Fear and rumours regarding placental biopsies in a malaria-in-pregnancy trial in Benin.

BACKGROUND: A multi-country, community-based trial on scheduled screening and treatment for malaria in pregnancy was conducted in Benin, The Gambia and Burkina Faso. Despite standardized procedures and outcomes, the study became subject to rumours and accusations of placenta being sold for mystical and financial gain by trial staff, leading to drop-out rates of 30% and the consequent halting of placental biopsy sampling in Benin. This paper explores the role of socio-cultural beliefs related to placenta and identified additional factors contributing these rumours. METHODS: A qualitative comparative emergent-theory design was used to assess social factors related to trial implementation and uptake in the three countries. Data from participant observation, informal conversations, group discussions and interviews were triangulated and analysed with NVivo Qualitative Analysis software. RESULTS: Despite similar sociocultural beliefs about the sacred nature of the placenta in all three study countries, these beliefs did not affect participation rates in Burkina Faso and The Gambia and placenta-related rumours only emerged in Benin. Therefore, the presence of beliefs is not a sufficient condition to have generated placenta-selling fears. The rumours in Benin reflected the confluence of placenta-related beliefs and factors related to the implementation of the trial (including a catalysing adverse event and miscommunication during the informed consent procedure). Furthermore, distinct socio-political factors contributed to the emergence of rumours, including the historical distrust in governmental organizations and the tense relationship between some of the actors involved in the trial. CONCLUSION: Transdisciplinary social science research designs should accompany the implementation of the trial. The integration of multiple stakeholders' knowledge and involvement is required to define and solve upcoming barriers.

A multicenter survey on toxoplasmosis knowledge among pregnant women in Poland (the TOWER study).

BACKGROUND: The seroprevalence of Toxoplasma gondii ranges widely in different areas of the world and different populations. Although toxoplasmosis is typically benign and asymptomatic, it induces major complications in immunocompromised individuals and during pregnancy. Prevention of maternal primary infection constitutes the major tool for avoiding congenital T. gondii infections and toxoplasmosis complications. The preventive measures depend on the women's knowledge about toxoplasmosis. The aim of the study was to assess the knowledge on toxoplasmosis among pregnant women in Poland. METHODS: The study was conducted between October 2016 and January 2017 in 3 Polish cities. During a visit in a hospital outpatient clinic, pregnant women aged > 16 years fulfilled a previously validated questionnaire. The questions concerned personal data (age, parity, educational level, place of residence), toxoplasmosis knowledge (etiology, routes of transmission, symptoms, sequelae), and sources consulted to collect information. RESULTS: Overall, 465 pregnant women participated in the survey; 439 (94.4%) were aware of toxoplasmosis. Toxoplasmosis was perceived as a zoonotic disease by 77.4%, as a parasitic disease by 41.7%, as a disease transmitted through poor hand hygiene by 8.6%, as a childhood illness by 4%, and as a congenital disease by 0.4%. Regarding the transmission route, 84.5% of women pointed at a domestic cat, 46.7% at eating raw or undercooked meat. The total of 84.3% did not know toxoplasmosis symptoms, and 12.0% stated that they did not present the symptoms. In multivariate analysis, younger age (OR, 2.74; 95% CI, 1.67-4.49; p <  0.001), city residence (OR, 13.45; 95% CI, 3.12-57.89; p <  0.003), and higher education level (OR, 6.81; 95% CI, 3.69-12.59; p <  0.001) were significantly associated with better knowledge of toxoplasmosis, and the number of children (OR, 0.32; 95% CI, 0.22-0.48; p <  0.001) - with higher knowledge of the symptoms. CONCLUSIONS: Among pregnant women in Poland, the basic knowledge on toxoplasmosis is very high (94.4%). Younger age, city residence, higher education level, and the number of children turned out significantly associated with better knowledge of T. gondii and toxoplasmosis symptoms.

Uptake of intermittent preventive treatment for malaria during pregnancy with Sulphadoxine-Pyrimethamine (IPTp-SP) among postpartum women in Zomba District, Malawi: a cross-sectional study.

