondii in Ethiopia 17 (88.2%)Burkina Faso 18 (62.5%), Ivory Coast (21%) and Zambia 19 . Since T. gondii infection is more pathogenic when acquired congenitally, there is need to determine the seroprevalence of toxoplasmosis among HIV infected pregnant women. The seroprevalence of T. gondii infection has been demonstrated to be higher in warm and humid areas, such as those in Western Kenya compared to regions with more temperate climate 20 . Additionally, some of the identified risk factors such as handling of free-range cats, improper handling and disposal of cat litter and consumption of untreated water is common in many Kenyan homes 21 , 22 . Furthermore, because Toxoplasmosis in pregnancy could increase the risk of spontaneous abortions, low birth weight newborns, congenital deformities and intrauterine deaths, there is need to document both the seroprevalence and the associated risk factors for T. gondii infection. Therefore, this study aimed to determine the sero-prevalence of T. gondii and associated risk factors among HIV infected pregnant women attending antenatal clinics comprehensive care centers in Kenya’s Uasin Gishu county. Methodology A descriptive cross-sectional study conducted among adult HIV-infected pregnant women attending the Academic Model Providing Access to Healthcare (AMPATH) centers’ antenatal clinics within Kenya’s Uasin Gishu county. Eligible participants were identified through systematic random sampling technique (k = 2), consented privately using a written informed consent form and their sociodemographic as well as clinical data collected using a pre-tested semi-structured questionnaire. 5 ml of venous whole blood was collected aseptically and the serum 13 . The clear sera was pippeted and aliquoted into Eppendoff™ tubes, labelled and tested for anti- T.gondii antibodies (IgG) using conventional ELISA assay. 10µl of serum sample was diluted using 1000 µl of sample diluent. The diluted specimen was incubated in T.gondii antigen-coated wells at 37 0 C for 1 hour. The wells were then washed with washing solution to remove residual test specimen. Enzyme-labeled antibodies to human IgG (conjugate) were then added. After another washing step to eliminate unbound antibodies an enzyme substrate solution containing a chromogen was added. The reaction was stopped using sulphuric acid after which the plates were read using an ELISA plate reader at 450 nm wavelength (DIALAB). A color change in the substrate was used as a qualitative indicator of the presence of anti- T.gondii IgG antibodies. Quality control was conducted by identifying a valid test if the absorbance of positive control ≥ 0.7 and absorbance of negative control ≤ 0.1, with a cut-off value 0.1 + mean absorbance of negative control replicates. The results obtained were keyed into the questionnaires. Data was then entered in a template created on Microsoft Excel (MS Excel®, Microsoft USA). Descriptive and inferential data analysis was conducted using Stata Version 11.2. Chi-square test was used to determine the association between seropositivity and various risk factors with a p-value ≤ 0.05 considered statistically significant. Logistic regression analysis was conducted for significant variables at the bivariate level. Ethical clearance was obtained from the Institutional Research and Ethics Committee (IREC) of Moi Teaching and Referral Hospital (MTRH) - approval number IREC/0001697. Results The study enrolled 102 women with a median age of 28 (IQR: 18–42) years attending three AMPATH centers in Burnt Forest, Turbo and Uasin Gishu county referral hospital. About half (47.1%) had attained secondary level of education while 63 (61.8%) were married (Table 1 ). Table 1 Participants’ sociodemographic characteristics AMPATH Centers Characteristic Overall Burnt Forest Turbo Uasin Gishu County Hospital Age group (years) 18–24 24(23.50%) 10(26.3) 9(28.1) 5(15.6) > 24–30 41(40.20%) 16(42.1) 10(31.3) 15(46.9) > 30–36 23(22.50%) 7(18.4) 8(25.0) 8(25.0) > 37–42 14(13.70%) 5(13.2) 5(15.6) 4(12.5) Level of Education Primary 24(23.5%) 11(28.9%) 11(34.4%) 2(6.3%) Secondary 48(47.1%) 19(50.0%) 12(37.5%) 17(53.1%) Tertiary 21(20.6%) 5(13.2%) 6(18.8%) 10(31.3%) None 9(8.8%) 3(7.9%) 3(9.4%) 3(9.4%) Marital status Married 63 (61.8%) 20 (52.6%) 19 (59.3%) 24(75.0%) Single 30 (29.4%) 12 (31.6%) 12 (37.5%) 6(18.8%) Divorced 9 (8.8%) 6 (16%) 1 (3.1%) 2(6.3%) Source of Income Supported 23(22.5%) 10 (26%) 8 (25%) 5(16%) Farming 21(20.6%) 8 (21%) 5 (16%) 8(25%) Employment 22(21.6%) 6 (16%) 4 (12%) 12(38%) Business 36(35.3%) 14 (37%) 15 (47%) 7(22%) The study reviewed a number of behavioural risk factors that could increase the risk of Toxoplasma gondii infections. These included lack of T. gondii awareness (73%), lack of boiling (32%) or treating (58%) water for consumption, handwashing after visiting the toilet (2%) or during food preparation (2%), vegetable washing (2%) presence of cats (39.2%) among others (Table 2 ). Table 2 Behavioural Risk factors for T. gondii and complications Parameter Overall AMPATH Centers Burnt Forest Turbo Uasin Gishu County Hospital T. gondii awareness No 74 (73%) 27 (71%) 26 (81%) 21 (66%) Yes 28 (27%) 11 (29%) 6 (19%) 11 (34%) Water boiling No 33 (32%) 12 (31%) 11 (34%) 10 (31%) Yes 69 (68%) 26 (69%) 22 (66%) 22 (69%) Water treatment No 59 (58%) 24 (63%) 17 (53%) 18 (56%) Yes 43 (42%) 14 (37%) 15 (47%) 14 (44%) Handwashing after visiting toilet No 2 (2%) 0 1 (3%) 1 (3%) Yes 100 (98%) 38 (100%) 31 (97%) 31 (97%) Handwashing during food preparation No 2 (2%) 0 2 (6%) 0 Yes 100 (98%) 38 (100%) 30 (94%) 32 (100%) Vegetable washing No 2(2%) 0 2 (6.3%) 0 Yes 100(98%) 38 (100%) 30 (93.8%) 32 (100%) Presence of cats No 62(60.8%) 25 (66%) 21(66%) 16(50%) Yes 40(39.2%) 1 (34%) 11 (34%) 16 (50%) Meat consumption frequency Never 5(5%) 3 (8%) 2 (6%) 0 Rarely 61 (60%) 23 (60%) 19 (60%) 19 (59%) Frequently 36(35%) 12 (31%) 11 (34%) 13 (41%) Meat preference None 5 (5%) 3 (8%) 2 (6%) 0 Beef 41 (40%) 17 (45%) 10 (31%) 14 (44%) Chicken 18 (18%) 6 (16%) 5 (16%) 7 (22%) Mutton 10 (10%) 4 (11%) 1 (3%) 5 (15%) Pork 2 (2%) 0 2 (6%) 0 Fish 26 (25%) 8 (21%) 12 (38%) 6 (18%) Milk preparation Not boiled 1 (1%) 0 1 (3%) 0 Boiled 101 (99%) 38 (100%) 31 (97%) 32 (100%) Source of water Borehole 55 (53.9%) 20 (52.63%) 19 (59.4%) 16 (50%) Tap water 43 (42.2%) 17 (44.8%) 13(40.6%) 13 (41%) Well 4 (3.9%) 1 (2.63%) 0 3 (9%) Distance to water source 0–1 Km 99 (97%) 36 (95%) 31 (97%) 32 (100%) > 1 Km 3 (3%) 2 (5%) 1 (3%) 0 Pregnancy trimester First 41 (40.2%) 17 (44.7%) 14 (43.8%) 10 (31.2%) Second 42 (41.2%) 13 (34.2%) 14 (43.8%) 15 (46.9%) Third 19 (18.6%) 8 (21%) 4 (12.5%) 7 (21.9%) Abortion 83(81%) 29(76%) 28 (87%) 26 (81%) 19(19%) 9 (24%) 4 (13%) 6 (19%) Lastly, this study reports that participants who lacked the ability to treat their water were three times (OR = 3.024; 95% CI: 0.900, 14.306) more likely