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Prevalence of Anti-Toxoplasma gondii and Anti-Brucella Spp. Antibodies in Pregnant Women From Mogadishu, Somalia

Authors:
  • Abrar University
  • Abrar University
  • Abrar University

Abstract

Toxoplasmosis and brucellosis are zoonotic diseases of worldwide distribution. They both cause abortion and infertility in human and animals. Limited data are available about these pathogens in Somali people and their animals. Hence, this study has evaluated the prevalence of anti-Toxoplasma gondii and anti-Brucella spp. antibodies in pregnant women in Mogadishu, Somalia. Serum samples from 307 pregnant women from Mogadishu, Somalia were tested for anti-T. gondii antibodies by Latex Agglutination Test (LAT) and anti-Brucella spp. antibodies by Rose Bengal Plate Test (RBPT) and a commercial competitive-ELISA (cELISA). A total of 119/307 (38.76%) pregnant women had a prior history of abortion. A total of 159/307 (51.79%; 95% CI: 46.2–57.35%) pregnant women were seroreactive for T. gondii by LAT at different stages of pregnancy. For Brucella spp., when RBPT and cELISA were combined 4/307 (1.30%; 95% CI: 0.36–3.30%) pregnant women were seroreactive to anti-Brucella spp. antibodies, being 2/307 (0.65%; 95% CI: 0.18–2.34%) by RBPT and 3/307 (0.98%; 95% CI: 0.33–2.83%) by cELISA. Two women were seroreactive for both agents. A high seropositivity to T. gondii and low seropositivity to Brucella spp. have been found in pregnant women from Mogadishu, Somalia. Considering the high number of abortions in the country associated to the fact that awareness on other zoonotic abortifacient pathogens in Somalis is very low, further studies should be conducted to evaluate the potential causes of abortions.
ORIGINAL RESEARCH
published: 04 August 2021
doi: 10.3389/frph.2021.672885
Frontiers in Reproductive Health | www.frontiersin.org 1August 2021 | Volume 3 | Article 672885
Edited by:
Renu Bharadwaj,
B. J. Medical College and Sassoon
Hospital, India
Reviewed by:
Theocharis Koufakis,
University General Hospital of
Thessaloniki AHEPA, Greece
Bahador Sarkari,
Shiraz University of Medical
Sciences, Iran
*Correspondence:
Abdulkarim A. Yusuf
karimvet@abrar.edu.so
Rafael F. C. Vieira
rvieira@ufpr.br
Specialty section:
This article was submitted to
Reproductive Epidemiology,
a section of the journal
Frontiers in Reproductive Health
Received: 10 March 2021
Accepted: 06 July 2021
Published: 04 August 2021
Citation:
Yusuf AA, Hassan-Kadle AA,
Ibrahim AM, Hassan-Kadle MA,
Yasin AM, Khojaly M, Garcia JL and
Vieira RFC (2021) Prevalence of
Anti-Toxoplasma gondii and
Anti-Brucella Spp. Antibodies in
Pregnant Women From Mogadishu,
Somalia.
Front. Reprod. Health 3:672885.
doi: 10.3389/frph.2021.672885
Prevalence of Anti-Toxoplasma
gondii and Anti-Brucella Spp.
Antibodies in Pregnant Women From
Mogadishu, Somalia
Abdulkarim A. Yusuf1, 2
*, Ahmed A. Hassan-Kadle 1,2 , Abdalla M. Ibrahim 1,2,3 ,
Mohamed A. Hassan-Kadle 3, Abdullahi M. Yasin3, Maha Khojaly 4, João L. Garcia 5and
Rafael F. C. Vieira 1,6
*
1Vector-Borne Diseases Laboratory, Department of Veterinary Medicine, Universidade Federal Do Paraná, Curitiba, Brazil,
2Abrar Research and Training Centre, Abrar University, Mogadishu, Somalia, 3College of Medicine and Health Science, Abrar
University, Mogadishu, Somalia, 4Central Veterinary Research Laboratory, Khartoum, Sudan, 5Department of Veterinary
Preventive Medicine, Londrina State University, Londrina, Brazil, 6Global One Health Initiative, The Ohio State University,
Columbus, OH, United States
Toxoplasmosis and brucellosis are zoonotic diseases of worldwide distribution. They
both cause abortion and infertility in human and animals. Limited data are available
about these pathogens in Somali people and their animals. Hence, this study has
evaluated the prevalence of anti-Toxoplasma gondii and anti-Brucella spp. antibodies
in pregnant women in Mogadishu, Somalia. Serum samples from 307 pregnant women
from Mogadishu, Somalia were tested for anti-T. gondii antibodies by Latex Agglutination
Test (LAT) and anti-Brucella spp. antibodies by Rose Bengal Plate Test (RBPT) and a
commercial competitive-ELISA (cELISA). A total of 119/307 (38.76%) pregnant women
had a prior history of abortion. A total of 159/307 (51.79%; 95% CI: 46.2–57.35%)
pregnant women were seroreactive for T. gondii by LAT at different stages of pregnancy.
For Brucella spp., when RBPT and cELISA were combined 4/307 (1.30%; 95% CI:
0.36–3.30%) pregnant women were seroreactive to anti-Brucella spp. antibodies, being
2/307 (0.65%; 95% CI: 0.18–2.34%) by RBPT and 3/307 (0.98%; 95% CI: 0.33–2.83%)
by cELISA. Two women were seroreactive for both agents. A high seropositivity to T.
gondii and low seropositivity to Brucella spp. have been found in pregnant women from
Mogadishu, Somalia. Considering the high number of abortions in the country associated
to the fact that awareness on other zoonotic abortifacient pathogens in Somalis is very
low, further studies should be conducted to evaluate the potential causes of abortions.
Keywords: foodborne pathogens, toxoplasmosis, brucellosis, abortion, One Health, Somalia
INTRODUCTION
Toxoplasmosis, caused by Toxoplasma gondii, and brucellosis, caused by Brucella spp., are
important zoonotic diseases with worldwide occurrence (13). These zoonotic pathogens may
be transmitted from animals to human beings and lead to negative health consequences such as
abortion and complete sterility (4).
