Conhecimento e comportamento preventivo de gestantes sobre Toxoplasmose no município de Imperatriz, Maranhão, Brasil / Toxoplasmosis knowledge and preventive behavior among pregnant women in the city of Imperatriz, Maranhão, Brazil

Resumo O objetivo desse estudo foi avaliar o conhecimento e o comportamento preventivo sobre a toxoplasmose e relacionar com as condições socioeconômicas, do pré-natal e ambientais entre as gestantes da Estratégia Saúde da Família (ESF), do município de Imperatriz, Maranhão, Brasil. Neste estudo transversal foi aplicado um questionário estruturado e pré-testado, com amostra de 239 gestantes. Somente 23,4% das gestantes apresentaram bom conhecimento sobre a doença, com ênfase no domínio prevenção; 58,9% adotaram adequadamente os comportamentos preventivos. Os resultados obtidos chamam a atenção pela associação significativa a vários fatores de risco para a toxoplasmose, como: consumo de água sem tratamento (OR = 2,1245; IC95% = 1,20-3,73; p = 0,0128), contato com gatos (OR = 7,6875; IC95% = 4,22-13,97; p < 0,0001), limpeza das fezes do gato (OR = 6,8738; IC95% = 3,02-15,60; p < 0,0001), consumo de carne crua (OR = 5,7405; IC95% = 3,21-10,24; p < 0,0001) e mexer com areia (OR = 10,7376; IC95% = 4,64-24,85; p < 0,0001), gerando a necessidade de uma educação continuada sobre a toxoplasmose para as gestantes atendidas na ESF de Imperatriz, e o estabelecimento de medidas preventivas mais integrais, com políticas públicas de saúde e educação que levem em consideração questões econômicas, sociais, ambientais e culturais.

Abstract The aim of this study was to assess toxoplasmosis knowledge and preventive behavior, and relate these to socioeconomic, pre-natal and environmental issues among pregnant women served by the Family Health Strategy in the municipality of Imperatriz, Maranhão, Brazil. This is a cross-sectional study performed by applying a structured and pre-tested questionnaire to a sample of 239 pregnant women. Only 23.4% of the pregnant women had good knowledge of the disease, primarily in the area of prevention, and 58.9% adopted suitable preventive behaviors. The results obtained show a significant association of various toxoplasmosis risk factors, such as drinking untreated water (OR = 2.1245; IC95% = 1.20-3.73; p = 0.0128), contact with cats (OR = 7.6875; IC95% = 4.22-13.97; p < 0,0001), cleaning cat feces (OR = 6.8738; IC95% = 3.02-15.60; p < 0.0001), eating raw meat (OR = 5.7405; IC95% = 3.21-10.24 and handling sand/cat litter OR = 10.7376; IC95% = 4.64-24.85; p < 0.0001). This shows a need for continued education on toxoplasmosis for the pregnant women seen by the Imperatriz FHS, and for more comprehensive preventive measures, with public health and education policies that take into consideration economic, social, environmental and cultural issues.

Asociación entre blastocistosis y anemia por déficit de hierro en mujeres embarazadas en el municipio La Lisa, La Habana, Cuba / Association between Blastocystosis and Iron Deficiency Anemia in Pregnant Women in La Lisa Municipality, Havana, Cuba

Introducción: Estudios recientes encontraron asociación entre blastocistosis y anemia por déficit de hierro. Uno de ellos demostró que en mujeres embarazadas la infección por Blastocystis spp. es un factor de riesgo para padecerla y puede tener consecuencias adversas tanto para la madre, como para el feto que en casos extremos puede conducir a mortalidad maternofetal. Objetivo: Conocer la prevalencia de blastocistosis en mujeres embarazadas y su posible asociación con la anemia ferropénica. Métodos: Se realizó un estudio parasitológico, clínico y epidemiológico, de tipo descriptivo y de corte transversal, al universo de las gestantes atendidas en tres policlínicos del municipio La Lisa, entre julio 2017 y junio 2018. Resultados: De 135 embarazadas, 43 (31,9 por ciento) estaban infectadas por protozoos parásitos. De estos, Blastocystis spp, fue el más prevalente (28,9 por ciento). Del total de gestantes, 41 padecían de anemia. En la mayoría de estas (85,4 por ciento), la anemia clasificaba como ferropénica. La proporción de embarazadas parasitadas por Blastocystis spp. que padecían este tipo de anemia, en relación con las gestantes que no estaban infectadas por ese protozoo y también padecían de ese tipo de anemia fue significativamente mayor (p lt; 0,05). Conclusiones: Blastocistosis es una parasitosis de prevalencia creciente e insuficientemente conocida. Iniciativas para mejorar conocimientos, percepciones y prácticas en relación con su diagnóstico, tratamiento y control son perentorias a nivel popular y académico. Las estrategias de comunicación que se implementen deben informar sobre las posibles consecuencias clínicas de la infección en relación con la mujer embarazada(AU)