to have Toxoplasma gondii infections. Furthermore, women with a history of abortion had a four-fold (OR = 4.264, 95% CI: 1.129, 13.754) increased likelihood to have a T. gondii infection. These two relationships were statistically significant (Table 3 ). Table 3 Factors Associated with T. gondii infection. Factor OR (95% CI) p-value T. gondii awareness 0.528 (0.134, 1.671) 0.245 Water boiling 1.217 (0.501, 4.161) 0.496 Lack of Water treatment 3.024 (0.900, 14.306) 0.040 Hand washing before food preparation 0.595 (0.013, 19.693) 0.717 Vegetable washing 1.212 (0.024, 39.208) 0.990 Presence of cats 1.729 (0.439, 4.750) 0.546 Frequent meat consumption 2.492 (0.201, 48.712) 0.416 Pork meat preference 0.442 (0.007, 8.560) 0.442 Source of water (underground well) 4.600 (0.234, 90.448) 0.315 Distance to water source (> 1 km) 0.973 (0.037, 4.746) 0.933 Third trimester of pregnancy 0.717 (0.188, 3.003) 0.685 History of Abortion 4.264 (1.129, 13.754) 0.032 Discussion Toxoplasma gondii seroprevalence and its associated risk factors within the global population has over the years received more exploration from scholars 23 – 27 . Proportions greater than 30% were reported in a four year (2013–2017) retrospective study conducted in Southern Italy 28 . Although T. gondii infection in more than 80% of immunocompetent population is majorly asymptomatic, primary infection during pregnancy can result to placental cross infection (congenital toxoplasmosis) which is highly associated with fetal morbidity 29 . Therefore, understanding T. gondii prevalence and its associated risks in immunocompromised expectant population such as HIV infected pregnant women is key in managing fetal health and reducing cases of abortion and still births. T. gondii seroprevalence as confirmed in the available literature is significantly associated with hygiene levels, meat consumption, socioeconomic and sociodemographic factors, and, educational levels 28 , 30 . This study is the first to report the local prevalence of T. gondii among HIV positive pregnant women attending antenatal Clinic in Uasin Gishu County in Western Kenya. Women in Uasin Gishu County regardless of their HIV status like in many African countries are responsible for taking care of their homes and families 30 . These tasks expose them to the associated T. gondii risk factors such as cats’ feces, raw meat and farm fresh vegetables and fruits which exposes them to the horizontal transmission of T. gondii 28 . In this study, the cumulative sero-prevalence of T. gondii among the HIV positive pregnant women in the three selected AMPATH clinics was 46%. This finding is close to that reported in West Africa’s at 52% 31 . However, higher prevalence of 88.2% was reported in Ethiopia 32 . From the findings in South Italy, the authors 28 explained that T. gondii prevalence difference among non-pregnant people living with HIV and their pregnant counterparts could be due to the fact that pregnant women are often put on an enhanced dietary and hygiene training programs in antenatal clinics. On the other hand, a systematic review and meta-analysis conducted in Iran reported a T. gondii prevalence of between 7–51.3% in pregnant women irrespective of their immune status 33 . Countries such as France which operate a congenital toxoplasmosis surveillance program which has shown a continuous decline in T. gondii prevalence in pregnant women 34 – 36 . Secondly, the study assessed the hypothesized risks of T. gondii infections among HIV positive pregnant women. We report that most participants did not have direct access to water and had to walk over a kilometer to access water or rely on boreholes for household water use. This raised a challenge in water treatment as very few treated water before consumption. Furthermore, majority of the participants did not practice meat preservation while a lower proportion of the respondents were found to have cats. The fact that cats exist closely with humans, could explain environmental oocyst contamination 37 , 38 . Although rearing of cats was an insignificant risk factor of T. gondii prevalence among HIV positive pregnant women, cats in Kenyan homes receive little or no veterinary care to control gastrointestinal parasites such as Toxocara spp which is responsible for T. gondii infection 39 . Cats in most Kenyan homes are kept free range and are able to access feed stores and grazing areas causing oocyst transmission to livestock 30 . High T. gondii contamination levels in the soil are reported in livestock and poultry farms as well as school playing grounds 40 . Although oocysts are only deposited on land as a result of the hosts being land animals, the prevalence of T. gondii in aquatic and marine life significantly highlight the role of waterborne transmission 37 . In this study, majority of HIV positive pregnant women lacked awareness of T. gondii risk factors and failed to practice the vital primary infection control measures such as meat preservation, water treatment and washing hands before and after meal preparations. This could have highly increased their chances of infection. In the present study, age of respondents, a sociodemographic characteristic was proven as a significant factor for T. gondii prevalence amongst HIV positive pregnant women. A different study 28 reported the influence of age in T.gondii seroprevalence amongst pregnant women; in this study, the age group 24–30 which constitutes the highly reproductive years showed significant association with T. gondii infection. In this study, source of income was a socioeconomic factor significantly proven to affect T. gondii seroprevalence in HIV positive pregnant women. Immunocompromised HIV positive pregnant women who undertook farming as their primary income source were highly at risk to T. gondii infection compared to their counterparts in business and lastly those employed were insignificantly at risk of infection. No occupation outside home and living in suburban areas characterized with low-income individuals demonstrated higher T. gondii prevalence 41 . Majority of Kenyan farmers practice mixed farming coupled with the use of compost manure due to its low cost and relative availability in order to combat food security 30 . There are chances compost manure mixed with cats’ fecal matter exposing HIV positive pregnant women direly to these parasite, thus increased chances of infection. In this present study, history of abortion was associated with T.gondii seropositivity. This finding corroborated that of a study 33 which reported that anti- T.gondii lgG antibodies seroprevalence in women with history of abortion was higher than those with present abortion. Conclusions and Recommendations Nearly half of HIV positive pregnant women attending AMPATH antenatal clinics in Uasin Gishu County in Western Kenya enrolled in this study had an infection