Yusuf et al. Toxoplasmosis and Brucellosis in Somalia
Brucellosis in humans is commonly caused by Brucella
melitensis and/or Brucella abortus, and is characterized by
inflammation of the genitals and fetal membranes, abortions,
sterility and lesions in the lymphatic system and joints
(4,5). Endocarditis and neurological outcomes including
motor deficits, cranial nerve deficits, sciatica, confusion and/or
psychological disturbances, meningitis and seizures are severe
clinical presentations of the disease (6). Spontaneous miscarriage
and intrauterine fetal death during the first trimesters have
also been reported among pregnant women (5,7). The most
common causes of human infection were linked to consumption
of unpasteurized dairy products and labor conditions (e.g.,
veterinarians, slaughterhouse workers, and animal breeders) (4,
8).
Toxoplasma gondii is an important food and waterborne
opportunistic pathogen that causes severe disease in
immunocompromised individuals including pregnant women
which may result in abortion, fetal anomaly, stillbirth, fetal
growth restriction, and preterm birth (4,9,10). Acute phase of the
disease during pregnancy also causes congenital toxoplasmosis
(11). Several risk factors have been associated with human
toxoplasmosis, particularly cat contact and a history of raw
or undercooked meat consumption (4). Somali people do not
usually keep pets, but stray cats sometimes let into the houses and
some households perform their house activities on the ground
with a possibility of high risk of contamination (12). Hygienic
conditions, socio-economic structure, food and environment can
collectively have a notable influence on the diffusion of T. gondii
(13). Moreover, a previous study has reported the presence of T.
gondii (3.12%) in raw milk of camel from Iran (14).
Somalia is a tropical developing country in which climatic and
living conditions favors the dissemination of zoonotic pathogens.
Despite public and economic importance of toxoplasmosis and
brucellosis, few data are available in Somali people (12,13,
15) and their animals (1620). In addition, there are little
or no concerted medical and veterinary efforts to maximize
toxoplasmosis and brucellosis detection rates. Therefore, the
present study aimed to assess the prevalence of anti-T. gondii
and anti-Brucella spp. antibodies in pregnant women in
Mogadishu, Somalia.
MATERIALS AND METHODS
Ethics Statement
This study was approved by the Ethics Committee on Human
Research at Abrar University, Somalia (Reference Number
AU/ARTC/EC/04/02/2017). The directors of the involved Health
Offices gave their permission to conduct the research in their
respective facility. All pregnant women that accepted being part
of this study provided a written consent to participate.
Study Design
A cross-sectional study design was conducted from August 2017
and November 2018 to determine the prevalence of anti-T.gondii
and anti-Brucella spp. antibodies in pregnant women referred
to the Banadir Maternity and Children Hospital or Maternal
and Child Health (MCH) clinics in Mogadishu city, Somalia.
Facilities were selected based on their specialty in this sector,
while the pregnant women were selected on their willingness to
cooperate for this study. Participants were informed about the
study and a written consent was signed. The age of pregnant
women was stratified into groups of 15–30, 31–40, and >40
years old for statistical analysis. All study participants were
interviewed using a questionnaire which included demographics
and obstetric information comprising age, gestational age and
history of abortion.
Sampling
A total of 307 blood samples including first trimester (gestational
age of <14 weeks; n=44), second trimester (gestational age
between 14 and 28 weeks; n=53) and third trimester (gestational
age >28 weeks; n=210) pregnant women were evaluated. Blood
samples (3 mL) were collected by nurses by venipuncture of
brachial vein using plain sterile vacutainer tubes and labeled.
Samples were kept at room temperature (25C) until visible clot
formation, and then centrifuged at 1,500 ×g for 5 min and stored
at 20C until laboratory analysis.
Serological Diagnosis of Anti-T. gondii and
Anti-Brucella Spp. Antibodies
For the detection of anti-T. gondii antibodies, serum samples
were screened by a commercial latex agglutination test (LAT)
(SPINREACT, S.A/S.A.U Ctra, Santa Coloma, Spain), according
to the manufacturers’ instructions. The positive reactors were
then diluted; two-fold dilution, 1:2 up to 1:128. Sera showing titer
of 1:2 were considered positive for T.gondii.
For anti-Brucella spp. antibodies detection, serum samples
were initially screened by the Rose Bengal Plate Test (RBPT)
(CVRL, Khartoum, Sudan) and retested by a commercial
competitive-ELISA (cELISA) (Svanova Biotech AB, Uppsala,
Sweden), according to the manufacturers’ instructions. The
optical density (OD) was measured using a wavelength of
450 nm, and samples with a percentage of inhibition (% I) 30%
were considered positive by cELISA. Samples were considered
seropositive for anti-Brucella spp. antibodies when the serum
tested positive to RBPT and/or cELISA.
Data Analysis
Data were compiled and analyzed by Statistical Package for
Social Sciences (SPSS) version 25 (IBM Corp., Armonk, NY,
USA). Either Chi-square or Fisher’s exact-test was used to assess
association of the age, gestational age and history of abortion with
seropositivity of anti-T.gondii and anti-Brucella spp. antibodies.
Odds ratio (OR), 95% confidence intervals (95% CI) and P-values
were calculated, and results were considered significant when
P<0.05.
RESULTS
The majority of pregnant women were found within the age
group 15–30 years (85.34%) and two-thirds were presented in
the third trimester of gestational age (68.40%). A total of 119/307
(38.76%) pregnant women had a prior history of abortion
(Table 1).
Frontiers in Reproductive Health | www.frontiersin.org 2August 2021 | Volume 3 | Article 672885
Yusuf et al. Toxoplasmosis and Brucellosis in Somalia
TABLE 1 | Prevalence of anti-Toxoplasma gondii and anti-Brucella spp. antibodies in pregnant women from Mogadishu, Somalia.
