SEROPREVALENCE AND RISK FACTORS ASSOCIATED WITH Toxoplasma gondii INFECTION AMONG RURAL COMMUNITIES IN NORTHERN IRAN

Toxoplasmosis is the fourth most common cause of hospitalization and the second cause of death due to food-borne infections. We conducted a cross-sectional study to determine the prevalence, disease awareness and risk factors associated with toxoplasmosis among rural communities in Northern Iran. Data were obtained from serological testing and from participant^'s questionnaires and were analyzed using a logistic regression. Of the 630 participants, 465 (73.8%), and 12 (1.9%) had IgG and both IgG and IgM anti-Toxoplasma gondii antibodies, respectively. In the logistic regression analysis, T. gondii seropositivity was associated with the following factors: age, occupation, consumption of undercooked meat, and of unwashed raw vegetables or fruits (p < 0.001). Our study showed a high prevalence of T. gondii infection in the general population of Northern Iran. A health program is needed to increase the public awareness of toxoplasmosis, and its associated risk factors.

KEYWORDS:
Toxoplasmosis; Seroprevalence; Cross-sectional study; Rural communities; Northern Iran

Authorship

Ali ROSTAMI

Department of Medical Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences. Tehran, Iran. E-mails: alirostami1984@gmail.com; Seyyedtabaei@gmail.com; saghamolaie@yahoo.com; hbehniyafar@gmail.com; Zohrehlasjerdi@gmail.comShahid Beheshti University of Medical SciencesIranTehran, IranDepartment of Medical Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences. Tehran, Iran. E-mails: alirostami1984@gmail.com; Seyyedtabaei@gmail.com; saghamolaie@yahoo.com; hbehniyafar@gmail.com; Zohrehlasjerdi@gmail.com

Seyyed Javad SEYYEDTABAEI

Somayeh AGHAMOLAIE

Hamed BEHNIAFAR

Zohreh LASJERDI

Alireza ABDOLRASOULI

Department of Medical Microbiology, Charing Cross Hospital, Imperial College Healthcare NHS Trust. London, United Kingdom. E-mail: a.abdolrasouli@imperial.ac.ukImperial College Healthcare NHS TrustUnited KingdomLondon, United KingdomDepartment of Medical Microbiology, Charing Cross Hospital, Imperial College Healthcare NHS Trust. London, United Kingdom. E-mail: a.abdolrasouli@imperial.ac.uk

Department of Infectious Diseases and Immunity, Imperial College London. London, United Kingdom. E-mail: a.abdolrasouli@imperial.ac.ukImperial College LondonUnited KingdomLondon, United KingdomDepartment of Infectious Diseases and Immunity, Imperial College London. London, United Kingdom. E-mail: a.abdolrasouli@imperial.ac.uk

Saeed MEHRAVAR

Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Science. Tehran, Iran. E-mail: saeed.mehravar@gmail.comTehran University of Medical ScienceIranTehran, IranDepartment of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Science. Tehran, Iran. E-mail: saeed.mehravar@gmail.com

Cosme ALVARADO-ESQUIVEL

Biomedical Research Laboratory, Faculty of Medicine and Nutrition, Juárez University of Durango State. Avenida Universidad S/N, 34000 Durango, Dgo, Mexico. E-mail: alvaradocosme@yahoo.comJuárez University of Durango StateMexicoDurango, MexicoBiomedical Research Laboratory, Faculty of Medicine and Nutrition, Juárez University of Durango State. Avenida Universidad S/N, 34000 Durango, Dgo, Mexico. E-mail: alvaradocosme@yahoo.com

Correspondence to: Seyyed Javad Seyyedtabaei, Department of Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences. Tehran, Iran. Tel: +982122439962, E-mail: Seyyedtabaei@gmail.com, seyyedtabaei@sbmu.ac.ir

CONFLICT INTEREST None.

AUTHORS' CONTRIBUTION A. Rostami and S.J. Seyyedtabaee designed the study, performed the research, evaluated the clinical records and collaborated to the manuscript writing. S. Aghamolaie, H. Behniafar and Z. Lasjerdi collaborated in the sample collection and to perform the laboratory tests. S. Mehravar performed the statistical analysis and has analyzed the data. A. Abdolrasouli and C. Alvarado-Esquivel have critically reviewed the manuscript.

SCIMAGO INSTITUTIONS RANKINGS

Figures | Tables

Figures (1)
Tables (2)

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Fig. 1
Age-associated prevalence of Toxoplasma gondii infections among rural populations in north of Iran.

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Table 1
Seroprevalence of Toxoplasma infection among rural individuals in Northern Iran according to sociodemographic characteristics (risk factors analysis by the Pearson's chi-square test)

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Table 2
Seroprevalence of Toxoplasma infection among rural individuals in Northern Iran according to sociodemographic characteristics (estimated by a full logistic regression model)

Fig. 1 Age-associated prevalence of Toxoplasma gondii infections among rural populations in north of Iran.

