REPUBLIC OF CAMEROON REPUBLIQUE DU CAMEROON

PEACE-WORK-FATHERLAND PAIX-TRAVAIL-PATRIE

MINISTRY OF HIGHER EDUCATION MINISTERE DE L‘ENSEIGNMENT SUPERIEUR

ST. LOUIS UNIVERSITY DOUALA

FACULTY OF HEALTH SCIENCES

DEPARTMENT OF MEDICAL LABORATORY SCIENCE

EVALUATING THE PREVALENCE AND RISK FACTORS OF

TOXOPLASMA GONDI IN THE DEVELOPMENT OF
CONGENITAL TOXOPLASMOSIS AMONGST PREGNANT
WOMEN ATTENDING SOLIDARITY HOSPITAL BUEA

A RESEARCH REPORT SUBMITTED TO THE DEPARTMENT OF MEDICAL

LABORATORY SCIENCE, FACULTY OF HEALTH SCIENCES, ST. LOUIS
UNIVERSITY INSTITUTE DOUALA IN PARTIAL FULFILLMENT OF THE
REQUIREMENTS FOR THE AWARD OF A HIGHER NATIONAL DIPLOMA
(HND) IN MEDICAL LABORATORY SCIENCE.

PRESENTED BY
PENN HADDISON ACHA (24MLSO593)

SUPERVISOR
Mr. FUMBUI LOUIS
1
(BSc, MSc PARASITOLOGY)
 CERTIFICATION

This research project of PENN HADDISON ACHA 24MLSO592, entitled “EVALUATING

THE PREVALENCE AND RISK FACTORS OF TOXOPLASMA GONDI IN THE

DEVELOPMENT OF CONGENITAL TOXOPLASMOSIS AMONGST PREGNANT

WOMEN ATTENDING SOLIDARITY HOSPITAL BUEA” is the original work carried out

by PENN HADDISON ACHA, as part of the requirements for the partial fulfilment for the award

of Higher National Diploma (HND)

Supervised by;

Mr. FOMBUI LOUIS

Signature………………………… Date………………………….

HOD

Signature………………......... Date…………………….

2
 DEDICATION

This work is dedicated to my

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 ACKNOWLEDGEMENT

I would like to express my sincere gratitude to my supervisor for their guidance and support

throughout my research on Toxoplasma gondii. Their expertise and insights have been invaluable

in helping me navigate the complexities of this topic.

I would also like to thank God for giving me the strength and wisdom to complete this research.

Without His grace, I would not have been able to overcome the challenges and obstacles that I

encountered along the way.

To my parents and loved ones, thank you for your unwavering support and encouragement.

Your love and belief in me have been a constant source of motivation and inspiration.

Once again, thank you to all who have contributed to my research journey on Toxoplasma gondii

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 ABSTRACT

BACKGROUND: Over 70% of the worlds‘ population is infected by Toxoplasma gondii; a pathogen capable of

causing cerebral toxoplasmosis in HIV patients and neonatal complications like miscarriage, chorioretinitis,

hydrocephalus, cerebral calcification and fetal death in the third trimester of pregnancy. In spite of this, the burden

of this zoonotic pathogen is poorly understood in Cameroon. The aim of the present study therefore, is to determine

the burden of T. gondii among normal individuals, HIV patients and pregnant women as well as the distribution of

the infection across Cameroon

OBJECTIVES: The main aim of this study is to assess the prevalence, risk factors in the development of

neurological disorders and congenital Toxoplasmosis amongst pregnant women at the Solidarity Hospital Buea.

MATERIALS AND METHODS; This study shall make use of a descriptive cross-sectional study design. Serum

samples were collected from 142 pregnant women attending the ante natal clinic after obtaining informed consent.

Toxoplasma Gondi specific IgG antibodies were detected by indirect solid-phase enzyme immunoassay (EIA),

immunoComb® Toxo lgG. A structured questionnaire was used to collect information on sociodemographic

parameters and predisposing risk factors for toxoplamosis from each patient.

RESULTS; The findings from this study showed that there is a moderate prevalence rate of congenital toxoplasmosis

of 52%. which is consistent with the study carried published by WHO 2021, which reveals a prevalence rate of

55.4%

CONCLUSION; The result of this study reveals that Congenital Toxoplasmosis can be caused by the consumption

of poorly cooked contaminated meat and through the soil from cats feces. Which are the predisposing risk factors.

KEYWORDS: Congenital Toxoplasmosis, Prevalence, Risk factors, Neurological disorders

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6
Contents
DEDICATION ................................................................................................................................. 3
APPENDIX ...................................................................................................................................... 8
LIST OF ABBREVIATIONS ........................................................................................................... 9
CHAPTER ONE .............................................................................................................................11
INTRODUCTION ..........................................................................................................................11
1.1 Background of the study .......................................................................................................11
1.2 Statement of the problem ..................................................................................................... 13
1.3 Significance of the study ...................................................................................................... 13
1.4 Research Question................................................................................................................ 14
1.4.1 Main Research Question ................................................................................................... 14
1.4.2 Specific Research Question .......................................................................................... 14
1.5.1 Main Objective .............................................................................................................. 14
1.5.2 Specific Objective ......................................................................................................... 15
1.6. Research Scope and Delimitation ....................................................................................... 15
1.7. Definition of Terms and Concept ........................................................................................ 15
LITERATURE REVIEW ............................................................................................................... 17
2.1 An overview of Congenital Toxoplasmosis ......................................................................... 17
2.1.1 Definition of Congenital toxoplasmosis ....................................................................... 17
2.1.3 Pathogenesis in Man ......................................................................................................... 20
Direct microscopy; Detection of tachyzoites in blood and tissue cyst in tissue biopsy......... 21
Detection of Toxoplasma antibody by Sabin Feldman dye test IgM ELISA, IgG ELISA IgG
avidity test, TORCH test in Newborn .................................................................................... 21
Immunity ................................................................................................................................ 21
2.1.5 Treatment ...................................................................................................................... 21
2.1.6 Control .......................................................................................................................... 22
2.2 Burden .............................................................................................................................. 22
2.1.3 Clinical Manifestations ................................................................................................. 24
2.1.4 Prevention of Congenital Toxoplasmosis...................................................................... 24
2.2 Prevalence of Congenital Toxoplasmosis ............................................................................ 25
2.3 Risks factors of Congenital Toxoplasmosis ......................................................................... 26
3.1 Study area and study setting................................................................................................. 29

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 3.3 Study population .................................................................................................................. 29
3.3.2 Exclusion criteria .......................................................................................................... 30
3.4 Sample size .......................................................................................................................... 30
3.5 Sampling Procedure ............................................................................................................. 31
3.6 Data Collection Procedure ................................................................................................... 31
3.6.1 Study of the variables .................................................................................................... 31
3.6.2 Data Collection Tool ..................................................................................................... 32
3.7 Data Management Plan ........................................................................................................ 33
3.8 Data Analysis Plan ............................................................................................................... 33
3.9 Ethical Consideration ........................................................................................................... 33
5.1 DICUSSIONS ...................................................................................................................... 44
5.3 RECOMMENDATION ........................................................................................................ 45
REFERENCES............................................................................................................................... 46
APPENDIX 1 ................................................................................................................................. 53
INFORMED CONSENT ............................................................................................................... 53
APPENDIX TWO ...................................................................................................................... 54
CONSENT FORM FOR PARTICIPANTS ............................................................................ 54
APPENDIX 3 ................................................................................................................................. 55
RESEARCH QUESTIONAIRE .................................................................................................... 55
APPENDIX 4 ................................................................................................................................. 58

APPENDIX

Appendix 1……………………………………………………………………

Appendix 2…………………………………………………………………….