Variable LAT RBPT cELISA
+/nPrevalence (%) (95% CI) P-value OR (95% CI) +/nPrevalence (%) (95% CI) +/nPrevalence (%) (95% CI)
Age 15–30* 132/262 50.38 (44.37–56.39) 1/262 0.38 (0.00–2.35) 2/262 0.76 (0.03–2.9)
31–40 25/42 59.52 (44.47–72.98) 0.272 (χ2=1.2) 1.4 (0.7–2.8) 1/42 2.38 (0.00–13.44) 1/42 2.38 (0.00–13.44)
>40 2/3 66.67 (20.25–94.37) 0.575 (χ2=0.3) 2 (0.2–22) 0/3 0.00 0/3 0.00
Gestational age 1st trimester 24/44 54.55 (40.06–68.3) 0.507 (χ2=0.4) 1.2 (0.6–2.4) 0/44 0.00 0/44 0.00
2nd trimester 32/53 60.38 (46.92–72.43) 0.140 (χ2=2.2) 1.6 (0.9–2.9) 0/53 0.00 0/53 0.00
3rd trimester* 103/210 49.05 (42.36–55.76) 2/210 0.95 (0.03–3.59) 3/210 1.43 (0.29–4.25)
History of abortion Yes 64/119 53.78 (44.85–62.48) 0.579 (χ2=0.3) 1.1 (0.7–1.8) 2/119 1.68 (0.08–6.2) 3/119 2.52 (0.52–7.29)
No* 95/188 50.53 (43.45–57.6) 0/188 0.00 0/188 0.00
*Reference, +, number of positive samples; n, number of samples; 95% CI, 95% confidence interval; OR, odds ratio.
A total of 161/307 (52.44%; 95% CI: 46.85–57.99%) pregnant
women were seroreactive for at least one pathogen. Anti-T. gondii
antibodies were detected in 159/307 (51.79%; 95% CI: 46.2–
57.35%) pregnant women by LAT. The antibody titers to T.
gondii positive sera were 5 (3.14%), 55 (34.59%), 50 (31.45%),
26 (16.35%), 16 (10.06%), 7 (4.40%), and 0 (0%) by dilution of
1:2, 1:4, 1:8, 1:16, 1:32, 1:64, and 1:128, respectively. Most of
pregnant women (34.59%) had antibody titer of 1:4 while higher
antibody titers, 1:64, were detected in seven pregnant women
serum sample.
Anti-Brucella spp. antibodies were detected in two out of
307 (0.65%; 95% CI: 0.18–2.34%) and three out of 307 (0.98%;
95% CI: 0.33–2.83%) pregnant women by RBPT and cELISA,
respectively. Only one out of 307 (0.33%; 95% CI: 0.06–1.82%)
pregnant woman was seroreactive for Brucella spp. by both
methods. All pregnant women seroreactive for Brucella spp. were
in the third trimester of gestational age and had a history of
abortion (Table 1).
Two out of 307 (0.65%; 95% CI: 0.18–2.34%) pregnant women
were seropositive for both T. gondii and Brucella spp. The
seroprevalence of Brucella spp. and T. gondii for each variable
evaluated is summarized in Table 1.
DISCUSSION
Toxoplasmosis and brucellosis are zoonotic diseases that may
lead to negative health consequences worldwide (14). Hence,
determining the prevalence of these pathogens among pregnant
women is paramount for prophylactic measures toward the
susceptible women and reducing the adverse health events
toward the seropositive women (21). Since the Somali civil war
of the 1990s, no studies have been conducted on the prevalence
and importance of toxoplasmosis and brucellosis in human
beings from Somalia, a livestock dependent country in East
Africa with a population of around 12.3 million (22). Previous
studies conducted in the 1980s in the country have showed
toxoplasmosis prevalence ranging from 10 to 61.2% in the general
human population (12,13,23) and 0% in pregnant women
(12), while prevalence of brucellosis ranged between 0 and 0.6%
(15,24).
Herein, the overall seroprevalence of brucellosis in pregnant
women was low (1.30%), in agreement with the prevalence
of brucellosis in animals (1.7%) from Somalia (16). This may
be due to the traditional prevention of diseases in livestock
farms through culling of animals with proven reproductive
problems. A strong association between human and animal
seropositivity of brucellosis has been reported in a linked study
in Kenya (25). However, the public health associated risk factors
of zoonotic pathogens like prevailing tradition of unheated milk
consumption and handling of aborted materials and reproductive
excretions with bare hands are commonly practiced in Somalia
(16), and this should be considered as a potential risk factor
for brucellosis and other abortifacients zoonotic pathogens.
Moreover, in the present study, all pregnant women seroreactive
for Brucella spp. were in the third trimester of gestational
age and had a prior history of abortion. However, pregnancy
Frontiers in Reproductive Health | www.frontiersin.org 3August 2021 | Volume 3 | Article 672885
Yusuf et al. Toxoplasmosis and Brucellosis in Somalia
complications associated with brucellosis in the country needs
further investigation.
The current finding on the prevalence of toxoplasmosis
(51.79%) is slightly higher than the previous reports of 43.6%
(13) and 40% (12) in Mogadishu, Somalia. However, the
present study is similar with previous reports from Kisumu,
Kenya (52%) (26), but lower than the findings from Arba
Minch, Ethiopia (79.3%) (27). The high seroprevalence of
toxoplasmosis found herein may be related to risk factors
described previously for the same location (12). Moreover, the
differences in the prevalence of toxoplasmosis between studies
may also be due to the antigen used (recombinant protein vs.
crude antigens).
In the present study, the seroreactivity rates to toxoplasmosis
were higher with the age, in agreement with previous studies
(4,27). This may be explained by the longer period of exposure
to risk factors (28). Moreover, association between seroreactivity
to T. gondii and history of abortion was not found (p=0.579).
Although the cause of abortion is multi-factorial, previous studies
have associated spontaneous abortion in pregnant women and
seroreactivity to T. gondii (2,29).
Previous studies have reported the majority of human beings
infected by T. gondii after birth are asymptomatic, however, some
may develop a mild disease or in rare cases, a more severe
systemic illness (2). Nonetheless, transplacental transmission of
T. gondii occurs if women acquire primary infection during
pregnancy (30). However, the risk of vertical transmission to
the fetus increases from the first trimester (10–24%) to the
third trimester (60–90%), but the potential of congenital defect
on fetus is more serious with earlier infections (27,31). In
the present study, we found higher rates of seroreactivity to
T. gondii in the first and second trimesters of gestational age,
indicating more serious effects on the fetus if fetal transmission
is developed. Unfortunately, no follow-up was conducted to
trace congenital transmission of toxoplasmosis and health
consequences of seroreactive pregnant women. Screening for T.
gondii infection during pregnancy is not regularly performed at
all maternity hospitals and clinics in Somalia, and most facilities
neglect this screening (data not shown). Prompt diagnosis
and treatment is essential for the prevention of a possible
vertical transmission of T. gondii and may minimize the fetal
sequelae (21).
