Toxoplasmosis knowledge and preventive behavior among pregnant women in the city of Imperatriz, Maranhão, Brazil

Moura, Ivone Pereira da Silva; Ferreira, Ilma Pastana; Pontes, Altem Nascimento; Bichara, Cléa Nazaré Carneiro

doi:10.1590/1413-812320182410.21702017

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

FREE THEMES • Ciênc. saúde coletiva 24 (10) • Oct 2019 • https://doi.org/10.1590/1413-812320182410.21702017 copy

Toxoplasmosis knowledge and preventive behavior among pregnant women in the city of Imperatriz, Maranhão, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The aim of this study was to assess toxoplasmosis knowledge and preventive behavior, and relate these to socioeconomic, pre-natal and environmental issues among pregnant women served by the Family Health Strategy in the municipality of Imperatriz, Maranhão, Brazil. This is a cross-sectional study performed by applying a structured and pre-tested questionnaire to a sample of 239 pregnant women. Only 23.4% of the pregnant women had good knowledge of the disease, primarily in the area of prevention, and 58.9% adopted suitable preventive behaviors. The results obtained show a significant association of various toxoplasmosis risk factors, such as drinking untreated water (OR = 2.1245; IC95% = 1.20-3.73; p = 0.0128), contact with cats (OR = 7.6875; IC95% = 4.22-13.97; p < 0,0001), cleaning cat feces (OR = 6.8738; IC95% = 3.02-15.60; p < 0.0001), eating raw meat (OR = 5.7405; IC95% = 3.21-10.24 and handling sand/cat litter OR = 10.7376; IC95% = 4.64-24.85; p < 0.0001). This shows a need for continued education on toxoplasmosis for the pregnant women seen by the Imperatriz FHS, and for more comprehensive preventive measures, with public health and education policies that take into consideration economic, social, environmental and cultural issues.

Key words
Toxoplasmosis; Knowledge; Attitude; Pregnant women

	GA		GB		Total
	N	%	n	%	N	%	p-value
Marital status**							1,0000(ns)
Single	20	23.8	28	18.1	48	20.1
Married	35	41.7	69	44.5	104	43.5
Stable Union	27	32.1	55	35.5	82	34.3
Separated	1	1.2	1	0.6	2	0.8
Divorced	1	1.2	2	1.3	3	1.3
Windowed	0	0.0	0	0.0	0	0.0
Goes to School^* * The current minimum monthly wage is R$ 880,00. Tests applied: Chi-squared, G**.							0.0827(ns)
Yes, goes to school	10	11.9	34	21.9	44	18.4
Does not go to school	74	88.1	121	78.1	195	81.6
Years of schooling**							0.3345(ns)
Illiterate	0	0.0	0	0.0	0	0.0
Primary school grades 1 to 3	1	1.2	0	0.0	1	0.4
Primary school grades 4 to 7	1	1.2	5	3.2	6	2.5
Primary school graduate	12	14.3	17	11.0	29	12.1
Did not finish Secondary School	21	25.0	34	21.9	55	23.0
Secondary School graduate	38	45.2	62	40.0	100	41.8
Did not finish university	8	9.5	29	18.7	37	15.5
University Graduate	3	3.6	8	5.2	11	4.6
Stated income^* * The current minimum monthly wage is R$ 880,00. Tests applied: Chi-squared, G**.							0.7886(ns)
Yes	77	91.7	139	89.7	216	90.4
No	7	8.3	16	10.3	23	9.6
Household Income**							0.2656(ns)
Less than 1 minimum salary	7	9.5	12	8.5	19	8.8
1 minimum salary	35	47.3	49	34.5	84	38.9
1-2 minimum salaries	25	33.8	58	40.8	83	38.4
2-3 minimum salaries	5	6.8	19	13.4	24	11.1
3-4 minimum salaries	1	1.4	4	2.8	5	2.3
Over 4 minimum salaries	1	1.4	0	0.0	1	0.5
How many people in household**							0.1446(ns)
Lives alone	6	7.1	8	5.2	14	5.9
1 or 2 people	23	27.4	44	28.4	67	28.0
3 or 4 people	51	60.7	82	52.9	133	55.6
5 or more people	4	4.8	21	13.5	25	10.5
Ethnicity^* * The current minimum monthly wage is R$ 880,00. Tests applied: Chi-squared, G**.							0.8933(ns)
White (Caucasian)	15	20.0	32	21.1	47	20.7
Black	12	16.0	22	14.5	34	15.0
Yellow	7	9.3	19	12.5	26	11.5
Brown	41	54.7	79	52.0	120	52.9
Religion**							1,0000(ns)
Religion	58	24.3	112	46.9	170	71.2
Catholic	36	62.1	60	53.6	96	56.5
Evangelical	22	37.9	51	45.5	73	42.9
Spiritism	0	0.0	0	0.0	0	0.0
Umbanda (Afro similar to Santeria)	0	0.0	0	0.0	0	0.0
Other	0	0.0	1	0.9	1	0.6
Employment status**							0.7778(ns)
Civil servant	3	3.7	6	3.9	9	3.8
Employed and registered	15	18.5	35	22.6	50	20.9
Employed and not registered	5	6.2	8	5.2	13	5.4
Independent	15	18.5	26	16.8	41	17.2
Employer	1	1.2	0	0.0	1	0.4
Does not work	45	53.6	80	51.6	123	52.3
Reason for not working**							1.0000(ns)
Housewife	28	33.3	54	34.8	82	34.3
Unable to find work	5	6.0	8	5.2	13	5.4
Unpaid work	0	0.0	0	0.0	0	0.0
In school	3	3.6	12	7.7	15	6.3
Ill	1	1.2	0	0.0	1	0.4
Other	6	7.1	8	5.2	14	5.9