Introduction: Recent studies found an association between blastocystosis and iron deficiency anemia. One of them showed that the infection with Blastocystis spp is a risk factor for in pregnant women to suffer. This infection can have adverse consequences for both the mother and the fetus. In extreme cases it can lead to maternal and fetal mortality. Objective: To know the prevalence of blastocystosis in pregnant women and its possible association with iron deficiency anemia. Methods: A parasitological, clinical and epidemiological study, descriptive and cross-sectional was conducted on the universe of pregnant women treated in three clinics in La Lisa municipality from July 2017 to June 2018. Results: We found 43 (31.9 percent) pregnant women infected by parasitic protozoa out of 135 who were studied. Blastocystis spp, was the most prevalent (28.9 percent). 41 pregnant women suffered from anemia. In most of them (85.4 percent), anemia classified as iron deficiency. The proportion of pregnant women parasitized by Blastocystis spp who suffered from this type of anemia was significantly higher (p lt;0.05) in relation to pregnant women who were not infected by that protozoan and also suffered from that type of anemia. Conclusions: Blastocystosis is a parasitosis of increasing prevalence which is insufficiently known. Initiatives to improve knowledge, perceptions and practices are peremptory to their diagnosis, treatment and control at the general and academic levels. The communication strategies that are implemented should inform about possible clinical consequences of this infection in pregnant woman(AU)

Congenital Chagas disease: an update

Congenital infection with Trypanosoma cruzi is a global problem, occurring on average in 5% of children born from chronically infected mothers in endemic areas, with variations depending on the region. This presentation aims to focus on and update epidemiological data, research methods, involved factors, control strategy and possible prevention of congenital infection with T. cruzi. Considering that etiological treatment of the child is always effective if performed before one year of age, the diagnosis of infection in pregnant women and their newborns has to become the standard of care and integrated into the surveillance programs of syphilis and human immunodeficiency virus. In addition to the standard tests, polymerase chain reaction performed on blood of neonates of infected mothers one month after birth might improve the diagnosis of congenital infection. Recent data bring out that its transmission can be prevented through treatment of infected women before they become pregnant. The role of parasite genotypes and host genetic factors in parasite transmission and development of infection in foetuses/neonates has to be more investigated in order to better estimate the risk factors and impact on health of congenital infection with T. cruzi.

A decade of malaria during pregnancy in Brazil: what has been done concerning prevention and management

In Brazil, malaria remains a disease of major epidemiological importance because of the high number of cases in the Amazonian Region. Plasmodium spp infections during pregnancy are a significant public health problem with substantial risks for the pregnant woman, the foetus and the newborn child. In Brazil, the control of malaria during pregnancy is primarily achieved by prompt and effective treatment of the acute episodes. Thus, to assure rapid diagnosis and treatment for pregnant women with malaria, one of the recommended strategy for low transmission areas by World Health Organization and as part of a strategy by the Ministry of Health, the National Malaria Control Program has focused on integrative measures with woman and reproductive health. Here, we discuss the approach for the prevention and management of malaria during pregnancy in Brazil over the last 10 years (2003-2012) using morbidity data from Malaria Health Information System. Improving the efficiency and quality of healthcare and education and the consolidation of prevention programmes will be challenges in the control of malaria during pregnancy in the next decade.

Consenso argentino de toxoplasmosis congénita / Argentine Consensus of Congenital Toxoplasmosis

La transmisión de la infección por Toxoplasma gondii de la madre al hijo ocurre cuando la madre se infecta por primera vez en el transcurso del embarazo. Tanto el diagnóstico prenatal, como el del primer año de vida se basa en pruebas serológicas; y la mayoría de las veces es necesario realizar más de una de estas pruebas ya que tienen distintos porcentajes de sensibilidad y/o especificidad así como distintos niveles de complejidad. El recién nacido requiere seguimiento serológico en el primer año de vida o hasta que se descarte el diagnóstico de toxoplasmosis congénita. El diagnóstico temprano de la infección, en la mujer embarazada, permite un tratamiento oportuno y se indica con el propósito de reducir la tasa de transmisión y el daño congénito. Es posible que con un programa activo, de prevención y tratamiento temprano, se pueda reducir la tasa de incidencia de la toxoplasmosis congénita de alrededor del 5 por mil nacimientos a 0.5 por mil. El objetivo de este consenso fue revisar la literatura científica para la prevención, el diagnóstico y el tratamiento de la toxoplasmosis congénita, para que se pueda implementar en nuestro país.