There were some limitations in the present study; the
serological tests used were for the detection of anti-IgG
antibodies to T. gondii and Brucella spp. Thus, pregnant
women seroreactive for T. gondii and Brucella spp. may
have been previously exposed to the agents. Further studies
should use diagnostic methods to detect acute infection (IgM
serology and/or qPCR) on pregnant women, in order to guide
physicians for administering or not the properly therapy.
Moreover, Mogadishu city harbors fewer animal populations
when compared to other regions of Somalia, and thus, our
findings may not represent pregnant women from other regions.
However, our findings may still be useful as baseline information
for antenatal care in regions where animal rearing is common,
and also help to increase awareness of zoonotic diseases affecting
maternal and neonatal health.
CONCLUSION
A high seropositivity to T. gondii and low seropositivity to
Brucella spp. have been found in pregnant women from
Mogadishu, Somalia. Considering the high number of abortions
in the country associated to the fact that awareness on other
zoonotic abortifacient pathogens in Somalis is very low, further
studies should be conducted to evaluate the potential causes
of abortions.
DATA AVAILABILITY STATEMENT
The raw data supporting the conclusions of this article will be
made available by the authors, without undue reservation.
ETHICS STATEMENT
The studies involving human participants were reviewed
and approved by the Ethics Committee on Human
Research at Abrar University, Somalia (Reference Number
AU/ARTC/EC/04/02/2017). The patients/participants provided
their written informed consent to participate in this study.
AUTHOR CONTRIBUTIONS
AAY, AH-K, AI, and MH-K designed the study. AAY, AH-K,
MH-K, and AMY collected the data. AAY, AH-K, and MH-K
curated the data. AAY, AH-K, AI, MH-K, AMY, MK, JG, and RV
carried out the methodology. AAY, AH-K, and RV performed the
data analysis. AAY, AH-K, JG, and RV drafted the manuscript.
All authors edited and approved the final manuscript.
FUNDING
This study was financially supported by Abrar University,
Somalia, with Grant Number AURG04022017. The funder had
no role in the study design, collection, analysis and interpretation
of data, preparation of the manuscript or decision to publish.
ACKNOWLEDGMENTS
The authors would like to thank staff members of Banadir
Maternity and Children Hospital and Maternal and Child Health
(MCH) clinics in Mogadishu, Somalia for their kind assistance
in the collection of blood samples and questionnaires. We also
thank pregnant women who participated in this study. This study
is part of a master’s degree for AAY at the Universidade Federal
do Parana. AAY was sponsored by a fellowship from the Brazilian
National Council of Scientific and Technological Development
(CNPq). AH-K acknowledges The World Academy of Sciences
(TWAS), UNESCO and Islamic Development Bank (IsDB) for
their support through IsDB-TWAS post-doctoral fellowship
program in Sustainability Sciences (Grant No. 15/2020) at the
Universidade Federal do Paraná, Brazil. CNPq also provided a
Research Productivity (PQ) fellowship of to JG and RV (CNPq
- 313161/2020-8).
Frontiers in Reproductive Health | www.frontiersin.org 4August 2021 | Volume 3 | Article 672885
Yusuf et al. Toxoplasmosis and Brucellosis in Somalia
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Frontiers in Reproductive Health | www.frontiersin.org 5August 2021 | Volume 3 | Article 672885
... Our research efforts have resulted in several notable scientific publications on zoonotic diseases, including the first molecular investigations of animal trypanosomiasis in Somalia [19,20]. Data provided by our studies on brucellosis and toxoplasmosis in pregnant women emphasized the significance of understanding zoonotic abortifacient pathogens in the Somali community [21]. Additionally, our recent data exploring Rift Valley Fever (RVF) and Brucella sp. in ruminants [22]. ...
... Local practices of drinking raw milk and dealing with aborted or dead animals without personal protective equipment (PPEs) in the community create an enabling environment facilitating the transmission of zoonotic pathogens [21,22]. Moreover, slaughtering livestock under poor hygienic conditions and proper meat inspection, sometimes in inappropriate places like rivers and water points, and mismanaging animal by-products can lead to environmental pollution and zoonotic diseases spreading throughout the community (Fig. 2). ...
... Zoonotic diseases are a major concern in Somalia. Diseases like brucellosis, RVF, Q fever, and toxoplasmosis pose significant health risks and economic burdens [21,22,32]. However, the surveillance, prevention, and control of zoonotic diseases face challenges due to limited resources, inadequate diagnostic capabilities, and weak surveillance systems. ...
Article
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One Health (OH) is an integrated approach aiming at improving the health of people, animals, and ecosystems. It recognizes the interconnectedness of human health with the health of animals, plants, and the environment. Since Somali people’s livelihoods are mainly based on livestock, agriculture, marine resources, and their shared environment, OH-oriented initiatives could significantly impact the country toward reducing complex problems affecting the health of humans, animals, and the environment. The term “One Health” was first introduced into the global scientific community in September 2004 and in 2013 in Somalia. After ten years, there is still a long road ahead for implementing the OH approach in the country. Herein, we present the status, opportunities, and challenges of OH in Somalia and recommend ways to promote and institutionalize it. The country has been involved in various OH initiatives solely driven by external funding, focusing on research, capacity development, and community interventions, apart from university-led initiatives such as Somali One Health Centre. In Somalia, OH initiatives face numerous challenges, ranging from limited infrastructure and resources to weak governance and institutional capacity. We urge the Somali government to address these challenges and prioritize OH as the main approach to tackling critical health issues. We suggest the Somali government institutionalize and implement OH actions at all administrative levels, including Federal, State, District, and community, through a mechanism to improve multisectoral coordination and collaboration to predict, prevent, detect, control, and respond to communicable and non-communicable diseases at the human-animal-ecosystem interface for improving health outcomes for all.
... Te impact of brucellosis is most severe among economically disadvantaged populations living near livestock with limited access to healthcare [1,14]. Studies in Somalia revealed diferent rates among pregnant women, ranging from 1.30% to 5%, particularly in pastoral and agro-pastoral communities [7,15]. ...
... Pearson's chi-square test was used to evaluate diferences between groups. Bivariate analysis was conducted to determine the variables associated with Brucella seropositivity, along with the crude odds ratio and 95% confdence interval [15]. Subsequently, multivariable logistic regression analysis was performed to examine the relationships between the outcome and independent variables. ...