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LIST OF ABBREVIATIONS

CT Congenital Toxoplasmosis

WHO World Health Organization

CDC Center of disease control

ATI Acute Toxoplasma Infection

DALYs Disability Adjusted Life Years (DALYs)

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10
 CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Acute toxoplasma infection (ATI) during pregnancy, if undiagnosed and untreated, can lead to

congenital toxoplasmosis (CT), a severe and often life-threatening disease with significant fetal

and neonatal morbidity and mortality (Ishaku et al, 2009) Worldwide, the annual incidence of CT

is estimated to be 190,100 cases (179,300–206,300), corresponding to 1.2 million disability

adjusted life years (DALYs) per year (Gamble HR et al, 2019). The spectrum of CT disease is

broad, and fetuses and infants with CT may be asymptomatic or have severe symptoms such as

cerebral calcification, hydrocephalus or microcephaly, seizures, developmental delay,

chorioretinitis, strabismus, vision loss, hearing loss, hepatosplenomegaly, jaundice, petechiae.,

thrombocytopenia, anemia and/or transaminases (Fakhri Y et al, 2019). ATI can also be

asymptomatic during pregnancy or cause a mild flu-like illness with low-grade fever, fatigue,

and lymphadenopathy. Without universal prenatal screening strategies, most ATIs in pregnancy

remain undiagnosed and untreated (Ishaku A et al, 2019). In the context of vertical transmission

from mother to child during pregnancy, it is estimated an average of 190,100 incident cases of

congenital toxoplasmosis yearly, with 1.5 neonatal cases occurring per 1,000 live births globally

(D. N et al, 2018). In addition, the infection with T. gondii is usually asymptomatic in

immunocompetent hosts but can cause devastating disease in immunocompromised individuals.

In Nigeria the seroprevalence rates of toxoplasmosis by serological investigations have been

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estimated to vary from 7% to 51.3% in normal pregnant women to 17.5% to 52.3% in women

with abnormal pregnancies and abortions (Ishaku et al 2018), reported prevalence rates to be

29.1%. Also, seroprevalence rates of 40.2% from Senegal; and 34.1% from pregnant women in

Sudan were reported. In Southern Turkey anti-Toxoplasma IgG and IgM antibody was found to

be 52.1% and 0.54% respectively (Nissapatorn et al)., found significant differences in

Toxoplasma seroprevalence rates among the races where: t0he highest rate was in the Malaysia

(55.7%), followed by the Indian (55.3%) and the Chinese (19.4%) populations.

In Cameroon, the few studies on toxoplasma have been limited to urban areas. For

example, the seroprevalence of T. gondii was shown to be high among HIV/AIDS patients in the

Yaoundé teaching hospital (69.9 %) (Dubey et al ,2015) and pregnant women who consulted at

the Department of Gynecology in the Douala general hospital (70 %) (Njunda et al 2011).

71.8 % prevalence was also observed among women attending antenatal care in Limbe, along the

coastal region of Cameroon. The study in Douala observed that the consumption of raw

vegetables and untreated water were the main risk factors associated with toxoplasmosis in

pregnant women (Ndumbe et al). The infection occurs widely, and varies depending on social

and cultural habits, geographic factors, climate, and route of transmission. It has been reported

that the prevalence is higher in warm and humid areas. Toxoplasma gondii is transmitted to

humans through ingestion of oocysts in water, food or soil contaminated with cat‘s faces, or by

eating raw or undercooked meat containing cysts, and women can transmit the infection through

the placenta to their unborn fetus. Other infectious pathways are blood transfusion, and organs

transplantation

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1.2 Statement of the problem

Toxoplasmosis has been described as the most widespread zoonotic infection caused by an

intracellular parasite called Toxoplasma gondii, Although, the mortality rate of this parasite in

adult is very low but it causes devastating effects including blindness, neurological impairment

and mental retardation in congenitally infected children. Toxoplasma gondii was implicated as

significant cause of fetal and neonatal mortality when acquired in-utero and an important

contributor to early and later childhood morbidity. Congenital infection occurs only when a

woman becomes infected during pregnancy and the severity of the illness is related to the

trimester period. It was observed that congenital infections acquired during the first trimester are

more severe than those acquired in the second and third trimester

In Cameroon, the few studies on toxoplasma have been limited to urban areas. For example, the

seroprevalence of T. gondii was shown to be high among HIV/AIDS patients in the Yaoundé

teaching hospital (69.9 %) and pregnant women who consulted at the Department of Gynecology

in the Douala general hospital (70 %). 71.8 % prevalence was also observed among women

attending antenatal care in Limbe, along the coastal region of Cameroon. The study in Douala

observed that the consumption of raw vegetables and untreated water were the main risk factors

associated with toxoplasmosis in pregnant women.

1.3 Significance of the study

To Researchers: This study will serve as a baseline to or for other researchers for further

research.

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To the Government: This research may help the government of Cameroon to draft policies to

help reduce some modifiable risk factors posing itself as a leading course in the prevalence of

Congenital Toxoplasmosis in pregnant women.

1.4 Research Question

1.4.1 Main Research Question

What is the Prevalence and risk factors of Toxoplasma gondii in the development of Congenital

toxoplasmosis amongst pregnant women attending Solidarity Hospital Buea ?

1.4.2 Specific Research Question

I. What is the Prevalence of Toxoplasma gondii in the development of congenital

toxoplasmosis amongst Pregnant women?

II. What are the risk factors of Toxoplasma Gondi in the development of Congenital

Toxoplasmosis amongst Pregnant women?

1.5 Study objective.

1.5.1 Main Objective

The main objective of this study was to evaluate Prevalence and risk factors of Toxoplasma

gondii in the development of neurological disorders and Congenital toxoplasmosis amongst

pregnant women attending Solidarity Hospital Buea.