of Toxoplasmosis. This study also highlights age, lack of water treatment and farming practices as significant risk factors for infection. Toxoplasmosis remains a neglected tropical disease in Kenya as suggested by the minimal level of awareness in the study area. There is need to institute risk reduction measures of factors associated with T. gondii infection. These include encouraging adequate cooking food to safe temperatures, avoiding direct contact with potentially infected soil or cat litter and treating water before use. Declarations Conflict of Interest The authors declare no conflict of interest in this study. Authors Contributions All the authors contributed equally in this study. Acknowledgements We would like to thank all the study’s participants. Secondly, we thank the management of AMPATH for allowing us to access their satellite clinics. Lastly, the management of Kenya Medical Research Institute (KEMRI) and Jomo Kenyatta University of Agriculture and Technology. References Dubey JP (2008) The History of Toxoplasma gondii—The First 100 Years. J Eukaryot Microbiol 55:467–475 Dubey JP, Jones JL (2008) Toxoplasma gondii infection in humans and animals in the United States. Int J Parasitol 38:1257–1278 Dubey JP, Jones JL (2008) Toxoplasma gondii infection in humans and animals in the United States. Int J Parasitol 38:1257–1278 Jones JL, Dubey JP (2010) Waterborne toxoplasmosis - Recent developments. 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PLoS ONE 17 Shapiro K et al (2019) Environmental transmission of Toxoplasma gondii: Oocysts in water, soil and food. Food Waterborne Parasitol 15 Zhu S, VanWormer E, Shapiro K (2023) More people, more cats, more parasites: Human population density and temperature variation predict prevalence of Toxoplasma gondii oocyst shedding in free-ranging domestic and wild felids. PLoS ONE 18 Njuguna A et al (2022) Isolation and Cryopreservation of Toxoplasma gondii Isolates from Cats and Chickens from Selected Households in the Thika Region, Kenya. J Appl Life Sci Int 18–24. 10.9734/JALSI/2022/V25I330290 Cong W et al (2020) Prevalence, risk factors and genotype distribution of Toxoplasma gondii DNA in soil in China. Ecotoxicol Environ Saf 189:109999 Mareze M et al (2019) Socioeconomic vulnerability associated to Toxoplasma gondii exposure in southern Brazil. PLoS ONE 14:e0212375 Additional Declarations The authors declare no competing interests. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4659431","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":320577602,"identity":"e8fd10f4-1096-4f42-a235-c49cbc5a8bca","order_by":0,"name":"Maureen Kurere","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAElEQVRIiWNgGAWjYBACCRTeBwMbIMnYeIBoLYwzKtJAVAPxWph5zhwGM/BqkZyR+/BxRcU2eYPbZ8we87adt1vbfhhoS41NNC4t0hLpxoZnztw23HAux9xwbtvt5G1nEoFajqXlNuDQIieRxibZ2HabccMZHjOJt0AtZgeAWhgbDuPTwv6z8d9te7AW3rZzyWbnH+LXIg20hbGx4XYiSIskz5kDdmY3CNgi2fOMWbLh2O3kmWfYyiRnVCQnmN0A2pKAxy8Sx9MYPzbU3LbtO8O8TeKDgZ292fn0hw8+1Njg1IIEOAxAZCJYZQJh5SDA/gBE2hOneBSMglEwCkYSAADNUWWgQtPj/AAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0009-0008-7454-7582","institution":"Jomo Kenyatta University of Agricultural Technology","correspondingAuthor":true,"prefix":"","firstName":"Maureen","middleName":"","lastName":"Kurere","suffix":""},{"id":320577603,"identity":"f0149dce-3871-4c30-84b6-f560911e4183","order_by":1,"name":"Charles Mwandawiro","email":"","orcid":"https://orcid.org/0000-0001-8175-3749","institution":"Eastern and Southern Africa Centre of International Parasite Control (ESACIPAC) - Kenya Medical Research Institute – Nairobi-Kenya.","correspondingAuthor":false,"prefix":"","firstName":"Charles","middleName":"","lastName":"Mwandawiro","suffix":""},{"id":320577604,"identity":"a052d861-e0c8-4ac5-a872-e98ffb30a283","order_by":2,"name":"John M. Kagira","email":"","orcid":"https://orcid.org/0000-0001-5513-2113","institution":"Department of Animal Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.","correspondingAuthor":false,"prefix":"","firstName":"John","middleName":"M.","lastName":"Kagira","suffix":""},{"id":320577605,"identity":"986978f6-0b98-4ed1-984e-f8285c8a93a0","order_by":3,"name":"Simon Karanja","email":"","orcid":"https://orcid.org/0000-0002-7584-4254","institution":"School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya","correspondingAuthor":false,"prefix":"","firstName":"Simon","middleName":"","lastName":"Karanja","suffix":""}],"badges":[],"createdAt":"2024-06-29 13:07:40","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-4659431/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4659431/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":59476606,"identity":"ae753c55-f825-4301-9682-1cd0c8dae0b2","added_by":"auto","created_at":"2024-07-02 09:02:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":575790,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4659431/v1/e735d247-4536-490e-ad51-d6f842bbc1da.pdf"},{"id":59476055,"identity":"5f29566f-30c1-48f1-8d1e-83ad6a6f04df","added_by":"auto","created_at":"2024-07-02 08:54:16","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":61128,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterial1.docx","url":"https://assets-eu.researchsquare.com/files/rs-4659431/v1/250759d950d73a62832dafb6.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eSeroprevalence and Associated Risk Factors for Toxoplasma Gondii Among HIV Positive Pregnant Women Attending Antenatal Clinics in Uasin Gishu County - Kenya.\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eToxoplasmosis, a disease associated with \u003cem\u003eToxoplasma gondii\u003c/em\u003e, a parasitic zoonotic infection, is a major cause of morbidity among both humans and animals. The causative pathogen, \u003cem\u003eT. gondii\u003c/em\u003e, is an intracellular Apicomplexan protozoan parasite capable of infecting almost any cell type. This characteristic makes \u003cem\u003eT. gondii\u003c/em\u003e one of the most \u0026lsquo;successful\u0026rsquo; protozoan parasites on earth. In its life cycle, cats act as the definitive hosts while human beings the intermediate hosts \u003csup\u003e\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. The infection pathway for humans includes ingesting raw or undercooked meat, cat-shed oocysts left on contaminated soil, food and water, as well as through vertical (transplacental) transmission of tachyzoites. Although the clinical disease is seen in few cases, it is more serious among infected pregnant women and immune-compromised patients. Toxoplasmosis presents as an asymptomatic disease during the first few weeks after exposure, which could be followed by mild flu-like illness\u003csup\u003e\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. However, among the immunocompromised, such as HIV infected individuals or pregnant women, it is symptomatic causing serious illness that could be fatal \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. Some of those infected could have encephalitis that present with neurological symptoms, affects the heart, liver, inner part of the ears and eyes\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Due to lack of systematically planned reporting of \u003cem\u003eT. gondii\u003c/em\u003e infections, there is limited data from majority of the sub-Saharan African countries. For instance, from the findings of a study conducted in South Africa, the seroprevalence of T. gondii was estimated at 20% in a cohort of immune competent individuals (Samra \u003cem\u003eet al.