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Background: Brucellosis typically spreads from animals to humans through contact with infected animals or their byproducts. This zoonotic disease can have serious consequences and is often caused by contact with infected livestock or their products, such as contaminated dairy, posing significant risks during pregnancy. This study aimed to evaluate the prevalence of Brucella infection among pregnant women residing in the Burao City area of northeast Somaliland, in environments where human-animal interaction is a frequent occurrence. Therefore, it is important to identify the factors that contribute to its occurrence. Methods: From January to June 2024, this cross-sectional study was conducted at five healthcare facilities that provide antenatal care. Pregnant women who attended these facilities were invited to participate in this study. A structured questionnaire was used to collect data on sociodemographic background, obstetric history, behaviors, and practices related to brucellosis. The presence of Brucella antibodies in the serum was detected using the Rose Bengal Plate Test (RBPT), and positive samples underwent further analysis with enzyme-linked immunosorbent assays (ELISA) to distinguish between IgG and IgM antibodies. Bivariate analysis was conducted to identify variables associated with Brucella seropositivity, whereas multivariable logistic regression was used to determine independent factors linked to Brucella seropositivity after adjusting for other variables. Results: A total of 216 participants were included in the study. The overall prevalence of Brucella infection, determined using the RBPT, was 25.93% (56 out of 216). Among those who tested positive, 61.14% (34 out of 56) had IgG antibodies and 21.42% (12 out of 56) had IgM antibodies against Brucella, as confirmed by ELISA, and IgM ELISA testing revealed 5.6% of pregnant women had recent Brucella infections. Brucella seropositivity was found to be less likely for individuals who frequently interacted with manure, as indicated by an adjusted odds ratio of 0.052 and a 95% confidence interval of 0.016–0.169. Consumption of raw animal milk (AOR 4.84, 95% CI 2.24–10.42), and involvement in assisting animals during childbirth (AOR 4.26, 95% CI 1.065–17.0) significantly increased the risk of Brucella seropositivity. Conclusion: Brucellosis poses a considerable public health threat to pregnant women residing in areas with frequent human-animal interactions. Factors such as the consumption of raw animal products, intimate contact with animals, and involvement in assisting with animal birth escalate this risk. These findings emphasize the importance of implementing strategies aimed at reducing exposure and enhancing the timely detection of brucellosis among pregnant women.
... High prevalence rates of anti-T. gondii antibodies among pregnant women, with rates of 45.2% and 51.8% reported by Hassan et al. (2023) and Yusuf et al. (2021) respectively, suggesting potential exposure to the parasite. Similarly, livestock in Somalia has shown significant infection rates, with Hassan-Kadle (2014) reporting prevalence rates of 6.3% in camels, 7.1% in cattle, 34.5% in sheep, and 26.7% in goats. ...
Article
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Toxoplasma gondii and Neospora caninum infect a wide range of domestic and wild animals, including humans, in the case of T. gondii, and cause economic losses in livestock due to abortion and neonatal mortality. In Somalia, zoonotic diseases are concerning due to cultural practices and livestock’s economic importance, but surveillance is limited. This study aimed to determine the seroprevalence and molecular prevalence of T. gondii and N. caninum in Somali sheep, goats, and cattle. A cross-sectional study was conducted between December 2018 and January 2020 in Benadir and Lower Shabelle regions of Somalia. Blood samples were collected from 128 cattle, 184 goats, and 46 sheep. Serum samples were tested for anti-T. gondii and anti-N. caninum antibodies using IFAT, and PCR was performed on extracted DNA to detect T. gondii and N. caninum DNA. Overall, 106/358 (29.6%) animals tested positive for anti-T. gondii antibodies, with the highest prevalence in sheep (62.5%), followed by goats (30.4%) and cattle (15.6%) (P < 0.001). For anti-N. caninum antibodies, 13/358 (3.6%) animals tested positive, with cattle showing the highest prevalence (6.2%), followed by goats and sheep (both 2.2%). Co-seropositivity for both antibodies was found in cattle and sheep. Molecular detection of T. gondii DNA revealed a prevalence of 9/358 (2.5%), primarily in sheep (15.2%) and cattle at 1.6% while all goat samples tested negative. No samples were positive for the N. caninum Nc5 gene. This study reveals T. gondii and N. caninum prevalence in Somali ruminants, highlighting the need for better surveillance and control.
... Moreover, Al-Faifi and Ibrahim described neonatal brucellosis in a premature baby, likely from exposure to infected amniotic fluids in utero or during delivery from a mother with recurrent abortions from brucellosis [10]. Congenital and neonatal cases reaffirm that inadequately treated maternal brucellosis can prompt placental seeding and fetal infection [16]. Therefore, prompt maternal diagnosis and antibiotic treatment is imperative. ...
Article
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Background While often unrecognized, brucellosis, a significant zoonotic disease, silently endangers the health of mothers and children worldwide. This scoping review sheds light on transmission pathways, maternal–fetal consequences, and treatment hurdles, specifically considering maternal and child health concerns. Method To comprehensively grasp brucellosis in mothers and children, we systematically scoured electronic databases (DOAJ, Google Scholar, PubMed, and Semantic Scholar) for studies published after 2005. Our search included experimental studies (both randomized controlled clinical trials and quasi-experimental), analytical observations, descriptive reports, qualitative papers, and existing systematic reviews. All retrieved data were then charted and processed following Arksey and O'Malley's established framework for scoping reviews. Result Twenty-five studies spanning varied regions and methodologies met inclusion criteria. Key findings demonstrate that zoonotic brucellosis acquisition from livestock exposures among vulnerable maternal groups accounts for up to 70% of cases. Vertical transmission from mother to child during pregnancy, delivery, or breastfeeding was reported in 15–20% of cases. Substantial risks of miscarriage (25%), preterm birth (20%), hepatosplenomegaly (10%), febrile illness (30%), and possible long-term complications were documented. Treatment success rates using combination antibiotic therapy were reported to be as high as 98%, though emerging antibiotic resistance patterns challenge effective treatment, with 25% of Brucella isolates resistant to rifampin and 51% resistant to both trimethoprim-sulfamethoxazole and streptomycin. Conclusion This review reveals the alarming yet hidden toll brucellosis takes on maternal–fetal pairs and breastfeeding. In regions battling this endemic disease, tailored education, upgraded diagnostic tools, prompt antibiotic therapy, responsible antimicrobial stewardship, and One Health collaborations offer crucial pathways to shield mothers and children from its harmful consequences. Continued research will pave the way for even better solutions to alleviate this complex zoonosis, particularly for vulnerable populations.