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1.5.2 Specific Objective

i. To determine Prevalence of Toxoplasma gondii in the development of neurological

disorders and congenital toxoplasmosis amongst Pregnant women attending Solidarity

hospital Buea.

ii. To identify risk factors of Toxoplasma Gondi in the development of neurological

disorders and congenital Toxoplasmosis amongst Pregnant women attending Sodality

hospital Buea.

1.6. Research Scope and Delimitation

Thematic scope: Toxoplasmosis is one of the common worldwide parasitic zoonosis, caused by

the Apicomplexa protozoan Toxoplasma gondii, but this study will focus on the prevalence and

risk factors.

Spatial scope: The prevalence and risk factors of Toxoplasmosis can be studied from schools

and in the community but this study was focused on pregnant women attending Solidarity

Hospital Buea.

1.7. Definition of Terms and Concept

Prevalence; Prevalence refers to the proportion of a particular population that has a specific

characteristic or condition at a given point in time. It is often expressed as a percentage or a ratio.

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Risk factors; A risk factor is any characteristic, behavior, or condition that increases the

likelihood of developing a particular disease or health condition. These can include genetic

predisposition, environmental exposures, lifestyle choices, and medical history. Identifying and

understanding risk factors is important for predicting and preventing the onset of certain health

issues.

Congenital toxoplasmosis; Congenital toxoplasmosis is a condition in which a fetus is infected

with the Toxoplasma gondii parasite while in the womb. Congenital toxoplasmosis can cause

serious complications for the fetus, including brain and eye damage, as well as other health

problems.

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 CHAPTER TWO

LITERATURE REVIEW

2.1 An overview of Congenital Toxoplasmosis

2.1.1 Definition of Congenital toxoplasmosis

Toxoplasmosis is one of the common worldwide parasitic zoonosis, caused by the

Apicomplexa protozoan Toxoplasma gondii. This parasite has cats as the definitive host, and

warm-blooded animals as intermediate hosts. High prevalence of the infection has been reported

among pregnant women and women of childbearing age from different parts of this is infected

with the Toxoplasma gondii parasite while in the womb. This can occur if a pregnant woman

becomes infected with the parasite for the first time during her pregnancy and passes it on to her

unborn child. Toxoplasma gondii is transmitted to humans through ingestion of oocysts in water,

food or soil contaminated with cat‘s faces, or by eating raw or undercooked meat containing

cysts [7–10], and women can transmit the infection through the placenta to their unborn fetus.

Other infectious pathways are blood transfusion, and organs transplantation

TAXONOMIC CLASSIFICATION OF TOXOPLASMA

Domain: Eukaryote

Kingdom: Chromalveolata

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Phylum: Apicomplexa

Class: Conoidasida

Order: Eucoccidiorida

Family: Sarcocystidae

Genus: Toxoplasma

Species: gondii

2.1.2 Life Cycle of Toxoplasma gondii

The life cycle of Toxoplasma can be divided into two stages;

I. The asexual cycle with little host specificity i.e., the stage that occurs in sheep, humans,

rodents and birds (intermediate host)

II. The sexual stage of the life cycle, confined to the intestinal epithelial cells of cats, which

results in the production of oocysts.

The asexual life cycle of Toxoplasma

Tachyzoite stage:

1. Cats shed millions of unsporulated oocysts in their faeces, these take 1-5 days to sporulate

depending on the climatic conditions

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2. The sheep ingests a sporulated oocyst

3. In the gut the sporozoites are released and they penetrate the intestinal wall an migrate via the

lymphatic and portal systems. Cats (young strays in particular) are the primary source of

infective oocysts as the shed millions in their faeces.

4. Tachyzoites penetrate host cells and become surrounded by a vacuole –Toxoplasma gondii can

infect cells in the reproductive system, central nervous system, lung, liver and muscle tissue

5. The tachyzoites multiply asexually by a process called ‗budding‘ 6. Once 8 – 16 tachyzoites

have accumulated, the cell ruptures and new cells are infected

Some cases result in the death of the host, but more usually the host develops immunity to the

infection and chronic infection is established, which is called the bradyzoite stage.

Bradyzoite stage:

1. Antibodies are produced by the host‘s immune system and any extra cellular parasites are

eliminated

2. The antibodies limit the invasiveness of intracellular tachyzoites to new cells, resulting in

the formation of cysts which are found most frequently in the brain and skeletal muscle

3. These cysts contain between a few and many thousands of organisms called bradyzoites,

which grow very slowly – this is the latent form. If immunity wanes, cysts may rupture releasing

bradyzoites.

The sexual stage of the life cycle of Toxoplasma.

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The sexual stage of the life cycle starts when a (usually) young cat ingests food containing cysts,

such as a rodent The walls of the cysts dissolve in the stomach and small intestine The released

bradyzoites penetrate the epithelial cells of the small intestine and form gametocytes over the 3-

15 days following infection The formed microgametes are released and swim to and penetrate

macrogametes The resulting oocysts, each containing a fertilized gamete, are passed out of the

cat and sporulate within 1 –

5days.

2.1.3 Pathogenesis in Man

Sources of infection: Contaminated water or food by oocysts, Ingestion of tachyzoites and

bradyzoites (cysts) in flesh of infected host. Undercooked meat. Mother to fetus. Organ

transplant (rare), Blood transfusion (rare).

When man ingests Oocysts with eight Sporozoites excreted in Cats feces, can establish an

infection and reproduces Asexually. In humans Oocysts open in duodenum and releases eight

Sporozoites which pass through the gut wall. Circulate in body and invade various cells

Toxoplasmosis in Pregnancy; In 1st Trimester May lead to s ay lead to still birth Major central

nervous system anomalies. In 2nd Trimester Less severe complications, Birth Anomalies still

Congenital infection; Lead to Still Birth, Chorioretinitis, Intracellular calcification,

Psychomotor, disturbances, Hydrocephaly, Microcephaly, Prenatal toxoplasmosis may manifest

with blindness apart from congenital defects Babies infected with Congenital Toxoplasmosis

manifest with brain damage, enlarged spleen and liver, eye damage jaundice, poor motor

coordination, unusually small head rash

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Non-Pregnant women and immunocompromised individuals; Varying degrees of disease may

occur in Immunosuppressed individuals results in Retinitis, Chorioretinitis, Pneumonia, Other

nonspecific manifestations. Toxoplasmosis produces severe Human infections in patient with

AIDS. The chronic infection is altered to Acute manifestations.

2.1.4 Diagnoses of congenital toxoplasmosis

Direct microscopy; Detection of tachyzoites in blood and tissue cyst in tissue

biopsy

Detection of Toxoplasma antibody by Sabin Feldman dye test IgM ELISA, IgG

ELISA IgG avidity test, TORCH test in Newborn

Diagnose of Congenital Toxoplasmosis; Toxoplasma antigens in amniotic fluid PCR, IgM

antibodies in fetal blood by ELISA. Ultrasound of fetus at 20 to 24 weeks of gestation

Immunity

Acquired immunity in women is particularly protective to the fetus.

