Evaluation of the level of awareness of congenital toxoplasmosis and associated practices among pregnant women and health workers in Tanzania's Temeke District
Toxoplasmosis is a zoonotic disease caused by an intracellular obligate coccidian protozoan called Toxoplasma gondii. The parasite infects all warm blooded animals and usually develops in immune-compromised hosts. The risk groups are pregnant women, children and HIV/AIDS patients. Congenitally infected foetuses and children may develop serious clinical outcomes including psychomotor and ocular disorders. In Tanzania, prevalence studies have shown an increase in the level of infection due to toxoplasmosis in the communities while the information on the level of awareness and practices of pregnant women and health workers in regard to toxoplasmosis has not been established. A cross-sectional study was carried out to assess the awareness and practices towards congenital toxoplasmosis among 371 pregnant women and 22 health workers from six healthcare facilities in Temeke municipality of Dar es Salaam, Tanzania. A structured questionnaire and review of prenatal screening forms were used to collect information during the study. The questionnaire focused on disease aetiology, signs and symptoms, modes of transmission, treatment and management, the antenatal cards/ the screening forms bearing pregnant women demographics and clinical records were reviewed. Of the pregnant women studied, 96% (95%, C.I 94-98%) were unaware of the diseases, had never heard, read or seen any information regarding toxoplasmosis. Majority of respondents including those who had heard read or seen information concerning toxoplasmosis were unaware of aetiology, signs and symptoms. However, the respondents unknowingly observed preventive practices towards the disease including avoiding eating raw, cured or rare meat 90% (95%, C.I 86–93%). There was a significant statistical relationship between practices towards toxoplasmosis and age of pregnant women, for every increase in age by ten years the practices towards toxoplasmosis increased 1.4 times (OR=1.41, 95%, C.I 1.05-1.90). The odds of risk practices regarding Toxoplasma were 0.4 times higher in pregnant women aged between 19-25 years as compared to those who were below 19 years old (OR=0.4, p<0.01). Multigravidae was statistically significant associated with the practices towards exposure to Toxoplasma (OR=2.65, p<0.01). Of the 22 health workers who participated in the study, only 36% (95%, C.I 15–58%) were aware of the congenital toxoplasmosis and its clinical outcomes but none of them had diagnosed the disease before. Generally, lack of awareness contributed by low level of education and lack of priority for prenatal toxoplasmosis screening services was observed among both health workers and pregnant women in Temeke Municipality. To promote awareness and preventive practices towards toxoplasmosis, health education and health promotion of medical personnel’s and vulnerable population of pregnant women on the importance of congenital toxoplasmosis is recommended. This can be done through strengthening the curriculum for training of medical personnel to cover more aspects of congenitally transmitted diseases including toxoplasmosis. Development and provision of prenatal brochures addressing different reproductive and child health issues including maternal behaviours’ and practices in conjunction with the diseases of congenital importance and their risks during pregnancy. The government through the health systems and policy should support and facilitate diagnostic services for screening of toxoplasmosis among pregnant women attending prenatal health care, not only HIV/AIDS, Syphilis and malaria which are currently screened. Lastly, more research work including population epidemiology studies of toxoplasmosis through one health approach to establish general exposure status and complications associated with the disease in different risk groups is also recommended.
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