... Valley fever (RVF), Q fever, and toxoplasmosis is a pressing concern in Somalia, contributing significantly to public health risks and economic burdens (Frangoulidis et al., 2021;Hassan-Kadle et al., 2019Yusuf et al., 2021). However, to the best of our knowl- Trataris et al., 2012), Bartonella clarridgeiae in dogs (Gundi et al., 2004), B. bovis in cattle (Boularias et al., 2020;Dahmani et al., 2017;Raoult et al., 2005), and African wild buffaloes (Syncerus caffer) (Gonçalves et al., 2018), 'Candidatus B. dromedarii' in dromedary (Bessas et al., 2022;Selmi et al., 2020), and a putative novel genotype of Bartonella spp. in African wild buffaloes (Gonçalves et al., 2018). ...
Article
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Background: Bartonellosis, caused by bacteria of the genus Bartonella, is a zoonotic disease with several mammalian reservoir hosts. In Somalia, a country heavily reli- ant on livestock, zoonotic diseases pose significant public health and economic chal- lenges. To the best of our knowledge, no study has been performed aiming to verify the occurrence of Bartonella spp. in Somalia. This study investigated the occurrence and molecular characterization of Bartonella in dromedary (Camelus dromedarius, Linnaeus, 1758), cattle, sheep, and goats from Somalia. Materials and Methods: 530 blood samples were collected from various animals (155 dromedary, 199 goat, 131 cattle, and 45 sheep) in Benadir and Lower Shabelle regions. DNA was extracted for molecular analysis, and a qPCR assay targeting the NADH dehydrogenase gamma subunit (nuoG) gene was used for Bartonella screening. Positive samples were also subjected to PCR assays targeting seven molecular mark- ers including: nuoG, citrate synthase gene (gltA), RNA polymerase beta-subunit gene (rpoB), riboflavin synthase gene (ribC), 60 kDa heat-shock protein gene (groEL), cell division protein gene (ftsZ), and pap31 and qPCR targeting the 16-23S rRNA internal transcribed spacer (ITS) followed by Sanger sequencing, BLASTn and phylogenetic analysis. Results: Out of 530 tested animals, 5.1% were positive for Bartonella spp. by the nuoG qPCR assay. Goats showed the highest Bartonella occurrence (17/199, 8.5%), followed by sheep (6/44, 6.8%), cattle (4/131, 3.1%), and dromedary (1/155, 1.9%). Goats, sheep, and cattle had higher odds of infection compared to dromedary. Among nuoG qPCR- positive samples, 11.1%, 14.8%, 11.1%, and 25.9% were posi - tive in PCR assays based on nuoG, gltA, and pap31 genes, and in the qPCR based on the ITS region, respectively. On the other hand, nuoG qPCR- positive samples were negative in the PCR assays targeting the ribC, rpoB, ftsZ, and groEL genes. While Bartonella bovis sequences were detected in cattle ( nuoG and ITS) and goats ( gltA), Bartonella henselae ITS sequences were detected in dromedary, goat, and sheep. Phylogenetic analysis placed gltA Bartonella sequence from a goat in the same clade of B. bovis. Conclusion: The present study showed, for the first time, molecular evidence of Bartonella spp. in dromedary and ruminants from Somalia and B. henselae in sheep and goats globally. These findings contribute valuable insights into Bartonella spp. occur- rence in Somali livestock, highlighting the need for comprehensive surveillance and control measures under the One Health approach.
Article
The One Health (OH) approach in Somalia, first introduced in 2013, remains in its early stages despite growing global recognition. With Somalia’s complex health challenges, including zoonotic diseases, antimicrobial resistance, food insecurity, and environmental degradation, the OH approach presents a critical strategy for addressing interconnected health issues across human, animal, and environmental sectors. However, the implementation of OH in Somalia faces significant obstacles, such as limited government commitment, weak institutional capacity, and the lack of cohesive policies and governance. While external funding has driven key initiatives, local ownership and sustainable leadership are essential for long-term success. The Somali One Health Centre (SOHC) at Abrar University has emerged as a key player in advancing OH principles in Somalia, through education, research, and community engagement. SOHC has facilitated collaborations with national, regional, and international stakeholders, producing significant research on zoonotic diseases and advancing capacity-building initiatives. Notable programs, such as the Postgraduate Certificate in One Health and the SOHC Youth One Health Talks, are fostering a new generation of OH advocates. Despite these strides, challenges remain, including the need for greater national ownership, policy development, and cross-sectoral collaboration. This manuscript explores the progress and challenges of OH implementation in Somalia, highlighting the role of SOHC in promoting OH integration. It underscores the importance of governance, institutional frameworks, and sustained funding to ensure the success and sustainability of OH initiatives. It suggests that a holistic, collaborative approach involving all sectors, from government to community, is essential for tackling Somalia’s health challenges and advancing the global One Health agenda. Information © The Authors 2025
Article
This article presents the results of a study on the diagnosis of the combined infection "brucellosis + toxoplasmosis" among the population of Azerbaijan. The aim of this study was to investigate the frequency and characteristics of detection of dual infection "brucellosis + toxoplasmosis" among samples received by the Special Dangerous İnfections Control Center. The results of the conducted study may have great scientific and practical significance both for fundamental science and for clinical practice. The analysis of the results of studies of the Special Dangerous İnfections Control Center’s laboratory of blood samples received in 2019-2021 from 3208 patients with suspected brucellosis who sought medical treatment in the country was carried out. Serological and molecular testing was carried out by generally accepted methods in accordance with the rules in BSL2.
