Global, regional, and country seroprevalence of Toxoplasma gondii in pregnant women: a systematic review, modelling and meta-analysis.

Efficient health-care for pregnant women require accurate data on the prevalence of toxoplasmosis in pregnancy at global, regional, and country levels. In this systematic review with meta- and modelling-analysis, we searched PubMed, EMBASE, Web of Knowledge, Global Index Medicus, and Africa Journal Online to identify studies that reported enough data to compute the immunoglobulins (Ig) M or G seroprevalence estimates of Toxoplasma gondii in pregnant women up to December 31st, 2018, without any language restriction. The global and regional estimates were done using a random-effects meta-analysis. We included 250 studies with 723,655 pregnant women. The global IgM seroprevalence was 1.9% (95%CI: 1.7-2.3). At the regional level, Eastern Mediterranean had the highest IgM seroprevalence (4.1%, 95%CI: 2.8-5.5) and The Americas, the lowest (1.1%, 0.8-1.4), with a statistically significant difference between WHO regions (p < 0.0001). The global IgG seroprevalence was 32.9% (95%CI: 29.4-36.4). Among WHO regions, The Americas had the highest prevalence (45.2%, 95%CI: 33.4-53.4) and Western Pacific the lowest (11.2%, 7.8-15.1), with a statistically significant difference between regions (p < 0.0001). This study presents a high toxoplasma seropositivity in pregnant women at global, regional and country levels, with a consequential high risk of maternal and congenital toxoplasmosis.

Global, regional and national estimates of Toxoplasma gondii seroprevalence in pregnant women: a protocol for a systematic review and modelling analysis.

INTRODUCTION: To set priorities for public health policy, funding for public health interventions, and healthcare planning which will ultimately contribute in bending the burden of toxoplasmosis towards maternal and neonatal health, it is necessary to have accurate data on the prevalence of toxoplasmosis in pregnancy. Therefore, we aimed to estimate the seroprevalence of Toxoplasma gondii infection in pregnant women by countries, WHO regions and globally. METHODS AND ANALYSIS: We will search multiple databases to identify studies that reported the prevalence (or enough data to compute this estimate) of Toxoplasma gondii in the global population of pregnant women up till December 31, 2018 without any language restrictions. Study selection, data extraction and risk of bias assessment will be conducted independently by three pairs of investigators. For each country, we will estimate the prevalence based on empirical studies if there is either one nationally representative study, or two or more not nationally representative studies. Then, we will perform a country-specific random-effects meta-analyses. The heterogeneity will be evaluated using the χ² test on Cochrane's Q statistic and quantified with H and I² statistics. For countries with one or no empirical studies or where the meta-analysis will result in a wide CI of 0%-100%, we will predict the country's prevalence by using a Bayesian generalised non-linear multilevel model. The model will have a hierarchical structure in which estimates for each country will be informed by its own data, if available, or by data from other countries in the same WHO region. ETHICS AND DISSEMINATION: Since this study will be based on published data, it does not require any ethical approval. Its findings will be published in a scientific peer-reviewed journal. They will also be presented at scientific conferences and to relevant public health sectors. PROSPERO REGISTRATION NUMBER: CRD42019125572.