\u003c/em\u003e, 2007). Additionally, in a generalized cohort, the seroprevalence was estimated at 6.4%\u003csup\u003e9\u003c/sup\u003e. In a study conducted among immunocompromised individuals who were occupationally exposed to livestock (as abattoir or animal health workers and livestock keepers in Tanzania, the estimated prevalence of T. gondii was 45.7%\u003csup\u003e10\u003c/sup\u003e. In Uganda\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e, the estimated prevalence of T. gondii was 27% and between 32%\u003csup\u003e12\u003c/sup\u003eand 39.1%\u003csup\u003e13\u003c/sup\u003e (among slaughter house workers) in Kenya.\u003c/p\u003e \u003cp\u003eIn a number of studies reviewing the incidences of \u003cem\u003eT. gondii\u003c/em\u003e among at risk HIV infected pregnant women and those within the reproductive age group\u003csup\u003e\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e,, the seroprevalence of \u003cem\u003eT.gondii\u003c/em\u003e in Ethiopia\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e (88.2%)Burkina Faso\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e (62.5%), Ivory Coast (21%) and Zambia\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSince \u003cem\u003eT. gondii\u003c/em\u003e infection is more pathogenic when acquired congenitally, there is need to determine the seroprevalence of toxoplasmosis among HIV infected pregnant women.\u003c/p\u003e \u003cp\u003eThe seroprevalence of T. gondii infection has been demonstrated to be higher in warm and humid areas, such as those in Western Kenya compared to regions with more temperate climate\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. Additionally, some of the identified risk factors such as handling of free-range cats, improper handling and disposal of cat litter and consumption of untreated water is common in many Kenyan homes\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. Furthermore, because Toxoplasmosis in pregnancy could increase the risk of spontaneous abortions, low birth weight newborns, congenital deformities and intrauterine deaths, there is need to document both the seroprevalence and the associated risk factors for \u003cem\u003eT. gondii\u003c/em\u003e infection. Therefore, this study aimed to determine the sero-prevalence of \u003cem\u003eT. gondii\u003c/em\u003e and associated risk factors among HIV infected pregnant women attending antenatal clinics comprehensive care centers in Kenya\u0026rsquo;s Uasin Gishu county.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eA descriptive cross-sectional study conducted among adult HIV-infected pregnant women attending the Academic Model Providing Access to Healthcare (AMPATH) centers\u0026rsquo; antenatal clinics within Kenya\u0026rsquo;s Uasin Gishu county. Eligible participants were identified through systematic random sampling technique (k\u0026thinsp;=\u0026thinsp;2), consented privately using a written informed consent form and their sociodemographic as well as clinical data collected using a pre-tested semi-structured questionnaire. 5 ml of venous whole blood was collected aseptically and the serum\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. The clear sera was pippeted and aliquoted into Eppendoff\u0026trade; tubes, labelled and tested for anti-\u003cem\u003eT.gondii\u003c/em\u003e antibodies (IgG) using conventional ELISA assay. 10\u0026micro;l of serum sample was diluted using 1000 \u0026micro;l of sample diluent. The diluted specimen was incubated in \u003cem\u003eT.gondii\u003c/em\u003e antigen-coated wells at 37\u003csup\u003e0\u003c/sup\u003eC for 1 hour. The wells were then washed with washing solution to remove residual test specimen. Enzyme-labeled antibodies to human IgG (conjugate) were then added. After another washing step to eliminate unbound antibodies an enzyme substrate solution containing a chromogen was added. The reaction was stopped using sulphuric acid after which the plates were read using an ELISA plate reader at 450 nm wavelength (DIALAB). A color change in the substrate was used as a qualitative indicator of the presence of anti-\u003cem\u003eT.gondii\u003c/em\u003e IgG antibodies. Quality control \u003cb\u003ewas conducted by identifying a valid test if the\u003c/b\u003e absorbance of positive control\u0026thinsp;\u0026ge;\u0026thinsp;0.7 and absorbance of negative control\u0026thinsp;\u0026le;\u0026thinsp;0.1, with a cut-off value 0.1\u0026thinsp;+\u0026thinsp;mean absorbance of negative control replicates. The results obtained were keyed into the questionnaires.\u003c/p\u003e \u003cp\u003eData was then entered in a template created on Microsoft Excel (MS Excel\u0026reg;, Microsoft USA). Descriptive and inferential data analysis was conducted using Stata Version 11.2. Chi-square test was used to determine the association between seropositivity and various risk factors with a p-value\u0026thinsp;\u0026le;\u0026thinsp;0.05 considered statistically significant. Logistic regression analysis was conducted for significant variables at the bivariate level. Ethical clearance was obtained from the Institutional Research and Ethics Committee (IREC) of Moi Teaching and Referral Hospital (MTRH) - approval number IREC/0001697.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe study enrolled 102 women with a median age of 28 (IQR: 18\u0026ndash;42) years attending three AMPATH centers in Burnt Forest, Turbo and Uasin Gishu county referral hospital. About half (47.1%) had attained secondary level of education while 63 (61.8%) were married (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipants\u0026rsquo; sociodemographic characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003eAMPATH Centers\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBurnt Forest\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTurbo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUasin Gishu County Hospital\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eAge group (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24(23.50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(26.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9(28.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5(15.