	GA		GB		Total
	n	%	N	%	N	%	p-value	OR	95% CI
First pregnancy	42	50.0	73	47.1	115	48.1	0.7693	1.1233	0.66 - 1.91
Previous pregnancies	42	50.0	82	52.9	124	51.9	0.9257	0.9885	0.58 - 1.68
Weeks Pregnant	25±8		26±8		26±8		0.7256	---
Number of visits	4±2.1		4±2.2		4.1±2.2		0.8087	---
Start of pre-natal care (months)	3.0±2.0		2.5±1.5		2.5±2.0		0.5614	---
Complications	13	15.5	19	12.3	32	13.4	0.6181	1.3106	0.61 a 2.80
Miscarriages	14	16.7	16	10.3	30	12.6	0.2267	1.7375	0.80 a 3.76

	GA		GB		Total
Sanitation	n	%	n	%	N	%	p-value	OR	95% CI
Water use
Public sewage system	H	98.8	153	98.7	234	98.7	0.4820	0.3529	0.05 - 2.15
Artesian well	0	0.0	2	1.3	2	0.8	0.7628	---	---
Open well	1	1.2	0	0.0	1	0.4	---	---	---
Filtered water	43	52.4	107	70.4	150	64.1	0.0098*	0.4705	0.27 - 0.81
Untreated water	35	42.7	39	25.7	74	31.6	0.0128*	2.1245	1.20 - 3.73
Bottled mineral water	4	4.9	6	3.9	10	4.3	0.9921	1.2417	0.34 - 4.52
Sewage
Public sewage system	22	26.2	62	40.0	84	35.1	0.0463*	0.5323	0.29 - 0.95
Septic Tank	47	56.0	81	52.3	128	53.6	0.6811	1.1605	0.68 - 1.97
Open air	8	9.5	9	5.8	17	7.1	0.4215	1.7076	0.63 - 4.60
River/Stream	7	8.3	3	1.9	10	4.2	0.0434*	4.6061	1.15 - 18.30
Destination of solid waste
City waste collection	74	88.1	148	95.5	222	92.9	0.0632	0.3500	0.12 - 0.95
Vacant lot	4	4.8	4	2.6	8	3.3	0.6041	1.8875	0.45 - 7.74
Back yard	1	1.2	1	0.6	2	0.8	0.7628	1.8554	---
Burnt	5	6.0	2	1.3	7	2.9	0.1012	4.8418	0.91 - 25.52
Conditions of the street the live on
Paved	41	48.8	84	54.2	125	52.3	0.5093	0.8059	0.47 - 1.37
Unpaved	40	47.6	64	41.3	104	43.5	0.4205	1.2926	0.75 - 2.20
Flooded	3	3.6	7	4.5	10	4.2	0.9921	0.7831	0.78 - 3.11