In Immunosuppressed and AIDS patients changes the host resistance and causes chronic

infection becomes fulminating acute Toxoplasmosis

2.1.5 Treatment

Combination of Pyrimethamine amethamine and Sulphadiazine or Trisulfapyramidines

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Other alternative Drugs; Spiramycin, Clindamycin, Trimethoprim – Sulphmethoxazole

In pregnancy – Spriamycin is recommended drug

2.1.6 Control

Avoidance of human contact with Cat feces is highly important measure.

Changing of Cat litter and safe disposal can prevent transmission.

Pregnant women should avoid contact with kittens.

Periodic screening of pregnant women with high risk for IgG and IgM antibodies to

Toxoplasmosis is recommended

Avoid eating raw or undercooked meat Freezing < -200c. Heating at 500c for 4-6 minutes

destroys the cysts and sterilizes the meat.

2.2 Burden

Worldwide, the annual incidence of Congenital Toxoplasmosis is estimated to be 190,100 cases

(179,300–206,300), corresponding to 1.2 million disability-adjusted life years (DALYs) per year

(Gamble HR et al, 2019). Toxoplasma parasite causes life-threatening diseases like

immunological impairments and congenital infection of the fetus. Congenital toxoplasmosis

results from a maternal infection acquired during gestation. The rate of congenital infection in

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fetus from women with acute infection ranges from 20% to 100% depending on which trimester

the acute infection occurs in: 15% to 25% in the first trimester, 30% to 54% in the second

trimester, and 60% to 65% in the third trimester; by the last week of gestation, the incidence

approaches 100% (Dubey et al). The outcome is more severe if the infection occurs early in the

pregnancy. The consequences include spontaneous abortions, stillbirth or serious birth defects

when infection takes place during the first trimester of pregnancy, and chorioretinitis, visual

impairment, hydrocephalus. T. gondii infections are common in humans. Seroprevalence rates

are highly variable, but they are typically 10-30% in North America, northern Europe and

Southeast Asia; 30-50% in Central and Southern Europe; and higher in Latin America and

tropical regions of Africa (Fakhri Y et al, 2019). The consequences of infection are most serious

in pregnant women and immunocompromised people. Estimates of the rate of congenital

toxoplasmosis range from approximately 1 in 3000 births to 1 in 10,000 births.

(Njunda et al 2011).

The serological screening of pregnant women for toxoplasmosis and the follow-up until delivery

are not routine procedures in Cameroon. In a few studies performed in our country,

seroprevalence of T. gondii infection among pregnant women was found to be 77.1% in 1992

and 65.5% in 2011 (Ndumbe et al, 2014). However, those previous study on the prevalence of

toxoplasmosis among pregnant women has been done only in urban setting. As a result,

information is very scarce on the prevalence of toxoplasmosis among pregnant women in rural

setting where some predisposal factors are more frequent than in urban area. The present study

aimed to determine the seroprevalence of Toxoplasma gondii specific IgG antibodies among

pregnant women and to identify the predisposing risk factors for toxoplasmosis.

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2.1.3 Clinical Manifestations

Toxoplasmosis is one of the most common parasitic zoonoses world-wide caused by Toxoplasma

gondii, which establishes long-lasting infections in humans and animals. The spectrum of CT

disease is broad, and fetuses and infants with CT may be asymptomatic or have severe symptoms

such as cerebral calcification, hydrocephalus or microcephaly, seizures, developmental delay,

chorioretinitis, strabismus, vision loss, hearing loss, hepatosplenomegaly, jaundice, petechiae,

thrombocytopenia, anemia and/or transaminases (Fakhri Y et al, 2019). Acute Toxoplasma

Infection can also be asymptomatic during pregnancy or cause a mild flulike illness with low-

grade fever, fatigue, and lymphadenopathy. Without universal prenatal screening strategies, most

ATIs in pregnancy remain undiagnosed and untreated (Rhostami A et al, 2019). Chronic

Toxoplasmosis include spontaneous abortions, stillbirth or serious birth defects when infection

takes place during the first trimester of pregnancy, and chorioretinitis, visual impairment,

hydrocephalus, intracranial calcifications, irreversible cognitive and other neurologic impairment

in case of infection during the second or third trimester

2.1.4 Prevention of Congenital Toxoplasmosis

Congenital toxoplasmosis is a condition that occurs when a pregnant woman becomes infected

with the Toxoplasma gondii parasite, which can be passed to the fetus and cause serious health

problems. Here are some ways to prevent congenital toxoplasmosis:

Avoid exposure to cat feces: The Toxoplasma gondii parasite is found in the feces of infected

cats. Pregnant women should avoid cleaning litter boxes and should wear gloves if they must

handle cat feces (World Health Organization, 2022).

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Cook meat thoroughly: The Toxoplasma gondii parasite can also be found in undercooked or raw

meat. Pregnant women should ensure that meat is cooked to an internal temperature of at least

160°F (World Health Organization, 2022).

Wash fruits and vegetables: The Toxoplasma gondii parasite can also be found in soil, so

pregnant women should wash fruits and vegetables thoroughly before eating them.

Practice good hygiene: Pregnant women should practice good hygiene by washing their hands

frequently, especially after handling raw meat or coming into contact with soil (World Health

Organization, 2022).

For primary prophylaxis, Trimethoprim sulfamethoxazole is the drug of choice

Get tested: Pregnant women can get tested for toxoplasmosis to determine if they have been

infected. If a woman is infected, she can receive treatment to reduce the risk of passing the

infection to her fetus. (World Health Organization, 2022).

By taking these precautions, pregnant women can reduce their risk of contracting toxoplasmosis

and protect their unborn child from congenital toxoplasmosis.