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;24\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41(40.20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16(42.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10(31.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15(46.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;30\u0026ndash;36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23(22.50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7(18.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8(25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8(25.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;37\u0026ndash;42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14(13.70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(13.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5(15.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4(12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eLevel of Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24(23.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11(28.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11(34.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2(6.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48(47.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19(50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12(37.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17(53.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21(20.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(13.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6(18.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10(31.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9(8.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(7.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3(9.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3(9.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63 (61.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (52.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19 (59.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e24(75.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30 (29.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (31.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 (37.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6(18.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (8.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (3.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2(6.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eSource of Income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSupported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23(22.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5(16%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFarming\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21(20.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8(25%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22(21.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12(38%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBusiness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36(35.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (37%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 (47%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7(22%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe study reviewed a number of behavioural risk factors that could increase the risk of Toxoplasma gondii infections. These included lack of T. gondii awareness (73%), lack of boiling (32%) or treating (58%) water for consumption, handwashing after visiting the toilet (2%) or during food preparation (2%), vegetable washing (2%) presence of cats (39.2%) among others (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBehavioural Risk factors for \u003cem\u003eT. gondii\u003c/em\u003e and complications\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c7\" namest=\"c4\"\u003e \u003cp\u003eAMPATH Centers\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eBurnt Forest\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eTurbo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eUasin Gishu County Hospital\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eT. gondii\u003c/em\u003e awareness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74 (73%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26 (81%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21 (66%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (27%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11 (34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eWater boiling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10 (31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69 (68%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (69%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22 (66%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22 (69%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eWater treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59 (58%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17 (53%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18 (56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (42%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (37%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 (47%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14 (44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHandwashing after visiting toilet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100 (98%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31 (97%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31 (97%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHandwashing during food preparation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100 (98%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30 (94%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVegetable washing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (6.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100(98%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30 (93.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePresence of cats\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62(60.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (66%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21(66%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16(50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40(39.