BACKGROUND: Malaria in pregnancy causes adverse birth outcomes. Intermittent preventive treatment of malaria during pregnancy with sulphadoxine-pyrimethamine (IPTp-SP) is recommended as a chemoprevention therapy. Zomba district IPTp uptake falls far below the national average. The study was conducted to assess determinants of IPTp-SP uptake during pregnancy among postpartum women in Zomba district after adoption of new IPTp-SP policy in 2014. METHODS: This was a cross-sectional survey. Two public health facilities (HFs) were randomly selected from urban and rural areas in Zomba district. Study participants were postpartum women selected by using exit poll method from HFs. A total of 463 postpartum women were interviewed using structured questionnaire. Bivariate and multiple logistic regression was used in data analysis. RESULTS: Out of all the enrolled participants (n = 463), 92% women had complete information for analysis. Of these, (n = 426) women, 127 (29.8%, 95% CI: 25.6%-34.3%) received three or more doses of SP, 299 (70.2%, 95% CI: 65.7%-74.4%) received two or less doses. Women receiving SP from rural HF were less likely to get at least three doses of SP than urban women, (AOR = 0.31, 95% CI 0.13-0.70); Others less likely were those with three or few antenatal care (ANC) visits versus four or more visits (AOR = 0.29, 95% CI 0.18-0.48); not taking SP under direct observation therapy (DOT) (AOR = 0.18, 95% CI (0.05-0.63). CONCLUSIONS: There is low utilisation of at least three doses of SP in this population and this seems to be associated with the number of ANC visits and use of DOTs. These determinants may therefore be important in shaping interventions aimed at increasing the uptake of IPTp in this district. In addition, the rural urban differential suggests the need for further research to understand the barriers and enablers of uptake in each context in order to improve the health of the community.

Malaria-related ideational factors and other correlates associated with intermittent preventive treatment among pregnant women in Madagascar.

BACKGROUND: The Malagasy Ministry of Health aimed to achieve 80% coverage of intermittent preventive treatment of malaria among pregnant women (IPTp) in targeted districts by 2015. However, IPTp coverage rates of have remained fairly static over the past few years. METHODS: During a cross-sectional household survey, mothers of children under the age of 2 years were asked about their most recent pregnancy. The primary outcome of interest was a mother receiving two or more doses of sulfadoxine-pyrimethamine (SP) (IPTp2) during their last pregnancy, at least one of which was obtained from a health provider. Multilevel analysis was used to account for community-level factors. Correlates included exposure to communication messages, the number of antenatal care (ANC) visits made by the woman, her household wealth, and other sociodemographic characteristics. RESULTS: Over one-tenth (11.7%) of women received two or more doses of SP, at least one of which was obtained during an ANC visit. Two-thirds (68.3%) of women who consulted a health provider but did not take IPTp attributed this to not being offered the medication by their health provider. The odds of a woman receiving IPTp2 varied with her knowledge, attitudes, and perceived social norms related to IPTp and ANC and exposure to malaria messages. General malaria ideation, specifically the perceived severity of and perceived susceptibility to malaria, however, was not associated with increased odds of receiving IPTp2. A large variation in the odds of receiving IPTp2 was due to community-level factors that the study did not examine. CONCLUSIONS: Health communication programmes should aim to improve IPTp/ANC-specific ideation, particularly the norms of seeking regular care during pregnancy and taking any prescribed medication. While ANC attendance is necessary, it was not sufficient to meet IPTp2 coverage. Women surveyed in Madagascar rely on health providers to prescribe SP according to national policy. At the same time, stock-outs prevent health providers from prescribing SP. The large observed community-level variation in IPTp2 coverage is likely due to supply-side factors, such as SP availability and health-provider ideation and practices.

[Malaria and intestinal parasitosis in pregnant woman at Abobo district (Abidjan, Côte d'Ivoire)]. / Paludisme et parasitoses digestives chez la femme enceinte de la commune d'Abobo (Abidjan, Côte d'Ivoire).