The mother-to-child transmission in Toxoplasma gondii infection occurs only when the infection is acquired for the first time during pregnancy. The prenatal and early postnatal diagnosis can only be achieved by serological testing. Serologic tests have different sensitivities, specificities and complexities, so that different tests in more than one blood sample are necessary for the diagnosis. Serological follow-up of the infants should be conducted during the first year of life or until the diagnosis of congenital toxoplasmosis can be ruled out. Treatment recommendations try to reduce the transmission rate and the risk of congenital damage. Congenital toxoplasmosis incidence rate is approximately 5 per 1000 births, but can be reduced to 0.5 per 1000 with an active screening program. The aim of this consensus group was to review the scientific literature on congenital toxoplasmosis and prepare a statement on prevention, diagnosis and treatment that should be implemented in our country.

Effect of Chloroquine Prophylaxis on Birthweight and Malaria Parasite Load among pregnant women delivering in a regional hospital in Cameroon

This survey was conducted between December, 1997 and August, 1998 at the Chantal Biya Maternity Section of the Ebolowa Provincial Hospital, Cameroon. A total of 231 parturient mothers who gave birth to 232 neonates were included in the study. Ninety-five of them (41.1 percent) took anti-malaria prophylaxis (chroloquine) in the index pregnancy, and 136 (58.9 percent) did not. Both groups were similar with respect to socio-demographic characteristics except for educational level of the mother, which was significantly higher in the group on prophylaxis (x2 = 8.05; df = 2, p = 0.02). The overall prevalence of maternal parasitaemia was 37.2 percent. The group on chloroquine (TG) experienced a lesser parasitaemia (26.3 percent) than the non-prophylactic group (CG) (44.9 percent odds ratio (OR) = 2.28, CI = 1.24 - 4.19). The proportion of women with severe parasitaemia (>4000 parasites/ul) was also lower in the TG than CG (17.6 percent vs. 7.3 percent; OR = 2.69, CI = 1.04 - 7.23). A modest reduction in low birthweight was found in the TG which was not significant (23.4 percent vs 16.0 percent; p = 0.16). In conclusion, chloroquine given to prevent malaria in pregnancy was found to be effective in reducing peripheral malaria parasitaemia, but improvement in birthweight could not be demonstrated. Among other factors, impaired biological activity of the drug at the level of the placenta where parasite sequestration frequently occurs might be the explanation. We recommend that further investigation be carried out in the study area to evaluate this finding, and if confirmed, institute appropriate changes in the present policy of chloroquine prophylaxis in pregnancy.

Routine use of mebendazole in pregnancy.

INTRODUCTION: The Ministry of Health has recommended the routine administration of a broad spectrum anthelmintic to all pregnant women after completion of the first trimester of pregnancy. OBJECTIVE: To estimate prevalence and intensity of geohelminth infections in pregnant women attending an antenatal clinic in Ragama and determine the use of anthelmintics by them. METHODS: Women on their first visit to antenatal clinics of the University Obstetrics Unit, General Hospital Colombo North, Ragama, during July-August 1995, were recruited for the study. Demographic details, duration of pregnancy and a history of using anthelmintics during the current pregnancy were noted. A stool sample was obtained and examined using modified Kato-Katz technique. RESULTS: 309 pregnant women were studied [mean age 26.6 years (SD 5.3)]. 94 (30.4%) had taken an anthelmintic during the current pregnancy. 78 (25.2%) had taken it in the second trimester, 9 (2.9%) in the third, 6 (1.8%) in the first, and one was uncertain of the timing. Stool samples were obtained from 181 women giving a compliance rate of 58.6%. Prevalence of geohelminth infections were: whipworm 10%, hookworm 2.2%, roundworm 1.1%. The intensities of the infections were mild. 157 (86.7%) did not have any geohelminth infection. Of the 181 women whose stools were examined, 52 had taken an anthelmintic. There was no significant difference in the prevalence of geohelminth infections between this group (6/52; 11.2%) and those who had not taken an anthelmintic (18/129; 13.9%) (Chi-square test). CONCLUSION: It may not be necessary to treat all pregnant women in Sri Lanka with anthelmintics, as some areas have a low prevalence of infection. Routine anthelmintic therapy could-be limited to areas where prevalence rates are known to be high.