Table 1 Seroprevalence of Toxoplasma infection among rural individuals in Northern Iran according to sociodemographic characteristics (risk factors analysis by the Pearson's chi-square test)

Characteristic	No. participants	No. of seropositives (%)	OR (95% CI)	p value
Age (years)				<0.001
≤10	18	8 (44.4)	1.0
11-20	60	36 (60.0)	1.88 (0.65-5.43)
21-30	141	101 (71.6)	3.16 (1.16-8.57) ^**
31-40	124	91 (73.4)	3.45 (1.25- 9.48) ^**
41-50	112	93 (83.0)	6.12 (2.14-17.53) ^**
51-60	109	93 (85.3)	7.27 (2.49-21.19) ^**
≥61	66	55 (83.3)	6.25 (2.01-19.40) ^**
Sex				0.512
Male	203	157 (77.3)	1.14 (0.77 -1.69)
Female	427	320 (74.9)	0.88 (0.59- 1.30)
Educational level				<0.001
Illiterate	158	132 (83.5)	1.0
Primary school	143	118 (82.5)	0.93 (0.51-1.70)
High school	234	166 (70.9)	0.48 (0.29 -0.80) ^**
College and higher	95	61 (64.2)	0.35 (0.20-0.64) ^**
Occupation				0.010
Farmer & shepherd	57	46 (80.7)	1.0
Housewife	312	251 (80.4)	0.98 (0.48 -2.01)
Student	99	70 (70.7)	0.58 (0.26 -1.27)
Government employee & other	162	110 (67.9)	0.51 (0.24 -1.06)
Region				0.992
Dabodasht	219	167 (76.3)	1.0
Litkoh & Larijan	208	157 (75.5)	0.96 (0.62 -1.49)
Dashtesar	138	104 (75.4)	0.95 (0.58-1.57)
Larijan	65	49 (75.4)	0.95 (0.50 -1.81)
Water supply				0.009
Treated	272	192 (70.6)	0.61 (0.43 -0.89) ^**
Untreated	358	285 (79.6)	1.63 (1.13 -2.35) ^**
Consumption of undercooked or raw meat				<0.001
Yes	386	318 (82.4)	2.50 (1.72 -3.62) ^**
No	244	159 (65.2)	0.40 (0.28-0.58) ^**
Consumption of raw unwashed vegetables or fruits				<0.001
Yes	322	271 (84.2)	2.63 (1.80 -3.85) ^**
No	308	206 (66.9)	0.38 (0.26 -0.56) ^**
Contact with cats				0.182
Yes	226	178 (78.8)	1.30 (0.88 -1.92)
No	404	299 (74.0)	0.77 (0.52 -1.13)
Contact with soil				0.005
Yes	317	255 (80.4)	1.69 (1.17 -2.44) ^**
No	313	222 (70.9)	0.59 (0.41 -0.86) ^**
Consumption of goat meat				0.655
Yes	140	108 (77.1)	1.11 (0.71 -1.73)
No	490	369 (75.3)	0.90 (0.58 -1.41)
Consumption of sheep meat				0.015
Yes	540	418 (77.4)	1.80 (1.11 -2.91) ^**
No	90	59 (65.5)	0.55 (0.34 -0.90) ^**
Consumption of cow meat				0.663
Yes	429	327 (76.2)	1.09 (0.74 -1.61)
No	201	150 (74.6)	0.92 (0.62- 1.35)
Consumption of poultry meat				<0.001
Yes	564	438 (77.7)	2.41 (1.42 -4.09) ^**
No	66	39 (59.1)	0.42 (0.24 -0.71) ^**

^*
^*95% confidence interval does not include 1.

Table 2 Seroprevalence of Toxoplasma infection among rural individuals in Northern Iran according to sociodemographic characteristics (estimated by a full logistic regression model)

Characteristic	No. of participants	OR	95% CI	p value
Age (years)
≤10	18	1.00^*	1.0
11-20	60	3.04	(0.90- 10.23)	0.73
21-30	141	11.35^**	(3.19- 40.34)	<0.001
31-40	124	13.31^**	(3.62- 48.97)	<0.001
41-50	112	14.04^**	(4.02- 49.00)	<0.001
51-60	109	17.80^**	(4.89- 64.76)	<0.001
≥61	66	11.71^**	(2.86- 48.00)	<0.001
Educational level
Illiterate	158	1.00^*	1.0
Primary school	143	1.25	(0.57- 2.78)	0.577
High school	234	0.67	(0.30- 1.49)	0.326
College and higher	95	0.44	(0.16- 1.17)	0,099
Occupation
Farmer & shepherd	57	1.00^*	1.0
Housewife	312	1.51	(0.65- 3.49)	0.337
Student	99	3.28^**	(1.13- 9.53)	0.029
Government employee & other	162	1.05	(0.42- 2.62)	0.915
Water supply				0.497
Treated	272	1.17	(0.75- 1.81)
Untreated	358	1.00^*
Consumption of undercooked or raw meat				0.004
Yes	386	0.52^**	(0.33- 0.81)
No	244	1.00^*
Consumption of raw unwashed vegetables or fruits				0.005
Yes	322	0.53^**	(0.34- 0.82)
No	308	1.00^*
Contact with soil				0.119
Yes	317	0.72	(0.48- 1.09)
No	313	1.00^*
Consumption of sheep meat				0.218
Yes	540 (84)	0.71	(0.42- 1.22)
No	90 (16)	1.00^*
Consumption of poultry meat				0.889
Yes	564 (89.5)	0.96	(0.51- 1.80)
No	66 (10.4)	1.00^*

* Reference. ** 95% confidence interval does not include 1.

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