A prospective study was carried out from 2010 to 2012 at the Hôpital Général d'Abobo (HGA) in Abidjan, in order to determine the impact of infectious and parasitic diseases on child cognitive development. Blood samples were examined by means of thick drop and blood smear; as for stool by direct examination and concentration by formalin-ether method. We evaluated the prevalence, the parasite load of malaria and gastrointestinal parasites; then we investigated the risk factors for these disorders. Overall, 331 pregnant women in the last trimester of their pregnancy were enrolled. The plasmodic index was 3.9% with infestation specific rates of P. falciparum from 100%. Concerning digestive protozoa, it has been observed 71.3% of nonpathogenic, against 9.7 % of pathogens, either an overall prevalence of 51.4% of digestive parasites. The calculated average parasitic loads revealed 3089.2 tpz/µl of blood (95 % CI: 591.1-5587.3) for malaria, 6.5 eggs per gram of stool (95 % CI: 0.4-13.4) for intestinal helminths and one parasite by microscopic field for protozoa (common infestation). It has been shown that the occurrence of malaria has been linked to the non-use of impregnated mosquito nets (x2 = 0.012; p = 0.018), not to age. No link could be established between the presence of digestive parasites and the age of pregnant women, or socioeconomic conditions (level of education, profession, type of toilet). Malaria is less common in pregnant women while the rate of digestive parasites remains high.

The impact of socioeconomic factors on the efficiency of voluntary toxoplasmosis screening during pregnancy: a population-based study.

BACKGROUND: Congenital toxoplasmosis is associated with severe complications. German state health insurance covers rubella, but not toxoplasmosis, immunity screening. We analysed the effect of socioeconomic factors on the efficiency of private toxoplasmosis screening during pregnancy. METHODS: Toxoplasmosis and rubella screening data (n = 5402 mothers) were collected within the population-based Survey of Neonates in Pomerania (SNiP). RESULTS: At the first-trimester screening, 34.4 % (88.1 %) of expecting mothers were immune to toxoplasmosis (rubella). Susceptibility for toxoplasmosis (rubella) was observed in 39.6 % (8.9 %) and 25.8 % (2.95 %) were not tested. Data on a 2(nd) screening were available in a subgroup of women with negative immunity showing less than 45 % participation rate. Active toxoplasmosis (no rubella) infection was observed in 0.3 % (n = 17) of pregnant women. A multiple logistic regression model (AIC = 719.67; AUC = 0.725) revealed that the likelihood of participating in a second toxoplasmosis screening increased among women with a good level of education and a steady partnership and decreased with paternal unemployment and the absence of breastfeeding. The highest probability of non-participation in toxoplasmosis screening was found among women with temporal burden and family responsibilities. A cost-benefit analysis showed that covering general screening for toxoplasmosis with health insurance saved costs. CONCLUSION: Toxoplasmosis carried a substantial risk of infection during pregnancy. Although increased socioeconomic status was positively associated with the participation in toxoplasmosis screening, this was not the case when pregnant women had strong temporal burden and family responsibilities. This data supports the need for toxoplasmosis screening among pregnant women as a general healthcare benefit covered by insurance.

Impact of helminth infection during pregnancy on cognitive and motor functions of one-year-old children.

OBJECTIVE: To determine the effect of helminth infection during pregnancy on the cognitive and motor functions of one-year-old children. METHODS: Six hundred and thirty five singletons born to pregnant women enrolled before 29 weeks of gestation in a trial comparing two intermittent preventive treatments for malaria were assessed for cognitive and motor functions using the Mullen Scales of Early Learning, in the TOVI study, at twelve months of age in the district of Allada in Benin. Stool samples of pregnant women were collected at recruitment, second antenatal care (ANC) visit (at least one month after recruitment) and just before delivery, and were tested for helminths using the Kato-Katz technique. All pregnant women were administered a total of 600 mg of mebendazole (100 mg two times daily for 3 days) to be taken after the first ANC visit. The intake was not directly observed. RESULTS: Prevalence of helminth infection was 11.5%, 7.5% and 3.0% at first ANC visit, second ANC visit and at delivery, respectively. Children of mothers who were infected with hookworms at the first ANC visit had 4.9 (95% CI: 1.3-8.6) lower mean gross motor scores compared to those whose mothers were not infected with hookworms at the first ANC visit, in the adjusted model. Helminth infection at least once during pregnancy was associated with infant cognitive and gross motor functions after adjusting for maternal education, gravidity, child sex, family possessions, and quality of the home stimulation. CONCLUSION: Helminth infection during pregnancy is associated with poor cognitive and gross motor outcomes in infants. Measures to prevent helminth infection during pregnancy should be reinforced.