2.2 Prevalence of Congenital Toxoplasmosis

Worldwide, the annual incidence of CT is estimated to be 190,100 cases (179,300–206,300),

corresponding to 1.2 million disability-adjusted life years (DALYs) per year (Gamble HR et al,

2019). With regard to the WHO-defined-regions, the highest prevalence of ATI in pregnant

women (2.5%; 95% CI: 1.7–3.4%; 671/30,149) was reported for the Eastern Mediterranean

25
region, and the lowest prevalence (0.5%; 95% CI: 0.4–0.7%; 3,568/681,265) was in the

European region

In Sub Saharan the seroprevalence rates of toxoplasmosis by serological investigations have

been estimated to vary from 7% to 51.3% in normal pregnant women to 17.5% to 55.5% in

women with Congenital Toxoplasmosis. In Cameroon the combined seroprevalence of anti-T.

gondii antibodies among the 178 women of child-bearing age in our study area was calculated to

be 54.5 % (Ndumbe et al 2014). Among the seropositive women, 86 were seropositive for IgG

antibodies, 30 were seropositive to IgM antibodies, and 19 were seropositive for both IgG and

IgM antibodies giving a prevalence of 48.3, 16.9 and 10.7 % respectively

2.3 Risks factors of Congenital Toxoplasmosis

There have been many studies of risk factors for Congenital Toxoplasmosis in pregnancy in sub-

Saharan Africa, the consumption of raw or undercooked meat was significant a risk factor

associated with T. gondii infection. In addition, consumption of unwashed vegetables or fruits

was observed to be significantly associated with toxoplasma seropositivity in the univariate

analysis, although it was only marginally significant in the multivariable analysis. Similar results

have been observed in studies done in Mexico Ethiopia and Sudan, whereas studies done in

Douala-Cameroon and Thailand, showed a significant association between T. gondii infection

and consumption of untreated water only. Although domestic cats are probably the major source

of contamination, cat ownership and contact with cats were not found to be significantly

associated with T. gondii infection. Indeed, only 6 % of the total study population reported

having cats at home. The prevalence of toxoplasmosis in the human population is associated

with exposure to risk factors. An increased prevalence of toxoplasmosis is detected in people

26
who are often in contact with soil, who eat raw or insufficiently heat-treated meat or raw

vegetables, or who lack basic personal hygiene or have unhygienic food preparation. Some risk

factors for congenital toxoplasmosis include:

1. First-time pregnancy: Women who are pregnant for the first time have a higher risk of

contracting toxoplasmosis.

2. Exposure to infected cats: Women who live with cats or work in environments where

they may come into contact with cat feces have a higher risk of contracting toxoplasmosis.

3. Eating undercooked or raw meat: Women who eat undercooked or raw meat, especially

pork, lamb, and venison, have a higher risk of contracting toxoplasmosis.

4. Exposure to contaminated soil: Women who work in agriculture or gardening may be at

risk of exposure to contaminated soil.

5. Traveling to areas with high rates of toxoplasmosis: Women who travel to areas with high

rates of toxoplasmosis, such as South America and parts of Europe, may be at increased risk of

contracting the infection.

It is important for pregnant women to take precautions to avoid these risk factors and protect

their unborn child from congenital toxoplasmosis.

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 CHAPTER THREE

MATERIALS AND METHODS

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3.1 Study area and study setting

This study was conducted at Solidarity Hospital Buea. The Solidarity Hospital Buea is found in

the Fako division of the South West Region of Cameroon on the foot of Mount Cameroon;

Situated precisely between the delegation of Education and the army camp along the high way to

the Bokwango neighborhood.

The study was carried out at the Solidarity hospital Buea because of its high patient inflow. Also,

malaria is holoendemic in the South West Region of Cameroon. The Mt. Cameroon Area has an

equatorial climate made up of a long rainy season which runs from March to October with

maximum rainfall usually recorded in the months of August and September. The climatic

condition of Buea (warm temperature, high rainfall, and humid air), favors the growth of malaria

transmitting mosquitos. The above reasons therefore increase the chances of obtaining a high

sample size.

3.2 Study design

A cross-sectional study was carried out.

3.3 Study population

The study population are all pregnant women attending Solidarity Hospital Buea.

3.3.1 Inclusion criteria

Participants of this study included and who satisfy the following criteria are:

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I. All pregnant women attending Solidarity Hospital Buea, who was present

during the period of the study (from the 01st of January to the 09th of

February 2024).

II. All pregnant women who will give their consent to participate in the study.

3.3.2 Exclusion criteria

Although this study will target all pregnant women, individuals that was excluded from this

study, in the cases where they will not satisfy the following criteria:

I. All pregnant women who was present at the Solidarity Hospital Buea, but will not

give their consent to participate in the study. ii. All pregnant women having mental

disorder.

3.4 Sample size

The sample size for this study was determined using the Corcoran‘s formula, which states that;

Sample Size (n) = Z²pq/e²

Where n= the sample size z= 1.96 (from the z table) p= expected proportion in the

population based on previous studies. From a study done in

Cameroon, the prevalence of Congenital Toxoplasmosis was 0.54599(545 (Ndumbe et al, 2014).

Hence, our p value is

= 0.545

q= 1-p, which is = 1-0.545

30
e= Absolute error or precision, which 0.5 (5%)

This implies our estimated sample size is, n = (1.96) ²x (0.545) x (0.455)/ (0.05) ² = 129 people

Taking into account a 10% non-response rate, which is 10% of the calculated participant size,

10/100x 129= 12.9 people This therefore implies our actual sample size was be 129+12.9 =

142people

3.5 Sampling Procedure

The sampling and sample collection technique was used for this study, whereby all pregnant

women present at the hospital and willing will take part in this study, through the filling of

questionnaire. It is an easy and inexpensive method of collecting data.

3.6 Data Collection Procedure

3.6.1 Study of the variables

Prevalence; Prevalence refers to the proportion of individuals in a population who have a

particular disease, condition, or risk factor at a specific point in time or over a certain period. It is

often expressed as a percentage or a rate and is used to estimate the burden of a disease or

condition on a population. Prevalence can be affected by various factors such as age, gender,

genetics, lifestyle, and environmental factors.

31
Risk factors are characteristics or behaviors that increase the likelihood of developing a

particular disease or condition. These can include genetic predisposition, lifestyle choices such as

smoking or poor diet, environmental factors such as exposure to toxins, and demographic factors

such as age, gender, and socioeconomic status.

3.6.2 Data Collection Tool

The data collection tool for this study was a Questionnaire and clinical examination involving

laboratory tests.

The questionnaire was structure into 02 sections that is;

SECTION A; was on the demography data ( age, name, occupation, marital status)

SECTION B; was on predisposing factors the participants

3.6.3 Data Collection

Participants were informed that participation in the data collection is voluntary, and little amounts

of venous blood were drawn for analysis. Patients' details (names, age, and sex) were collected

during the data collection process. After that, patients were welcomed, invited to take a

comfortable seat. Participants were given an explanation of collecting, and they would also

receive a questionnaire with. The antecubital vein of the forearms was selected and disinfected

with 70% alcohol cotton wool swab. Venous blood was collected into a dry tube, which was

labeled with the patients name and code.

32
3.7 Data Management Plan

Data was entered into Microsoft Excel sheets and exported to Epi-Info for analysis using

descriptive statistics and noted on a registration notebook.

3.8 Data Analysis Plan

Statistical significance was set at 95% confidence interval (CI). At the initial step of the analyses,

frequency distributions of each variable were produced and the information arranged according

to age groups and risk factors.

