Global prevalence of latent toxoplasmosis in pregnant women: a systematic review and meta-analysis.

BACKGROUND: Toxoplasma gondii infection, if acquired as an acute infection during pregnancy, can have substantial adverse effects on mothers, fetuses and newborns. Latent toxoplasmosis also causes a variety of pathologies and has been linked to adverse effects on pregnancy. OBJECTIVE: Here, we present results of a comprehensive systematic review and meta-analysis of the global prevalence of latent toxoplasmosis in pregnant women. DATA SOURCE: We searched PubMed, EMBASE, Web of Science, SciELO and Scopus databases for relevant studies that were published between 1 January 1988 and 20 July 2019. STUDY ELIGIBILITY CRITERIA: All population-based, cross-sectional and longitudinal studies reporting the prevalence of latent toxoplasmosis in healthy pregnant women were considered for inclusion. PARTICIPANTS: Pregnant women who were tested for prevalence of latent toxoplasmosis. INTERVENTIONS: There were no interventions. METHOD: We used a random effects model to calculate pooled prevalence estimates with 95% confidence intervals (CIs). We grouped prevalence data according to the geographic regions defined by the World Health Organization (WHO). Multiple subgroup and meta-regression analyses were performed. RESULTS: In total, 311 studies with 320 relevant data sets representing 1 148 677 pregnant women from 91 countries were eligible for inclusion in the meta-analysis. The global prevalence of latent toxoplasmosis in pregnant women was estimated at 33.8% (95% CI, 31.8-35.9%; 345 870/1 148 677). South America had the highest pooled prevalence (56.2%; 50.5-62.8%) of latent toxoplasmosis in pregnant women, whereas the Western Pacific region had the lowest prevalence (11.8%; 8.1-16.0%). A significantly higher prevalence of latent toxoplasmosis was associated with countries with low income and low human development indices (p < 0.001). CONCLUSION: Our results indicate a high level of latent toxoplasmosis in pregnant women, especially in some low- and middle-income countries of Africa and South America, although the local prevalence varied markedly. These results suggest a need for improved prevention and control efforts to reduce the health risks to women and newborns.

Toxocara eggs in public places worldwide - A systematic review and meta-analysis.

Toxocariasis is a neglected tropical disease of humans. Although many studies have indicated or shown that environmental contamination with Toxocara species eggs is a major risk factor for toxocariasis in humans, there has been no comprehensive analysis of published data or information. Here, we conducted the first systematic review and meta-analysis of current literature to assess the global prevalence of Toxocara eggs in public places (including beaches, parks and playgrounds). We conducted searches of the PubMed, Embase, Scopus and Science Direct databases for relevant studies published until 20 April 2018, and assessed the prevalence rates of Toxocara eggs in public places. We used the random effects model to calculate pooled prevalence estimates, with 95% confidence intervals (CIs), and analysed data in relation to WHO geographical regions. Subgroup analysis and meta-regressions regarding the geographical and environmental variables were also performed. Of 2384 publications identified, 109 studies that tested 42,797 soil samples in 40 countries were included in the meta-analysis. The pooled global prevalence of Toxocara eggs in public places was 21% (95% CI, 16-27%; 13,895/42,797). The estimated prevalence rates in the different WHO regions ranged from 13% to 35%: Western Pacific (35%; 95% CI, 15-58%), Africa (27%; 95% CI, 11-47%), South America (25%; 95% CI, 13-33%), South-East Asia (21%; 95% CI, 3-49%), Middle East and North Africa (18%; 95% CI, 11-24%), Europe (18%; 95% CI, 14-22%), and North and Central Americas (13%; 95% CI, 8-23%). A high prevalence was significantly associated with high geographical longitude (P = 0.04), low latitude (P = 0.02) and high relative environmental humidity (P = 0.04). This meta-analysis of data from published records indicates that public places are often heavily contaminated with eggs of Toxocara. This finding calls for measures to reduce the potential risk of infection and disease in humans.