Toxoplasmosis seroprevalence in relation to knowledge and practice among pregnant women in Dhahran, Saudi Arabia.

The epidemiological importance of the different routes of Toxoplasma gondii transmission is not known and depends largely on population behaviour and knowledge. This study was conducted to assess toxoplasmosis seropositivity and the related knowledge and preventive practices that are necessary for the prevention of the disease among pregnant women. All pregnant women attending antenatal clinic were tested for T. gondii immunoglobulins followed by a survey questionnaire that tested their knowledge and preventive practice. Statistical comparisons were made between the seropositive and negative ones. We determined a low to moderate seroprevalence of toxoplasmosis among pregnant women in Dhahran, Saudi Arabia as compared to many other parts of the world. The overall positivity rates of IgG and IgM against T. gondii among 400 pregnant women were 28.5 and 3%, respectively. 75.5% of the participants had never heard about toxoplasmosis and the associated risk factors. Lack of knowledge was associated with the higher risk of infection (OR = 4.04, p < 0.001). Keeping pet cats was not common and poorly associated with infections (OR = 1.15, p ≥ 0.64). Consumption of undercooked meat was reported frequently and only slight risk was associated with sheep/goat meat (OR = 1.39, p = 0.15). Eating outside the home at restaurants was reported for the first time to be related to a higher risk of infection (OR = 2.69, p < 0.001). Several possible risk factors were suggested through odds ratios calculation and overall knowledge of toxoplasmosis by pregnant women was poor. It is therefore vital to provide a formal education about toxoplasmosis risk factors to women of childbearing age.

[Evaluation of anti-Toxoplasma gondii antibody distribution and risk factors among pregnant women admitted to obstetrics polyclinic of Canakkale Onsekiz Mart University Hospital]. / Çanakkale Onsekiz Mart Üniversitesi Tip Fakültesi Hastanesi Obstetri Poliklinigine Müracaat Eden Gebelerde Anti-Toxoplasma gondii Antikorlarinin Dagilimi ve Risk Faktörlerinin Irdelenmesi.

OBJECTIVE: In this study, we aimed to investigate Toxoplasma gondii seroprevalence and risk factors in pregnant women. METHODS: A total of 196 patients, admitted to the clinic in the first trimester and with ongoing pregnancy follow-up of between May 2012 and January 2013, were included in the study. Toxoplasma IgG and IgM antibodies were detected by ELISA test in blood samples obtained from patients during routine screening. SPSS statistical software, version 19.0 was used to analyze the data. Descriptive statistics were used to present the data, percentage, mean, and standard deviation. Chi-square test was used for categorical variables. p-value for statistical significance was defined as p<0.05. RESULTS: The mean age was 29.07±5.3 years in our study group. Anti-Toxoplasma IgG and IgM antibodies were found in 28.8% and 2.7%, respectively; 58.9% of pregnant women in the study reported that they had done at least one risky behavior during their pregnancy. However, there was no significant association between T. gondii IgG antibody positivity and risk factors, such as pregnancy, feeding animals in the past years, and consumption of raw food products (p>0.05). CONCLUSION: We found that Toxoplasma IgG antibody seropositivity (28.8%) was similar to that found in the other studies from western Turkey.

Neuropsychiatric manifestations of latent toxoplasmosis on mothers and their offspring.

Toxoplasmosis is one of the most common parasitic diseases worldwide. It is estimated that approximately one-third of the world's population is latently infected. Infection generally occurs via oral the route and maternal transmission. Damage of the central nervous system is one of the most serious consequences of congenital toxoplasmosis. Moreover, recent investigations proposed that acute and sub-acute congenital toxoplasmosis as well as latent toxoplasmosis during pregnancy; play various roles in the etiology of different neuropsychiatric disorders in mothers and their offspring. This paper reviews new findings about the role of latent toxoplasmosis in the etiology of various neuropsychiatric disorders in mothers and their offspring.

[Effect of Toxoplasma gondii prugniaud strain infection in pregnant mice on the learning ability of the F1 generation].