3.9 Ethical Consideration

It is crucial to take certain ethical guidelines into account before beginning any scientific

research, particularly when working with human subjects.

For this study, an ethical clearance was obtained from the research community of ST. LOUIS

UNIVERSITY INSTITUTE DOUALA upon deposition of research proposal. An authorization

was gotten from the South West Regional Delegation of public Health. Also, an authorization

was obtained from the Director of the Solidarity Hospital Buea, permitting the principal

investigator to carry out this study.

Finally, a form of informed consent was signed out by all participants, without any influence on

them from the principal investigator. This will give participants the right to withdraw when they

want. Also, signing this form increased trust between the participant and principal investigator.

33
An assent will equally be signed out by parents for very young participants seeking for their

parent consent before examining their child. Sensitive information for participants will not be

included nor considered in this study.

Participants‘ results were handed over to them, except in cases of children where it was handling

to their parent or guardians. Participation was free to and participants will not be influenced by

any means to partake in this study, and also, participants will have free malaria tests and

counselling on management strategies on how to prevent malaria.

34
 CHAPTER FOUR

RESULTS

4.0 Introduction

4.1 Demographic data

This study had a study population of 142 but only 110 people participated in this study. A

majority of women were within the age of 17-25years 58 (53%) and the minority age >40 was 8

(7%). Most of the participants 62(56%) were workers, students 25(23%) and the least were

retired 10(9%). With respect to marital status, most of the participants were married 61(55%),

single 32(29%), and divorced 18(16). Looking at the level of education most of the participants

were secondary level 42(38%), university 36(33%) and the least did not go to school.

35
Table 1: Socio demographic distribution of study participants

Variable characteristics Frequency Percentage %

Age group 17-25 58 53
26-35 26 24
36-40 18 16
>40 8 7
Total 110 100
Occupation Student 25 23
Worker 62 56
Retired 10 9
Unemployed 13 12
Total 110 100
Marital Status Single 32 29
Married 61 55
Divorced 18 16
Widow 0 0
Total 110 100
Educational level Primary 18 16
Secondary 42 38
University 36 33
None 14 13
Total 110 100
Religion Christian 69 63
Muslim 32 29
Others 9 8
Total 110 100

36
4.2 PREVALENCE OF CONGENITAL TOXOPLASMOSIS

The overall prevalence of congenital toxoplasmosis in the study was 57 as shown in figure 1

Overall prevalence of Congenital toxoplasmosis

48%
52%

1st Qtr 2nd Qtr

Figure1: overall prevalence of Congenital Toxoplasmosis

37
4.2.0 Prevalence of Congenital Toxoplasmosis with respect to Socio demographic

Characteristics

Table 2 below shows the respective prevalence values of Congenital Toxoplasmosis with respect

to Socio demographic characteristics of positive cases. Out of 110 participants, a total of 57

participant were diagnose Toxo positive (IgG or IgM). With respect to age group greater than 40

years had 4.5%, 17 – 25 years (21.8%), age group 26 -35 (14.5%), and the age group 36-40 years

(4.5%). Most of the participants with higher prevalence 29.1% were married, second by single

with 16.4%, divorced with 6.4% and finally the widowed with 0%. Per occupational distribution,

unemployed respondents came out with 4.5%, workers with 32%, students with 12.7% and the

least retired with 2.7%

38
Table 2: Prevalence of Congenital Toxoplasmosis with respect to Socio demographic

Characteristics

Variable Number examined(n) Percentage %

Age

17-25 58(24) 22

26-35 26(16) 14.5

36-40 18(5) 11

>40 8(5) 4.5

Total 110(57) 52

Occupation

Student 25(14) 12.7

Worker 62(35) 32

Unemployed 13(5) 2.7

Retired 10(3) 4.5

Total 110(57) 52.0

Marital status 32(18) 16.4

Single 61(32) 29.1

Married 18(7) 6.4

Divorced 18(7) 6.36

Total 110(57) 52.0

Educational level

Primary 18(13) 11.8

39
Secondary 42(21) 19.1

University 36(15) 13.6

None 14(8) 7.3

Total 110(57) 52.0

Religion

Christian 69(37) 33.6

Muslim 32(17) 15.4

Others 9(4) 2.8

Total 110(57) 52.0

40
4.3 RISK FACTORS OF CONGENITAL TOXOPLASMOSIS

Table 3 below shows results on various risk factors of congenital toxoplasmosis for positive

cases. With those that have heard of Congenital Toxoplasmosis being 37(33.7) and those who

haven‘t heard has a value of 20(18.2). Most of the participants 31(28.2%) says Toxoplasmosis can

be poorly transmitted through poorly uncooked meat, 9(8.2%) through the soil from cats‘ feces, 5

(4.5%) believes through insect bites. Majority of the participants 39(35.5%) believes that

Toxoplasmosis cannot be transmitted through direct skin contact while others say it can be

transmitted through direct skin contact 18(16.36%). Most of the respondents 21(19.1%) consider

consuming properly cooked meat as a method of prevention.

41
 Table 3: Distribution of study population with respect to Socio demographic data

Variables Number Percentage %

Examined(n)

Do you have a cat at home

Yes 79(37) 33.7

No 31(20) 15.2

Total 110(57) 52.0

Do you practice proper hand hygiene after consuming

after handling raw meat or soil 7(3) 2.7

Always 18(8) 7.3

Sometimes 85(46) 41.8

Rarely/never 110(57) 52.0

Total

How can one get Congenial Toxoplasmosis?

Through insect bites 14(5) 4.5

No washing of hands after siting the rest room 27(12) 11

Consuming poorly cooked meat 44(31) 28.2

Through the soil from cat`s feces 25(9) 8.2

Total 110(57) 52

Can you get Toxoplasmosis through Skin contact?

Yes 37 (18) 16.4

No 73 (39) 35.5

42
Total 110(57) 52

Have you ever been diagnosed of Toxoplasmosis?

Yes 79(41) 37.3

No 31(16) 14.6

Total 110(57) 52.0

How can you prevent Congenital Toxoplasmosis?

Washing hands after visiting the rest room 15(4) 3.6

Through spraying Insecticide 25(15) 13.6

By consuming properly cooked meat 38(21) 19.1

Washing hands after touching cats and soil 32(17) 15.5

110(57) 52.0

43
 CHAPTER FIVE

DISCUSSION, CONCLUSION, RECOMMENDATION

5.1 DICUSSIONS

The findings from this study showed that there is a moderate prevalence rate of congenital

toxoplasmosis of 52%. Which is consistent with the study carried published by WHO 2021,

which reveals a prevalence rate of 55.4%

The result of this study reveals that Congenital Toxoplasmosis can be caused by the consumption

of poorly cooked contaminated meat and through the soil from cat‘s feces. Which are the

predisposing risk factors. This results are similar to the result conducted by Ndumbe et al, 2014

on the associated risk factors of Congenital Toxoplasmosis which it was revealed that Congenital

Toxoplasmosis is transmitted through the consumption of poorly cooked contaminated meat,

through consuming unwashed vegetables and fruits which may be contaminated and through cats

and cats feces.

