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Serological Prevalence of Toxoplasmosis in Pregnant Women in Brazilian Federal District and its Possible Association with Sanitation Conditions

Author(s): Fernando Saab, Carlos Tomaz, Renato Álvaro Genaro, Jéssica Mendes de Souza, Pedro Barata

Introduction: Toxoplasma infects up to a third of the world's population and the infection can be dangerous to the fetus during pregnancy. In the congenital form, the sequelae in the fetus can be severe and irreversible. Some babies infected with the parasite can be born without complications but present neurological changes during the first year of life, in childhood or even in adulthood. On the other hand, basic sanitation has been considered an important environmental determinant of health. Some studies observed that aspects associated with urban cleaning services and personal hygiene are important factors in the dissemination of toxoplasmosis.

Objective: This study aims to analyze the prevalence of seropositivity for toxoplasmosis in pregnant women screened by the Pregnant Women Protection Program (PWPP) in the Federal District of Brazil between years 2017 to 2020 and its possible association with data related to the infrastructure available for basic sanitation services that households and the urban population of the Federal District have.

Materials and Methods: This is a retrospective study that included a historical series of 127,866 pregnant women screened by the PWPP during prenatal care in the Federal District of Brazil between years 2017 to 2020. The Sanitation Ranking prepared by the Institute Trata Brazil was used, considering the data from the SNIS (National Sanitation Information System - Ministry of Regional Development, Brazil). Sanitation data of Brasília, Federal District, was provided by CODEPLAN (Federal District Planning Company) and “Companhia de Saneamento Ambiental do Distrito Federal - CAESB”.

Results: Of the 127,866 patients examined, 48,534 were positive, resulting in an overall prevalence of 38,06% in pregnant women. Analysis of prevalence over time indicate a drop over the years, starting in 2017 with 41,93% to 35,15% in 2020. The prevalence of positive cases grouped by regional health and sewage treatment plants indicated a significant effect for each sewage treatment plant between the years 2017 and the others and between the years 2018 and 2020. That is, a decrease in the prevalence of positive cases from 2017 and 2020. Regarding health region (SRS), there were differences between SRS/Central and SRS/West and SRS/West and SRS/South. The data indicate a lower prevalence of cases in the Central and South SRS, and a higher prevalence in the SRS/West. On the other hand, data on sanitation indicate that the West SRS region present the lowest levels while the Central SRS and South SRS regions present good indices.

Conclusions: Take together, our results showed, over time, a significant drop in the prevalence from 2017 to 2020 that may be due to the implementation of the PWPP in the current molds, based on public policies to protect pregnant women and newborns. Data on sanitation and health conditions indicate the highest prevalence of pregnant women infected by toxoplasmosis in the Western SRS region, and a lower prevalence of cases in the central SRS and southern SRS regions of the Federal District. Poor sanitation situation is observed in Western SRS region, while good sanitation conditions are observed in the central SRS and southern SRS regions. Therefore, it seems plausible to suggest, in this case, a relationship between sanitary conditions and the prevalence of seropositivity for toxoplasmosis in pregnant women screened by the Pregnant Women Protection Program (PWPP) in the Federal District of Brazil.

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