Date Published: September 9, 2019
Publisher: Public Library of Science
Author(s): Nadia Velázquez-Hernández, Ana Yuliana Avilés Ávila, Manuel Arturo Rivas-González, Selma Paola Delgado-González, Gustavo Alexis Alvarado-Félix, Ángel Osvaldo Alvarado-Félix, Isabel Beristain-Garcia, Cosme Alvarado-Esquivel, Zhicheng Dou.
We aimed to determine the knowledge and practices regarding toxoplasmosis among housewives in the northern Mexican city of Durango. One hundred eighty-five women (mean age: 41.27 ± 12.40 years old) with an occupation of housewife were studied. A self-administered questionnaire was used. This tool included items about the parasite Toxoplasma gondii, its transmission routes, general clinical, diagnostic, and treatment aspects of toxoplasmosis, and practices to avoid infection. A minority (<10%) of women knew about the parasite, the disease, how the transmission occurs, the clinical manifestations, how an infection is diagnosed, the treatment, and how to avoid toxoplasmosis. Some women knew that cats can transmit T. gondii infection (20%), and that the parasite can be found in cat feces (20.5%). Only 7.6% of women knew that infection with T. gondii can be transmitted by consumption of contaminated food or water. Only 1.1% of women knew about the prevalence of T. gondii infection. Some (4.9%) women used to taste raw meat while cooking, and 7.6% used to undercook meat. In addition, 20% of women used to eat raw dried meat, and 13.5% consumed untreated water. Less than 90% of women always washed their hands before cooking, and washed fruits or vegetables. The majority (75.1%) of women never wore gloves when handling raw meat. About one quarter (27.6%) of women always froze meat. And 16.2% of women cleaned cat feces. This is the first study regarding knowledge and practices about toxoplasmosis in housewives. Poor knowledge regarding T. gondii infection, toxoplasmosis, and practices to avoid infection among the housewives studied was found. High risk practices for infection were identified. Strategies to improve toxoplasmosis-related knowledge and practices to avoid T. gondii infection and its sequelae in housewives are highly needed.
Infections with the parasite Toxoplasma gondii (T. gondii) are common in humans and animals around the world . Nearly one-third of humanity has been exposed to this parasite . Infection in humans usually occurs by consumption of meat from infected animals or by ingestion of water or food contaminated with feces from infected cats [3, 4]. Soil is a source of T. gondii infection . Raw or undercooked meat from T. gondii-infected warm-blooded animals is an important source of infection for humans [6, 7]. Infection with T. gondii can also occur by blood transfusion , or organ transplant . Congenital infection with T. gondii may occur when a primary infection is present in a pregnant woman leading to miscarriage, fetal death, and neurological, ocular, or other damage in the fetus . Sexual transmission of T. gondii might occur and this could have an impact on the risk of congenital toxoplasmosis . Infection with T. gondii is usually asymptomatic but may lead to chorioretinitis and encephalitis mainly in immune deficiency conditions . In addition, infection with T. gondii may cause lymph node enlargement . Serological diagnosis is used routinely to determine the immune status for infection with T. gondii . There is treatment for T. gondii infection, but failure rates remain significant .
Studied women were 20 to 78 (mean: 41.27 ± 12.40) years old. Most of them were born in Durango State, Mexico (89.2%), resided in urban areas (88.1%), and had a medium socioeconomic status (94.1%). Details of the sociodemographic data of the studied women are shown in Table 1.
It is important to study housewives regarding knowledge and practices about toxoplasmosis because they prepare meals to their family, and failure in performing hygienic sanitary measures may result in transmission of T. gondii infection among members of their family. Thus, a housewife is of paramount importance in prevention of infections specially food- and water-borne infection within a family. However, no study regarding knowledge and practices about toxoplasmosis in housewives has been previously reported. Therefore, we determined the knowledge and practices regarding toxoplasmosis in women with housewife occupation in the northern Mexican city of Durango. Results of the present study indicate that studied housewives had a poor knowledge about the parasite, its transmission, the clinical manifestations of the disease, diagnosis, prevention and treatment of infection since less than 10% of surveyed women provided affirmative or correct answers to these items. This finding cannot be compared with others in housewives in other countries because no previous study on knowledge and practices about toxoplasmosis in housewives have been reported. However, a study about knowledge and practices on Toxoplasma infection in pregnant women from Malaysia, Philippines, and Thailand reported that only 11% of the studied pregnant women have read, heard, or seen information regarding toxoplasmosis . A very few women knew about the magnitude of T. gondii infection in the general population in the city. A 6.1% seroprevalence of T. gondii infection in the general population in Durango City was reported . Only one fifth of the studied women knew about the relation of T. gondii infection with cats and cat feces. This knowledge should be increased among housewives since 16.2% clean cat feces and therefore, they are at risk for T. gondii infection and, if they are pregnant, a congenital infection may occur. If the mother is infected for the first-time during pregnancy, she can present a temporary parasitemia that will infect the fetus . Most surveyed women did not have cats at home, but about one fifth of women who had cats at home allowed them to enter the kitchen. Cooking is one of the routine activities of housewives, but a lack of knowledge about the preventive measures against infection regarding hygiene of food and water, degree of meat cooking, and inactivation of the parasite may lead to wrong practices that may favor transmission of infection among family members. In fact, only 7.6% of women knew about the risk of infection with T. gondii by consumption of contaminated food or water. About one of ten women did not always washed fruits or vegetables or wash hands before cooking. Results reflect poor hygiene practices among a considerable number of studied housewives. Thus, education of housewives to improve their hygiene practices when preparing food and avoid T. gondii infection is needed. Seropositivity to T. gondii has been associated with consumption of unwashed raw fruits , and unwashed raw vegetables  in Durango City. An important number of women ate raw dried meat (20%), tasted raw meat when cooking (4.9%), and undercooked meat (7.6%). An association between T. gondii seropositivity and consumption of dried meat was reported in the USA . In addition, consumption of raw or undercooked meat was associated with T. gondii seropositivity in Durango City [20, 23]. A minority of women wore gloves when handling raw meat and this might increase the risk for T. gondii infection specially if hands are not washed after this handling. A considerable number (23.8%) of women did not always washed the knife after used for raw meat cutting. This practice might represent a risk for contamination of food. Freezing raw meat can kill T. gondii . However, only about one quarter of the surveyed women always froze meat. Consumption of untreated water is a risk for T. gondii infection. In a study in Mennonites in rural Durango, Mexico, consumption of untreated water was associated with T. gondii seropositivity . In the present study, the finding of consumption of untreated water in housewives is of concern and suggests that this practice might also occur in other members of their family.
This is the first study regarding knowledge and practices about toxoplasmosis in housewives. Poor knowledge regarding T. gondii infection, toxoplasmosis, and practices to avoid infection among the housewives studied was found. High risk practices for infection were identified as consumption of dried raw meat, undercooked meat, and untreated water. Strategies to improve toxoplasmosis-related knowledge and practices to avoid T. gondii infection and its sequelae in housewives are highly needed.