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Background Toxoplasmosis has public health importance, particularly in immunocompromised individuals such as pregnant women leading to congenital abnormalities and fetal losses. In this study, we aimed to determine the seroprevalence of toxoplasmosis in sheep at Mandeeq Slaughter House in Hargeisa and pregnant women attending antenatal care at Hargeisa Group Hospital. Methods Cross‐sectional study design with systematic random sampling method and Questionnaire surveys were used for the collection of data from sheep and pregnant women. Sera were collected and examined for anti‐Toxoplasma gondii antibodies using latex agglutination test. Results The overall prevalences of toxoplasmosis were 25.5% and 28% in sheep and human, respectively. Multivariable logistic regression analysis indicated that female (AOR = 2.18; 95% CI: 1.38–3.47; p = 0.001) and young age groups of sheep (AOR = 3.04; 95% CI: 1.04–8.86; p = 0.041) were significantly associated with T. gondii seropositivity. In pregnant women, age groups between 25 and 34 (AOR = 2.76; 95% CI: 1.07–7.14; p = 0.037), pregnant women who have cats in their home (AOR = 6.45; 95% CI: 2.37–17.52; p = 0.000), women who have close contact with garden soil (AOR = 6.74; 95% CI: 2.55–17.81; p = 0.000), poor hand washing practices before food eating (AOR = 29.5; 95% CI: 5.41–161.11; p = 0.000), and drinking tap water (AOR = 8.4; 95% CI: 2.54–28.08; p = 0.000) were significantly associated with T. gondii seropositivity. Conclusion Toxoplasmosis is prevalent in sheep and pregnant women in Hargeisa. We recommend that pregnant women should avoid eating uncooked mutton, reduce gardening activities, keep personal and environmental hygiene, and drink boiled water to reduce the risk of the toxoplasmosis.
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Background: The COVID-19 pandemic has highlighted the need for a holistic health approach, emphasizing the interconnectedness of human, animal, plant, and environmental health. Somalia faces significant health challenges, including drought, floods, disease outbreaks, and food and feed insecurity, underscoring the importance of integrating One Health (OH) concepts into its education system. This study evaluated the inclusion of the OH concept in Somalia’s national school curriculum and textbooks and assessed teacher preparedness to deliver the content effectively. Methods: This study employed content analysis of Somalia’s school curriculum and textbooks in science, social studies (grades 1–8), and biology (grades 9–12) to assess OH integration. The survey evaluated the coverage of human, animal, and plant health; environmental issues; and key terms such as infectious diseases, zoonoses, antimicrobial resistance, food safety and security, climate change, environmental health, and pandemic preparedness. Additionally, a questionnaire was used to survey 53 Somali primary and secondary teachers across disciplines to assess the integration of OH, explore inclusion strategies, and gather perspectives on challenges and approaches. Results: An analysis of the textbooks revealed that a significant majority (88.4%) of the topics lacked OH content. Of the 11.6% with OH content, 80.4% integrated concepts from environmental health (46 topics) and infectious diseases (26 topics); however, the term OH was not directly mentioned. The upper primary science materials had the highest proportion (63%) of OH content, followed by the lower primary materials (28.3%), while the secondary subject biology materials had the least amount of OH integration (8.7%). Science textbooks had the highest inclusion (60 topics), while secondary subject biology had the least (8 topics). Among the 53 Somali teachers surveyed, there was moderate awareness (47.2%) and limited implementation (24.5%) of OH concepts, despite widespread support (98.1%) for integration. Challenges such as inadequate OH training and resources (86.8%) were cited, while 96.2% emphasized the importance of interdisciplinary collaboration. Conclusions: Limited integration of OH in Somalia’s education system hampers preparedness for health challenges. Collaborative efforts to revise curricula can bolster resilience against pandemics and promote holistic well-being, benefitting the overall well-being of people, animals, plants, and the environment. One Health impact statement This study highlights the critical need to incorporate One Health concepts into Somalia’s education system to equip future generations with the knowledge and skills necessary to address interconnected health challenges facing humans, animals, plants, and the environment. The findings reveal a significant gap in the integration of One Health principles within the current curriculum, with many topics lacking relevant content. While some materials address environmental health and infectious diseases, crucial areas such as zoonosis, antimicrobial resistance, and climate change are minimally covered. Additionally, the study underscores the challenges faced by teachers, including inadequate OH training and resources, and the importance of interdisciplinary collaboration for successful One Health implementation. By integrating One Health concepts into the education system, Somalia’s young will gain the interdisciplinary knowledge necessary to respond effectively to health emergencies and contribute to enhancing the country’s resilience against pandemics.
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Background Toxoplasma gondii (T. gondii) is an intracellular pathogen that can lead to abortion in pregnant women infected with this parasite. Therefore, the present study aimed to estimate the global seroprevalence of anti-T. gondii antibodies in women who had spontaneous abortion based on the results of published articles and evaluate the relationship between seroprevalence of anti-T. gondii antibodies and abortion via a systematical review and meta-analysis. Methods Different databases were searched in order to gain access to all studies on the seroprevalence of anti- T. gondii antibodies in women who had spontaneous abortion and association between seroprevalence of anti-T. gondii antibodies and abortion published up to April 25th, 2019. Odds ratio (OR) and the pooled rate seroprevalence of T. gondii with a 95% confidence interval (CI) were calculated using the random effects model. Results In total, 8 cross-sectional studies conducted on 1275 women who had abortion in present pregnancy, 40 cross-sectional studies performed on 9122 women who had a history of abortion, and 60 articles (involving 35 cross-sectional studies including 4436 women who had spontaneous abortion as case and 10398 as control and 25 case-control studies entailing 4656 cases and 3178 controls) were included for the final analyses. The random-effects estimates of the prevalence of anti-T. gondii IgG antibody in women who had abortion in present pregnancy and women who had a history of abortion were 33% (95% CI: 17%-49%) and 43% (95% CI: 27%-60%), respectively. In addition, the pooled OR for anti-T. gondii IgG antibody in cross-sectional and case-control studies among women who had spontaneous abortion were 1.65 (95% CI: 1.31–2.09) and 2.26 (95% CI: 1.56–3.28), respectively. Also, statistical analysis showed that the pooled OR of the risk of anti-T. gondii IgM antibody 1.39 (95% CI: 0.61–3.15) in cross-sectional and 4.33 (95% CI: 2.42–7.76) in case-control studies. Conclusion Based on the results of the current study, T. gondii infection could be considered a potential risk factor for abortion. It is recommended to carry out further and more comprehensive investigations to determine the effect of T. gondii infection on abortion to prevent and control toxoplasmosis among pregnant women around the world.