	GA		GB		Total
	n	%	N	%	N	%	p-value	OR	CI 95%
Risk and transmission factors
Q1 - Toxoplasmosis is an infectious disease	38	45.2	111	71.6	149	62.3	0.0001*	0.3275
Q2 - Toxoplasmosis is caused by a toxin	32	38.1	99	63.9	131	54.8	0.0002*	0.3481	0.18 - 0.56
Q3 - Toxoplasmosis can be found in cat feces	53	63.1	127	81.9	180	75.3	0.0022*	0.3769	0.20 - 0.60
Q4 - You can get toxoplasmosis when you clean up cat feces	47	56.0	105	67.7	152	63.6	0.0954	0.6049	0.20 - 0.68
Q5 - Toxoplasmosis can be caused by eating raw or undercooked meat	28	33.3	100	64.5	128	53.6		0.2750	0.35 - 1.04
Q6 - Toxoplasmosis can be caused by touching raw meat	17	20.2	34	21.9	51	21.3	0.8883	0.9030	0.15 - 0.48
Q7 - You can get toxoplasmosis by touching sand/soil (garden, yard)	31	36.9	85	54.8	116	48.5	0.0120*	0.4817	0.46 - 1.73
Clinical Status									0.27 - 0.83
Q8- Pregnant women with toxoplasmosis always present symptoms of the disease	15	17.9	45	29.0	60	25.1	0.0808	0.5314
Q9 - In pregnant women toxoplasmosis can cause fever or "flu-like symptoms"	24	28.6	63	40.6	87	36.4	0.0870	0.5841	0.27 - 1.02
Q10 - In pregnant women toxoplasmosis can cause swollen lymph nodes in the neck and/or body	19	22.6	52	33.5	71	29.7	0.1059	0.5790	0.32 - 1.03
Congenital toxoplasmosis									0.31 - 1.06
Q11 - A pregnant woman can only pass along toxoplasmosis to the fetus if she acquires the disease while she is pregnant	9	10.7	24	15.5	33	13.8	0.4099	0.6550
Q12 - Women who have toxoplasmosis before they get pregnant will rarely transmit it to the baby	26	31.0	64	41.3	90	37.7	0.1513	0.6374	0.28 - 1.48
Q13 - A baby with toxoplasmosis can be born without any symptoms of the disease	19	22.6	77	49.7	96	40.2	< 0.0001*	0.2961	0.36 - 1.11
Q14 - In newborns, the signs of toxoplasmosis can appear months after delivery	19	22.6	73	47.1	92	38.5	0.0004*	0.3283	0.18 - 0.59
Q15 - Babies with toxoplasmosis can have vision problems	24	28.6	93	60.0	117	49.0	< 0.0001*	0.2667	0.15 - 0.47
Q16 - Toxoplasmosis in pregnant women can be treated	45	53.6	105	67.7	150	62.8	0.0430*	0.5495	0.31 - 0.94
Q17 - Toxoplasmosis in the baby can be treated	38	45.2	103	66.5	141	59.0	0.0023*	0.4171	0.24 - 0.71
Prevention
Q18 - Pregnant women who feed cats only cat food can avoid toxoplasmosis	20	23.8	67	43.2	87	36.4	0.0045*	0.4104	0.22 - 0.74
Q19 - Cats who eat rats can cause toxoplasmosis in pregnant women	29	34.5	88	56.8	117	49.0	0.0016*	0.4014	0.23 - 0.69
020 - Pregnant women who avoid contact with stray cats can avoid toxoplasmosis	37	44.0	115	74.2	152	63.6	< 0.0001*	0.2738	0.15 - 0.48
Q21 - Pregnant women who allow others to replace the cat litter can avoid toxoplasmosis	30	35.7	92	59.4	122	51.0	0.0008*	0.3804	0.21 - 0.65
Q22 - Cat litter should be replaced daily	53	63.1	121	78.1	174	72.8	0.0198*	0.4804	0.26 - 0.86
Q23 - Pregnant women who eat well-done meat can avoid toxoplasmosis	48	57.1	110	71.0	158	66.1	0.0442*	0.5455	0.31 - 0.94
Q24 - Carefully washing and peeling all fruits and vegetables before eating can avoid toxoplasmosis	51	60.7	125	80.6	176	73.6	0.0014*	0.3709	0.20 - 0.67