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMeat consumption frequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRarely\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61 (60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19 (60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19 (59%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequently\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36(35%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13 (41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eMeat preference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBeef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14 (44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChicken\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMutton\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePork\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 (38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 (18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMilk preparation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot boiled\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBoiled\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101 (99%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31 (97%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSource of water\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBorehole\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55 (53.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (52.63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19 (59.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTap water\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (42.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (44.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13(40.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13 (41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWell\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (3.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDistance to water source\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;1 Km\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99 (97%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (95%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31 (97%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;1 Km\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePregnancy trimester\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (40.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (44.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14 (43.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10 (31.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecond\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (41.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (34.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14 (43.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15 (46.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThird\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (18.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (12.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7 (21.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAbortion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83(81%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29(76%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (87%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26 (81%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19(19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eLastly, this study reports that participants who lacked the ability to treat their water were three times (OR\u0026thinsp;=\u0026thinsp;3.024; 95% CI: 0.900, 14.306) more likely to have Toxoplasma gondii infections. Furthermore, women with a history of abortion had a four-fold (OR\u0026thinsp;=\u0026thinsp;\u003cb\u003e4.264, 95% CI: 1.129, 13.754)\u003c/b\u003e increased likelihood to have a \u003cem\u003eT. gondii\u003c/em\u003e infection. These two relationships were statistically significant (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFactors Associated with \u003cem\u003eT. gondii\u003c/em\u003e infection.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eT. gondii\u003c/em\u003e awareness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.528 (0.134, 1.671)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.245\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWater boiling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.217 (0.501, 4.161)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.496\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of Water treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e3.024 (0.900, 14.306)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.040\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHand washing before food preparation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.595 (0.013, 19.693)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.717\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVegetable washing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.212 (0.024, 39.208)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.990\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresence of cats\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.729 (0.439, 4.750)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.546\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrequent meat consumption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.492 (0.201, 48.712)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.416\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePork meat preference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.442 (0.007, 8.560)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.442\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSource of water (underground well)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.600 (0.234, 90.448)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.315\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDistance to water source (\u0026gt;\u0026thinsp;1 km)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.973 (0.037, 4.746)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.933\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThird trimester of pregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.717 (0.188, 3.003)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.685\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of Abortion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e4.264 (1.129, 13.754)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.032\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e \u003cem\u003eToxoplasma gondii\u003c/em\u003e seroprevalence and its associated risk factors within the global population has over the years received more exploration from scholars\u003csup\u003e\u003cspan additionalcitationids=\"CR24 CR25 CR26\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. Proportions greater than 30% were reported in a four year (2013\u0026ndash;2017) retrospective study conducted in Southern