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Background Brucellosis, coxiellosis, and toxoplasmosis can be transmitted from infected ruminants to pregnant women and may induce adverse pregnancy outcomes; however, there are to date few studies. This study aimed to examine the seropositivities of immunoglobulin G (IgG) against those three pathogens among pregnant women with adverse pregnancy outcomes, and to explore the associated factors. Methods A cross-sectional study was conducted in southern Thailand, where goat production is common. A total of 105 pregnant Thai women who had adverse pregnancy outcomes and serum samples collected at first antenatal care visit before their 28th gestational week from June 2015 to June 2016 were included. The seropositivities of IgG anti-Brucella abortus, Toxoplasma gondii, and Coxiella burnetii antibodies were tested by using commercial enzyme-linked immunosorbent assay (ELISA) kits. Associated factors with seropositivity were analyzed using multiple logistic regression. Results Most women were Muslim aged 20–34 years and 32.4% had a prior history of one or more adverse pregnancy outcomes. One-third of the women had been exposed to goats or raw goat products. Of the 105 serum samples, the seropositivity of anti-T. gondii IgG was highest (33/105, 31.4%), followed by anti-C. burnetii IgG (2/105, 1.9%), and anti-B. abortus IgG (1/105, 1.0%), respectively. None of the pregnant women were found to be co-seropositive for those three pathogens. Conclusions One-third of women with adverse pregnancy outcomes showed positive antibodies for toxoplasmosis, coxiellosis and brucellosis. A dose-response relationship between seropositivity of anti-T. gondii IgG and age was noticed.
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Background Brucellosis is a neglected debilitating zoonosis with a high prevalence in many developing countries. Bovine brucellosis is widespread in Cameroon but the epidemiological situation of human brucellosis is not known. A cross sectional study was carried to determine the seroprevalence and factors associated with bovine and human Brucellosis among abattoir personnel and pregnant women in Ngaoundéré, Cameroon. Methods Serum sample from 590 abattoir cattle and 816 plausible occupational risk and vulnerable humans to brucellosis (107 abattoir personnel and 709 pregnant women) were collected and screened for anti-brucella antibodies using Rose Bengal Plate Test (RBPT) and ELISA tests. Structured questionnaires were used to collect data on socio-demographics and risk-factors. The differences in proportions between seropositive and seronegative reactors were tested using odds-ratio and χ²tests. Results Bovine brucellosis seroprevalence was at 3.40% (n = 590; 3.4% for RBPT, 5.93% for i-ELISA). Human Brucella seroprevalence was at 5.6% among abattoir personnel (n = 107; 5.6% for RBPT, 12.15% for Brucella IgG ELISA) and 0.28% in pregnant women (n = 709; both tests). Breed (P < 0.00001) was associated with increased risk of brucellosis in cattle and the seroprevalence was highest among the Djafoun (OR = 16.67, 95%CI: 4.49–28.85) and Akou (OR = 16.96, 95% CI: 0.10–23.91) cattle compared to the other breeds. There was a moderate positive correlation (R² = 0.5025) of Brucella IgG concentrations (> 200 U/ml) and clinical data for Brucella IgG ELISA seropositive humans. Several potential factors were associated (P > 0.05) with increased risk of human brucellosis seroprevalence among the abattoir personnel. The abattoir personnel were essentially males; the seropositive respondents were male and did not use protective equipment at work. Handling of foetus and uterine contents (OR = 13.00, 95%CI: 1.51–111.88) was associated with increased risk of human brucellosis. Conclusions Antibrucella antibodies are prevalent in cattle (3.40%), among abattoir personnel (5.60%) and in pregnant women (0.28%) in Ngaoundéré, Cameroon. The study reports the first evidence of human brucellosis in Cameroon and therefore, an indication of a real public health problem. Public awareness campaigns and health education especially among livestock professional and in agropastoral communities should be highlighted to disseminate knowledge, associated risk factors and control measures of brucellosis.
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Background Relevant seroprevalence data for endemic pathogens in a given region provide insight not only into a population’s susceptibility to acute infection or risk for reactivation disease but also into the potential need for policy initiatives aimed at reducing these risks. Data from sub-Saharan Africa are sparse and since Aga Khan University Hospital Nairobi is an internationally accredited hospital equipped with a laboratory electronic medical record system, analysis of pertinent local seroprevalence data has been made possible. Methods We have analyzed serology data from laboratory electronic records at a 300 bed tertiary private teaching hospital in Kenya for the dates, 2008 to 2017 for Toxoplasma gondii, cytomegalovirus, and rubella, which were used primarily for antenatal screening. We also analyzed the data from hepatitis A and amebiasis serologies, which were used primarily for diagnostic purposes. Results For T. gondii, cytomegalovirus, and rubella, we used IgG serology to determine seroprevalence, finding rates of 32%, 86%, and 89%, respectively. There was no significant age-related difference in the 20 to 49 year old age range for any of these three pathogens. Of the Hepatitis A IgM tests that were ordered, 33% were positive with a peak positive rate of 70% in the five to nine year old age range. The seroprevalence of amebiasis was 4% and all cases of seropositivity were accompanied by compatible clinical illness (hepatic abscess). Conclusions These data provide insight into seroprevalence rates of selected pathogens that can be used to guide screening and diagnostic laboratory testing as well as private and public immunization practices.
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Primary Toxoplasma gondii infection in pregnant women may result in abortion, stillbirth, or lifelong disabilities of the unborn child. One of the main transmission routes to humans is consumption of raw or undercooked meat containing T. gondii tissue cysts. We aim to determine and compare the regional distribution of T. gondii seroprevalence in pregnant women and meat-producing livestock in China through a systematic literature review. A total of 272 eligible publications were identified from Medline, Scopus, Embase and China National Knowledge Infrastructure. Apparent and true seroprevalence were analysed by region using a novel Bayesian hierarchical model that allowed incorporating sensitivity and specificity of the applied serological assays. The true seroprevalence of T. gondii in pregnant women was 5.0% or less in seven regions of China. The median of the regional true seroprevalences in pigs (24%) was significantly higher than in cattle (9.5%), but it was not significantly higher than in chickens (20%) and small ruminants (20%). This study represents the first use of a Bayesian hierarchical model to obtain regional true seroprevalence. These results, in combination with meat consumption data, can be used to better understand the contribution of meat-producing animals to human T. gondii infection in China.
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