OBJECTIVE: To study the effect of Toxoplasma gondii prugniaud strain infection on female reproductive toxicity in mice and learning ability of their F1 generation. METHODS: Thirteen ICR mice were each infected intragastrically with 10 T. gondii cysts on the 15th day of pregnancy (late stage pregnancy). 12 mice were treated with physiological saline as control. The time from conception to birth and the number of offspring were recorded. Three mice from each group were sacrificed when pregnant 20 d, placentas from the sacrificed and output stillbirth mice were examined by using histopathology and immunohistochemistry. DNA extraction was performed from placenta tissue, and then T. gondii B1 gene was amplified by PCR. The F1 generation mice from experiment group and control group were tested by Morris water maze test. Statistical analysis on learning and memory ability was made by SPSS 13.0 software. RESULTS: The time from conception to birth in experiment group [(19.2 +/- 1.751)d] was shorter than that in control group [(21.0 +/- 1.732)d] (P < 0.05). No significant difference was found in the number of offspring between experiment group (70) and control group (85) (P > 0.05). Microscopic examination with HE staining showed multiple T. gondii among placental villi, the increase of the number of Hofbauer cells, blood sinus expansion and hyperemia, and visible nucleated erythrocytes. Immunohistochemically, T. gondii antigen was detected in placenta tissue. T. gondii B1 gene was detected in placenta tissue (194 bp). On the third and fourth day of the Morris water maze test, the latency of experiment group [(29.92 +/- 4.28) s, (27.69 +/- 6.23) s] was longer than that of the control [(24.07 +/- 5.32) s, (22.25 +/- 7.94) s] (P < 0.05). In the spatial probe test, the distance across the platform quadrant of experiment group [(384.66 +/- 41.33) cm] was shorter than that of the control [(426.12 +/- 46.48) cm] (P < 0.05). CONCLUSION: T. gondii Prugniaud strain infection in late stage pregnancy of mice may induce reproductive toxicity and affect the learning and memory capability of the F1 generation.

Toxoplasma infection and later development of schizophrenia in mothers.

OBJECTIVE: Several studies based on clinical samples have found an association between Toxoplasma gondii infection and schizophrenia, and a case-control study among U.S. military personnel with specimens available from both before and after diagnosis found a positive association between T. gondii immunoglobulin G (IgG) antibody level and schizophrenia. These findings have never been replicated in a prospective cohort study. The purpose of this study was to determine whether mothers infected with T. gondii have an elevated risk of schizophrenia or related disorders and whether the risk depends on IgG antibody level. METHOD: In a register-based prospective cohort study of 45,609 women born in Denmark, the level of T. gondii-specific IgG antibodies was measured in connection with childbirth between 1992 and 1995. Women were followed up from the date of delivery until 2008. RESULTS: A significant positive association between T. gondii IgG antibody level and schizophrenia spectrum disorders was found. Mothers with the highest IgG level had a relative risk of 1.73 (95% confidence interval [CI]=1.12-2.62) compared with mothers with the lowest IgG level. For schizophrenia, the relative risk was 1.68 (95% CI=0.77-3.46). When the mothers were classified according to IgG level, only those with the highest IgG levels had a significantly higher risk of schizophrenia spectrum disorders. CONCLUSIONS: Women with high levels of T. gondii-specific IgG antibodies have a significantly elevated risk of developing schizophrenia spectrum disorders.

Knowledge, attitude, perception of malaria and evaluation of malaria parasitaemia among pregnant women attending antenatal care clinic in metropolitan Lagos, Nigeria.

BACKGROUND & OBJECTIVES: Little information exists on the compliance of pregnant women to malaria management in malaria endemic countries. This study was designed to access knowledge, attitude, perception and home management of malaria among consenting pregnant women attending antenatal care (ANC) clinic. METHODS: In total, 350 pregnant women were randomly recruited during their ANC Clinic in Lagos. Structured questionnaires were administered in a two-stages research design; first during their early months of ANC visit and the second approximately 1-2 months before delivery. Information on occupation, parity, symptoms used to recognise malaria, treatment sources, control measures, knowledge factors, anti-vector measures, health-seeking practices, malaria parasitaemia and packed cell volume (PCV) were recorded. RESULTS: The results revealed that 78.9% of the pregnant women identified infected mosquitoes as the cause of malaria while 86% of the pregnant women identified stagnant water as its breeding sites. Knowledge of the benefit of insecticide-treated mosquito bednets was less prominent as most of the selected subjects decried its high market price. Our data also showed that educational programme targeted on potential mothers is beneficial. Overall, 27.4% (96/350) of the pregnant women had peripheral malaria infection with 88.5% (85/96) of the parasite positive women infected with Plasmodium falciparum and 11.5% (11/96) with P. malariae. PCV ranged from 20-40% (median 33.9%) with 25.7% (90/350) of the pregnant women being anaemic with PCV <33%. We found an association between malaria infection and occupation, and this association was not influenced by parity. INTERPRETATION & CONCLUSION: Our findings revealed that improvement in knowledge and education of women of child-bearing age has an influential impact on malaria control.