Italy\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. Although \u003cem\u003eT. gondii\u003c/em\u003e infection in more than 80% of immunocompetent population is majorly asymptomatic, primary infection during pregnancy can result to placental cross infection (congenital toxoplasmosis) which is highly associated with fetal morbidity\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. Therefore, understanding \u003cem\u003eT. gondii\u003c/em\u003e prevalence and its associated risks in immunocompromised expectant population such as HIV infected pregnant women is key in managing fetal health and reducing cases of abortion and still births. \u003cem\u003eT. gondii\u003c/em\u003e seroprevalence as confirmed in the available literature is significantly associated with hygiene levels, meat consumption, socioeconomic and sociodemographic factors, and, educational levels\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e,\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis study is the first to report the local prevalence of \u003cem\u003eT. gondii\u003c/em\u003e among HIV positive pregnant women attending antenatal Clinic in Uasin Gishu County in Western Kenya. Women in Uasin Gishu County regardless of their HIV status like in many African countries are responsible for taking care of their homes and families\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. These tasks expose them to the associated \u003cem\u003eT. gondii\u003c/em\u003e risk factors such as cats\u0026rsquo; feces, raw meat and farm fresh vegetables and fruits which exposes them to the horizontal transmission of \u003cem\u003eT. gondii\u003c/em\u003e \u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn this study, the cumulative sero-prevalence of \u003cem\u003eT. gondii\u003c/em\u003e among the HIV positive pregnant women in the three selected AMPATH clinics was 46%. This finding is close to that reported in West Africa\u0026rsquo;s at 52%\u003csup\u003e31\u003c/sup\u003e. However, higher prevalence of 88.2% was reported in Ethiopia\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. From the findings in South Italy, the authors\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e explained that \u003cem\u003eT. gondii\u003c/em\u003e prevalence difference among non-pregnant people living with HIV and their pregnant counterparts could be due to the fact that pregnant women are often put on an enhanced dietary and hygiene training programs in antenatal clinics. On the other hand, a systematic review and meta-analysis conducted in Iran reported a \u003cem\u003eT. gondii\u003c/em\u003e prevalence of between 7\u0026ndash;51.3% in pregnant women irrespective of their immune status\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e. Countries such as France which operate a congenital toxoplasmosis surveillance program which has shown a continuous decline in \u003cem\u003eT. gondii\u003c/em\u003e prevalence in pregnant women\u003csup\u003e\u003cspan additionalcitationids=\"CR35\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSecondly, the study assessed the hypothesized risks of \u003cem\u003eT. gondii\u003c/em\u003e infections among HIV positive pregnant women. We report that most participants did not have direct access to water and had to walk over a kilometer to access water or rely on boreholes for household water use. This raised a challenge in water treatment as very few treated water before consumption. Furthermore, majority of the participants did not practice meat preservation while a lower proportion of the respondents were found to have cats. The fact that cats exist closely with humans, could explain environmental oocyst contamination\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e,\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e. Although rearing of cats was an insignificant risk factor of \u003cem\u003eT. gondii\u003c/em\u003e prevalence among HIV positive pregnant women, cats in Kenyan homes receive little or no veterinary care to control gastrointestinal parasites such as \u003cem\u003eToxocara\u003c/em\u003e spp which is responsible for \u003cem\u003eT. gondii\u003c/em\u003e infection \u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e. Cats in most Kenyan homes are kept free range and are able to access feed stores and grazing areas causing oocyst transmission to livestock\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. High \u003cem\u003eT. gondii\u003c/em\u003e contamination levels in the soil are reported in livestock and poultry farms as well as school playing grounds\u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e. Although oocysts are only deposited on land as a result of the hosts being land animals, the prevalence of \u003cem\u003eT. gondii\u003c/em\u003e in aquatic and marine life significantly highlight the role of waterborne transmission\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e. In this study, majority of HIV positive pregnant women lacked awareness of \u003cem\u003eT. gondii\u003c/em\u003e risk factors and failed to practice the vital primary infection control measures such as meat preservation, water treatment and washing hands before and after meal preparations. This could have highly increased their chances of infection.\u003c/p\u003e \u003cp\u003eIn the present study, age of respondents, a sociodemographic characteristic was proven as a significant factor for \u003cem\u003eT. gondii\u003c/em\u003e prevalence amongst HIV positive pregnant women. A different study\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e reported the influence of age in \u003cem\u003eT.gondii\u003c/em\u003e seroprevalence amongst pregnant women; in this study, the age group 24\u0026ndash;30 which constitutes the highly reproductive years showed significant association with \u003cem\u003eT. gondii\u003c/em\u003e infection. In this study, source of income was a socioeconomic factor significantly proven to affect \u003cem\u003eT. gondii\u003c/em\u003e seroprevalence in HIV positive pregnant women. Immunocompromised HIV positive pregnant women who undertook farming as their primary income source were highly at risk to \u003cem\u003eT. gondii\u003c/em\u003e infection compared to their counterparts in business and lastly those employed were insignificantly at risk of infection. No occupation outside home and living in suburban areas characterized with low-income individuals demonstrated higher \u003cem\u003eT. gondii\u003c/em\u003e prevalence\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e. Majority of Kenyan farmers practice mixed farming coupled with the use of compost manure due to its low cost and relative availability in order to combat food security\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. There are chances compost manure mixed with cats\u0026rsquo; fecal matter exposing HIV positive pregnant women direly to these parasite, thus increased chances of infection. In this present study, history of abortion was associated with \u003cem\u003eT.gondii\u003c/em\u003e seropositivity. This finding corroborated that of a study\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e which reported that anti-\u003cem\u003eT.gondii\u003c/em\u003e lgG antibodies seroprevalence in women with history of abortion was higher than those with present abortion.