The findings of this study revealed that Congenital Toxoplasmosis can be prevented through

consuming properly cooked meats and vegetables, through cats and proper handling of cats feces

and washing of hands after touching the soil

5.2 CONCLUSION

This study has shown that the overall prevalence of Congenital Toxoplasmosis among the adults

17-50yeras was 52% prevalence. The results of this study also revealed that theres a high

prevalence between women of age 17-25 22% and married women 29.1%

44
This study revealed that consumption of poorly cooked meat, vegetables and through the soil

from cats feces are the main risk factors of Congenital Toxoplasmosis

5.3 RECOMMENDATION

Based on the findings of this study the following were recommended;

Minister of Public Health

1. Should stipulate a standard drug regiment for Toxoplasma patients as well as derive or drafts

measures on how these regiments can be properly respected.

2. Health education of general population, Free neonatal screening and treatment and vaccination

of food and animals

3. She should create sensitization programs to help increase the level of awareness of this

condition as some people turn to be unaware of these conditions

Health Personnel

1 Educate the public about the importance of neonatal and prenatal screening

2 Sensitize the population on the prevention of Toxoplasmosis so as to reduce the spread and

prevalence of congenital toxoplasmosis

45
 REFERENCES

1. Alvarado-Esquivel, C. A., Sifuentus-Alvarez, S. C., Nano-Duarti, S., Estrada-Martinez, J. H., Di-

Garcia, O., Lisensfeld, S.A, Martinez-Garcia, A. S., Canales-Molina, A. (2006).

Seroepidemiology of Toxoplasma gondii Infection in Pregnant Women in a Public Hospital in

Northern Mexico.

BMC Infectious Diseses., 6:113-117

2. Gilbert, R.E., 1999. Epidemiology of Infection in pregnant women. In: Petersen E. and

Amboise-

Thomas P, (eds). Congenital toxoplasmosis: Scientific background, clinical management and

control. Paris: Springer Velag France, 153-164.

3. Harold, S. and D.T. Spira, 2004. A cross-sectional survey of Toxoplasma gondii antibodies in

Jerusalem cats. Veterinary Parasitology, 124: 167-177.

4. Dubey, J.P., 1985. Serologic prevalence of toxoplasmosis in cattle, sheep, pigs, bison, and elk in

Montana. Journ. Am. Vet. Med. Association, 918: 969-970.

5. Dubey, J.P., 1987. Toxoplasmosis. Veterinary Clinic. N. Am. Sm. Ani. Prac., 17: 1389-1404

6. Wallace, G.D., 1969. Serologic and epidemiologic Observation on Toxoplasmosis on three

pacific Altols. Am. Journ. Epidemiol., 90: 103-111.

46
7. Munday, B.L., 1972. Serological evidence of Toxoplasma infection in isolated groups of

sheep.Res. Vet. Sci., 13: 100-102.

8. Dubey., J.P., C.A. Speer, S.K. Shen, O.C.H. Kwok and J.A. Blixt, 1997. Oocyst – induced

murine toxoplasmosis: lifecycle, Pathogenicity, and stage conversion in Mice fed Toxoplama

gondii oocysts. Journ. Parasitol., 83: 870-882.

9. Rostami A, Riahi SM, Contopoulos-Ioannidis DG, Gamble HR, Fakhri Y, et al. (2019) Acute

Toxoplasma infection in pregnant women worldwide: A systematic review and meta-analysis.

PLOS Neglected Tropical Diseases 13(10): e0007807.

10. Rostami A, Keshavarz H, Shojaee S, Mohebali M, Meamar AR. Frequency of Toxoplasma

gondii in HIV positive patients from west of Iran by ELISA and PCR. Iran J Parasitol.

2014;9:474–

81.

11. Rostami A, Riahi SM, Contopoulos-Ioannidis DG, Gamble HR, Fakhri Y, et al. (2019) Acute

Toxoplasma infection in pregnant women worldwide: A systematic review and meta-analysis.

PLOS Neglected Tropical Diseases 13(10): e0007807.

https://doi.org/10.1371/journal.pntd.0007807

12. Nissapatorn, M.A. Azmi Toxoplasmosis: prevalence and risk factors J. Obstet. Gynaecol., 23

(2003), pp. 618-624

47
13. Dubey JP. Toxoplasmosis of animals and humans. 2nd Edition. CRC Press. Florida, U.S.A.;

2010.

14. Ndumbe PM, Andela A, Nkemnkeng-Asong J, Watensi E, Nyambi P. Prevalence of infections

affecting the child among pregnant women in Yaounde Cameroon. Med Microbiol Immunol.

1992;181(3):127-309.

15. Ndumbe PM, Andela A, Nkemnkeng-Asong J, Watonsi E, Nyambi P. Prevalence of infections

affecting the child among pregnant women in Yaounde, Cameroon. Med Microbiol Immunol.

1992;181(3):127–30.

16. Dubey JP. The history and life cycle of Toxoplasma gondii. In: Weiss LM, Kim K, editors.

Toxoplasma gondii, the model apicomplexan: perspectives and methods, 2nd edn. Waltham,

MA: Elsevier; 2013. p. 1–14

17. Dubey JP. Toxoplasmosis—a waterborne zoonosis. Vet Parasitol.

2004;126(1–2):57–72.

18. Njunda AL, Assob JCN, Nsagha DS, Kamga HL, Nde PF, Yugah VC. Seroprevalence of

Toxoplasma gondii infection among pregnant women in Cameroon. J Public Health Africa.

2011;2:e24.

19. Dubey JP. Oocyst shedding by cats fed isolated bradyzoites and compari-son of infectivity of

bradyzoites of the VEG strain Toxoplasma gondii to cat sand mice. J Parasitol. 2001;87:215–9.

48
20. Dubey JP, Beattie CP. Toxoplasmosis of animals and man. Boca Raton: CRC Press; 1988. p.

220

21. CDC. Parasites—Toxoplasmosis (Toxoplasma infection). 2013.

http://www.cdc.gov/parasites/toxoplasmosis/gen_info/index.html. Accessed 26 Aug 2014.

22. Nissapatorn V, Kamarulzaman A, Init I, Tan LH, Rohela M, Norliza A, Chan LL, Latt HM,

Anuar AK, Quek KF. Seroepidemiology of toxoplasmosis among HIV-infected patients and

healthy blood donors. Med J Malaysia. 2002;57:304–10.