Prenatal depression and anxiety in Toxoplasma gondii-positive women.

OBJECTIVE: This study analyzed a relationship between prenatal mood states and serologic evidence of immune response to Toxoplasma gondii. A secondary aim was to determine whether thyroid peroxidase autoantibody status was related to T gondii status. STUDY DESIGN: Pregnant women (n = 414) were measured at 16-25 weeks' gestation with demographic and mood questionnaires and a blood draw. All plasma samples were analyzed for thyroid peroxidase and T gondii immunoglobulin G, tryptophan, kynurenine, and neopterin. T gondii serotypes were also measured in the women who were T gondii positive. Cytokines were available on a subset (n = 142). RESULTS: Women with serologic evidence of exposure to T gondii (n = 44) showed positive correlations between immunoglobulin G levels and the Profile of Mood States depression and anxiety subscales. Plasma tumor necrosis factor-α was higher in women who were positive for T gondii. Serotypes were type I (27%), type II (31%), and unclassified (42%, which shows intermediate levels of reactivity). The depression and anxiety scores were highest in type I, but this was not significant. The Profile of Mood States vigor score was lowest in type II, compared with the type I or unclassified groups. CONCLUSION: Higher T gondii immunoglobulin G titers in infected women were related to anxiety and depression during pregnancy. Subclinical reactivation of T gondii or immune responses to T gondii may worsen mood in pregnant women.

Malaria, danger, and risk perceptions among the Yao in rural Malawi.

Findings from a study designed to discover how local understanding of malaria among Yao in Malawi relate to pregnancy risk definitions reveal that malaria in pregnancy is not perceived as a major risk. Using extended ethnographic field research and multiple methods, we argue a shift from narrow single-disease approaches to malaria during pregnancy is required and document women's concerns about exposure to multiple vulnerabilities during pregnancy, including witchcraft, extramarital affairs, and multiple dangerous illnesses. Four dimensions are implicated in Yao perceptions of risk: perceived adverse consequences in pregnancy; ease of treatment and cure; transmission and agency to control; and type of risk (social-medical). We discuss implications and consider malaria program features needed to address the complexity of perceived vulnerabilities and living conditions in resource-poor settings.

Use of intermittent preventive treatment for malaria in pregnancy in a rural area of western Kenya with high coverage of insecticide-treated bed nets.

Kenya established intermittent preventive treatment (IPT) with sulfadoxine-pyrimethamine (SP) for malaria in pregnancy as national policy in 1998. We assessed the coverage of IPT among women who had recently delivered in a rural area of western Kenya with perennial malaria transmission and high coverage with insecticide treated nets (ITNs) through a cross-sectional, community-based survey in December 2002. Antenatal clinic (ANC) attendance was high (89.9% of the 635 participating women); 77.5% of attendees visited an ANC before the third trimester and 91.9% made more than one visit. Delivery of SP by the ANC was reported by 19.1% of all women but only 6.8% reported receiving more than one dose. Given the high rate of use of ANC services, if SP were given at each visit after the first trimester, the potential coverage of IPT (two doses of SP) would be 80.3% in this study population. ITNs were used by 82.4% of women during pregnancy, and almost all mothers (98.5%) who slept under an ITN shared the nets with their newborns after delivery. Women who thought malaria in pregnancy caused foetal problems were more likely to have used an ITN (adjusted odds ratio [AOR] 1.6, 95% confidence interval [CI] 1.0-2.4), and to have visited ANC more than once (AOR 2.4, 95% CI 1.2-4.7) compared to women who thought malaria in pregnancy was either not a problem or caused problems for the mother only. These findings illustrate the need for improved IPT coverage in this rural area. Identification and removal of the barriers to provision of IPT during ANC visits can help to increase coverage. In this area of Kenya, health messages stressing that foetal complications of malaria in pregnancy may occur in the absence of maternal illness may improve the demand for IPT.