\u003c/p\u003e"},{"header":"Conclusions and Recommendations","content":"\u003cp\u003eNearly half of HIV positive pregnant women attending AMPATH antenatal clinics in Uasin Gishu County in Western Kenya enrolled in this study had an infection of Toxoplasmosis. This study also highlights age, lack of water treatment and farming practices as significant risk factors for infection. Toxoplasmosis remains a neglected tropical disease in Kenya as suggested by the minimal level of awareness in the study area. There is need to institute risk reduction measures of factors associated with \u003cem\u003eT. gondii\u003c/em\u003e infection. These include encouraging adequate cooking food to safe temperatures, avoiding direct contact with potentially infected soil or cat litter and treating water before use.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eConflict of Interest\u003c/h2\u003e\n\u003cp\u003eThe authors declare no conflict of interest in this study.\u003c/p\u003e\n\u003ch2\u003eAuthors Contributions\u003c/h2\u003e\n\u003cp\u003eAll the authors contributed equally in this study.\u003c/p\u003e\n\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eWe would like to thank all the study\u0026rsquo;s participants. Secondly, we thank the management of AMPATH for allowing us to access their satellite clinics. Lastly, the management of Kenya Medical Research Institute (KEMRI) and Jomo Kenyatta University of Agriculture and Technology.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDubey JP (2008) The History of Toxoplasma gondii\u0026mdash;The First 100 Years. J Eukaryot Microbiol 55:467\u0026ndash;475\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDubey JP, Jones JL (2008) Toxoplasma gondii infection in humans and animals in the United States. Int J Parasitol 38:1257\u0026ndash;1278\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDubey JP, Jones JL (2008) Toxoplasma gondii infection in humans and animals in the United States. Int J Parasitol 38:1257\u0026ndash;1278\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJones JL, Dubey JP (2010) Waterborne toxoplasmosis - Recent developments. 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PLoS ONE 14:e0212375\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Jomo Kenyatta University of Agriculture and Technology","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Toxoplasma gondii, seroprevalence, pregnancy, HIV, AMPATH, Uasin Gishu County, Western Kenya","lastPublishedDoi":"10.21203/rs.3.rs-4659431/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4659431/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e \u003cem\u003eToxoplasma gondii\u003c/em\u003e is an intracellular Apicomplexan protozoan parasite that infects humans who ingest raw or undercooked meat or congenitally by trans-placental transmission. Immunocompromised patients are at risk of contracting \u003cem\u003eT. gondii\u003c/em\u003e which can be fatal if not promptly treated. This study determined the seroprevalence of \u003cem\u003eT. gondii\u003c/em\u003e and its associated risk factors among HIV infected pregnant women. We enrolled pregnant, HIV positive women aged 18 years and above from the antenatal clinics of Academic Model Providing Access to Healthcare Program (AMPATH) centers within Uasin Gishu County, Kenya. Blood samples from the women were collected aseptically, transported to the immunology laboratory and screened for anti-\u003cem\u003eT. gondii\u003c/em\u003e IgG antibodies using the enzyme linked immunosorbent assay (ELISA) technique. Participant sociodemographic, clinical and risk factor data were collected using a structured questionnaire. Descriptive and inferential data analysis was conducted using Stata Version 11.2. Chi-square test was used to determine the association between seropositivity and various risk factors with a p-value\u0026thinsp;\u0026le;\u0026thinsp;0.05 considered statistically significant. Logistic regression analysis was conducted for significant variables at the bivariate level. Of the 102 women enrolled, ___(46%) had \u003cem\u003eT. gondii IgG\u003c/em\u003e antibodies. __ (27%) were aware of \u003cem\u003eT. gondii\u003c/em\u003e transmission mechanisms and boiled water prior to consumption, 98% washed their hands during food preparation and after visiting the toilet, while 39.2% kept cats in their homesteads. __ (41.2%) were in their second trimester of pregnancy and ___(19%) had a history of abortion. Women aged 25\u0026ndash;30 years had nearly five-fold significant risk (RR\u0026thinsp;=\u0026thinsp;4.840 [95% CI; 0.699\u0026ndash;23.297, p\u0026thinsp;=\u0026thinsp;0.017) of having a \u003cem\u003eT. gondii\u003c/em\u003e infection compared to their counterparts. Additional infection risks were seen among women who did not treat water were (RR\u0026thinsp;=\u0026thinsp;2.801 [95% CI; 1.00-7.851]) and practiced farming (RR\u0026thinsp;=\u0026thinsp;9.950 [95% CI; 0.691\u0026ndash;8.197]). In conclusion, \u003cem\u003eT. gondii\u003c/em\u003e is a highly prevalent pathogen among HIV infected pregnant women receiving antenatal care at AMPATH clinics in Uasin Gishu county. This study also highlights age, lack of water treatment and farming practices as significant risk factors for infection. There is need to institute risk reduction measures of factors associated with \u003cem\u003eT. gondii\u003c/em\u003e infection. These include encouraging adequate cooking food to safe temperatures, avoiding direct contact with potentially infected soil or cat litter and treating water before use.\u003c/p\u003e","manuscriptTitle":"Seroprevalence and Associated Risk Factors for Toxoplasma Gondii Among HIV Positive Pregnant Women Attending Antenatal Clinics in Uasin Gishu County - Kenya.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-02 08:54:11","doi":"10.21203/rs.3.rs-4659431/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6aac41e9-fb24-4540-956e-6b5fe3f0a14a","owner":[],"postedDate":"July 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":33999557,"name":"Parasitology"}],"tags":[],"updatedAt":"2024-07-12T07:36:09+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-02 08:54:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4659431","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4659431","identity":"rs-4659431","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}
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