23. Nissapatorn V, Lee C, Quek KF, Leong CL, Mahmud R, Abdullah KA. Toxo-plasmosis in

HIV/AIDS patients: a current situation, Japan. J Infect Dis. 2004;57(4):160–

25. Dubey, J.P., 1987. Toxoplasmosis. Veterinary Clinic. N. Am. Sm. Ani. Prac., 17: 1389-

1404.

26. Dubey, J.P., 1994. Toxoplasmosis. Journ. Am. Vet. Med. Assoc., 205: 1593-1598.

27. Rostami A, Riahi SM, Contopoulos-Ioannidis DG, Gamble HR, Fakhri Y, et al. (2019) Acute

Toxoplasma infection in pregnant women worldwide: A systematic review and meta-analysis.

PLOS Neglected Tropical Diseases 13(10): e0007807.

49
https://doi.org/10.1371/journal.pntd.0007807

28. Nissapatorn, M.A. Azmi Toxoplasmosis: prevalence and risk factors J. Obstet. Gynaecol.,

23 (2003), pp. 618-624

29. Dubey JP. Toxoplasmosis of animals and humans. 2nd Edition. CRC Press. Florida,

U.S.A.; 2010.

30. Ndumbe PM, Andela A, Nkemnkeng-Asong J, Watensi E, Nyambi P. Prevalence of

infections affecting the child among pregnant women in Yaounde Cameroon. Med

Microbiol Immunol.

31. Ndumbe PM, Andela A, Nkemnkeng-Asong J, Watonsi E, Nyambi P. Prevalence of

infections affecting the child among pregnant women in Yaounde, Cameroon. Med

Microbiol Immunol

32. Dubey JP. The history and life cycle of Toxoplasma gondii. In: Weiss LM, Kim K,

editors.

33. Dubey JP. Toxoplasmosis—a waterborne zoonosis. Vet Parasitol.

2004;126(1–2):57–72.

50
 34. Njunda AL, Assob JCN, Nsagha DS, Kamga HL, Nde PF, Yugah VC. Seroprevalence of

Toxoplasma gondii infection among pregnant women in Cameroon. J Public Health

Africa.

2011;2:e24.

35. Dubey JP. Oocyst shedding by cats fed isolated bradyzoites and compari-son of

infectivity of bradyzoites of the VEG strain Toxoplasma gondii to cat sand mice. J

Parasitol. 2001;87:215–9.

36. Dubey JP, Beattie CP. Toxoplasmosis of animals and man. Boca Raton: CRC Press; 1988.

37. Berger F, Goulet V, Le Strat Y, De Valk H, Désenclos JC. La toxoplasmose en France

chez la femme enceinte en 2003: séroprévalence et facteurs associés. Institut de veille

sanitaire; 2007.

French.

38.Kapperud G, Jenum PA, Stray-Pedersen B, Melby KK, Eskild A, Eng J. Risk factors for

Toxoplasma gondii infection in pregnancy: results of a prospective case-control study in Norway.

Am J Epidemiol. 1996;144(4):405-412.

51
 39. Nissapatorn V, Noor Azmi MA, Cho SM, Fong MY, Init I, Rohela M, Khairul Anuar

A, Quek KF,

Latt HM. Toxoplasmosis: seroprevalence and risk factors. Journal of Obstetrics and Gynecology.

2003; 23(6): 618-624.

40. Dubey JP, Speer CA, Shen SK, Kwok OCH, Blixt JA. Oocyst – induced murine

toxoplasmosis: lifecycle, Pathogenicity, and stage conversion in Mice fed Toxoplama

gondiioocysts. Journ.

52
APPENDIX 1

INFORMED CONSENT

Dear Respondents

I am PENN HADDISON ACHA a third year student of the Department of Nursing, St Jude

Polytechnic Higher Institute of Health Douala, carrying out a research on the Topic

―EVALUATING THE PREVALENCE AND RISK FACTORS OF TOXOPLASMA GONDI IN

THE DEVELOPMENT OF CONGENITAL TOXOPLASMOSIS‖. I plead with you to kindly

assist with your most honest and faithful responses by ticking the boxes that correspond to your

most appropriate response and filling in the blank spaces as needed. This activity is strictly for

academic purpose and will not be used in any way to judge your knowledge on the subject matter.

For confidential purpose, please do not write or mention your name nor disclose your identity

anywhere on the questionnaires during the interview process.

Date…………………………… Signature…………………………

53
APPENDIX TWO

CONSENT FORM FOR PARTICIPANTS

I, the parents or legal guardian of this child, give my consent for my child to participate in a

research project entitled ―EVALUATING THE PREVALENCE, AND RISK FACTORS OF

CONGENITAL TOXOPLASMOSIS AMONGST PREGNANT WOMEN AT

SOLIDARITY HOSPITAL BUEA”. Conducted by PENN HADDISON ACHA a level 300

student at St Louis University Institute, Douala. The purpose of this study is strictly for academic

purpose and to help improve and bring in awareness on the knowledge of this study. I have read

and understood the risks and benefits of the study, and agree to allow my child to participate.

Parents/ guardians signature _____________________ Date __________

Investigator's signature _________________ Date __________ Contact--------------------

THANK YOU FOR ACCEPTING TO PARTICIPATE IN THIS STUDY.

54
APPENDIX 3

RESEARCH QUESTIONAIRE

SECTION A: SOCIO DEMOGRAPHIC CHARACTERICS

1. What is your Age?

☐ 17-25 ☐ 26-35 ☐ 36-40 ☐ Above 40

2. What is your Marital Status?

☐ Single ☐ Married ☐ Divorced ☐ Widowed

3. What is your Employment Status?

☐ Student ☐ Worker ☐ Unemployed ☐ None

4. What is your educational level?

☐ Primary ☐ Secondary ☐ University ☐ None

55
5. What is your Religion

☐Christian ☐Muslim

SECTION B: RISK FACTORS EVALUATION

1. Do you own any cats at home?

☐ Yes ☐ No

2. How can one get Congenial Toxoplasmosis?

☐ through insect bites ☐ No washing of hands after siting the rest room

☐ Consuming poorly cooked meat ☐ Through the soil from cat`s feces

3. Can you get Toxoplasmosis through Skin contact?

☐ Yes ☐ No

4. Do you practice proper hand hygiene after consuming after handling raw meat or soil

☐ Always ☐ Sometimes ☐ Rarely/never

5. Can you get Toxoplasmosis through Skin contact?

☐Yes ☐ No

6. Do you have a history of gardening or exposure to soil?

56
☐ Yes ☐ No

7. How can you prevent Congenital Toxoplasmosis?

☐ washing hands after visiting the rest room ☐Through spraying Insecticide

☐ by consuming properly cooked meat ☐ washing hands after touching cats and soil

57
APPENDIX 4

58