Knowledge of malaria influences the use of insecticide treated nets but not intermittent presumptive treatment by pregnant women in Tanzania.

BACKGROUND: To reduce the intolerable burden of malaria in pregnancy, the Ministry of Health in Tanzania has recently adopted a policy of intermittent presumptive treatment for pregnant women using sulphadoxine-pyrimethamine (IPTp-SP). In addition, there is strong national commitment to increase distribution of insecticide treated nets (ITNs) among pregnant women. This study explores the determinants of uptake for both ITNs and IPTp-SP by pregnant women and the role that individual knowledge and socio-economic status has to play for each. METHODS: 293 women were recruited post-partum at Kibaha District Hospital on the East African coast. The haemoglobin level of each woman was measured and a questionnaire administered. RESULTS: Use of both interventions was associated with a reduced risk of severe anaemia (Hb<8 g/dL) compared to women who had used neither intervention (OR 0.31, 95% CI 0.14-0.67). In a logistic regression model it was found that attendance at MCH health education sessions was the only factor that predicted IPTp-SP use (OR 1.8, 95% CI 1.1-2.9) while high knowledge of malaria predicted use of ITNs (OR 2.3, 95% CI 1.1-4.9). CONCLUSION: Individual knowledge of malaria was an important factor for ITN uptake, but not for IPTp-SP use, which was reliant on delivery of information by MCH systems. When both these interventions were used, severe anaemia postpartum was reduced by 69% compared to use of neither, thus providing evidence of effectiveness of these interventions when used in combination.

Implementation of intermittent preventive treatment with sulphadoxine-pyrimethamine for control of malaria in pregnancy in Kisumu, western Kenya.

OBJECTIVE: In 1998, the Kenyan Ministry of Health introduced intermittent preventive treatment (IPT) with sulphadoxine-pyrimethamine (SP), one treatment dose in the second trimester (16-27 weeks) and one treatment dose between 28 and 34 weeks of gestational age, for the control of malaria in pregnancy. We evaluated the coverage and determinants of receipt of IPT after its introduction in the Provincial Hospital in Kisumu, western Kenya. METHODS: Information on the use of IPT in pregnancy was collected from women who attended the antenatal clinic (ANC) and delivered in the same hospital. In exit interviews, we assessed patterns of IPT use in the ANC. RESULTS: Of 1498 women who delivered between June 1999 and June 2000, 23.7%, 43.4% and 32.9% received > or =2, 1 or no dose of SP, respectively. Late first ANC attendance was the most important factor contributing to incomplete IPT; 45% of the women started attending ANC in the third trimester. More women received at least one tetanus toxoid immunization than at least one dose of IPT (94%vs. 67%, P < 0.05). In exit interviews, 74% correctly associated IPT with treatment of malaria; however, knowledge on the need for the second dose was poor. Three per cent of the administrations were given despite contraindications. The agreement between gestational age by date of last menstrual period and by palpation was low (kappa = 0.1). CONCLUSIONS: Education of pregnant women and ANC staff to increase earlier attendance for ANC has the potential to substantially increase the proportion of women receiving two doses of IPT with SP.

Changes in the personality profile of young women with latent toxoplasmosis.

Latent toxoplasmosis is the most widespread parasite infection in developed and developing countries. The prevalence of Toxoplasma gondii infection varies mostly between 20 to 80% in different territories. This form of toxoplasmosis is generally considered to be asymptomatic. Recently published results, however, suggest that the personality profiles of infected subjects differ from those of uninfected controls. These results, however, were obtained on non-standard populations (biologists or former acute toxoplasmosis patients). Here we studied the personality profiles of 191 young women tested for anti-Toxoplasma immunity during gravidity. The results showed that the differences between Toxoplasma-negative and Toxoplasma-positive subjects exits also in this sample of healthy women. The subjects with latent toxoplasmosis had higher intelligence, lower guilt proneness, and possibly also higher ergic tension. The difference in several other factors (desurgency/surgency, alaxia/protension, naiveté/shrewdness, and self-sentiment integration) concerned changes in the variances, rather than the mean values of the factors.