	GA		GB		Total
	N	%	N	%	N	%	p-value	OR	CI 95%
Contact with animals	72	85,7	55	35,5	127	53,1	< 0,0001*	10,9091	5,44 a 21,8
Cats	56	66,7	32	20,6	88	36,8	< 0,0001*	7,6875	4,22 a 13,97
Cats around the home	4	4,8	5	3,2	9	3,77	0,8105	1,5000	0,39 a 5,74
Birds	4	4,8	3	1,9	7	2,93	0,4035	2,5333	0,55 a 11,59
Litter of kittens	4	4,8	2	1,3	6	2,51	0,2283	3,8250	0,68 a 21,33
Dogs	46	54,8	38	24,5	84	35,1	< 0,0001*	3,7271	2,11 a 6,55
Dogs running loose in street	27	32,1	9	5,8	36	15,1	< 0,0001*	7,6842	3,40 a 17,34
Cleaning cat feces	25	29,8	9	5,8	34	14,2	< 0,0001*	6,8738	3,02 a 15,60
Uses glove to clean feces	0	0,0	0	0,0	0	0	---	---	---
Gats under a year old	39	46,4	17	11,0	56	23,4	< 0,0001*	7,0353	3,63 a 13,63
Cat goes outside	33	39,3	10	6,5	43	18	< 0,0001*	9,3824	4,31 a 20,38
Cat eats raw meat	27	32,1	11	7,1	38	15,9	< 0,0001*	6,2010	2,88 a 13,32
Does not own cats but cats appear	4	4,8	3	1,9	7	2,93	0,4035	2,5333	0,55 a 11,59
Eats raw or rare meat	54	64,3	37	23,9	91	38,1	< 0,0001*	5,7405	3,21 a 10,24
Beef	50	59,5	30	19,4	80	33,5	< 0,0001*	6,1275	3,39 a 11,05
Pork	2	2,4	9	5,8	11	4,6	0,3771	0,3957	0,08 a 1,87
Chicken	10	11,9	9	5,8	19	7,95	0,1575	2,1922	0,85 a 5,62
Lamb	0	0,0	0	0,0	0	0	---	---	---
Other meats	1	1,2	3	1,9	4	1,67	0,9208	0,6104	---
Eats raw fruits and vegetables	76	90,5	136	87,7	212	88,7	0,6719	1,3272	0,55 a 3,17
Washes fruits and vegetables before eating them	70	83,3	132	85,2	202	84,5	0,8527	0,8712	0,42 a 1,79
Eats raw ground beef	0	0,0	2	1.3	2	0,84	0,7628	0,0000	---
Washes kitchen utensils after contact with raw meat and with unwashed fruits and vegetables
Washes with water	29	34,5	30	19,4	59	24,7	0,0147*	2,1970	1,20 a 4,00
Washes with warm water and soap	49	58.3	117	75,5	166	69,5	0,0093*	0,4547	0,25 a 0,80
Does not wash	6	7,1	8	5,2	14	5,9	0,7381	1,4135	0,47 a 4,22
Drinks unpasteurized milk	41	48,8	55	35,5	96	40,2	0,0618	1,7336	1,01 a 2,97
Boils the milk	38	45,2	52	33,5	90	37,7	0,1008	1,6363	0,94 a 2,81
Cow's milk	40	47,6	55	35,5	95	39,7	0,0907	1,6529	0,96 a 2,83
Goat's milk	1	1,2	0	0,0	1	0,42	---	---	---
Eats artisanal sausage	59	70,2	86	55,5	145	60,7	0,0366*	1,8935	1,07 a 3,33
Eats fresh cheese	69	82,1	85	54,8	154	64,4	< 0,0001*	3,7882	1,99 a 7,19
Handles sand/soil	31	36,9	8	5,2	39	16,3	< 0,0001*	10,7376	4,64 a 24,85
Goes fishing or swimming in river	20	23,8	16	10,3	36	15,1	0,0095*	2,7148	1,32 a 5,58
Goes fishing or swimming in lake	0	0,0	0	0,0	0	0	---	---	---
Goes fishing or swimming in reservoir/dam	1	1,2	4	2,6	5	2,09	0,8075	0,4548	0,05 a 4,13
Does not normally go fishing or swimming	62	73,8	132	85,2	194	81,2	0,0488*	0,4910	0,25 a 0,94
Prepares food	53	63,1	101	65,2	154	64,4	0,8595	0,9141	0,52 a 1,58
Does not prepare food	4	4,8	12	7,7	16	6,7	0,4525	0,5958	0,19 a 1,90
Sometimes prepares food	27	32,1	42	27,1	69	28,9	0,5013	1,2744	0,71 a 2,27
Has a vegetable garden at home	12	14,3	7	4,5	19	7,95	0,0157*	3,5238	1,33 a 9,33

ABRASCO - Associação Brasileira de Saúde Coletiva Av. Brasil, 4036 - sala 700 Manguinhos, 21040-361 Rio de Janeiro RJ - Brazil, Tel.: +55 21 3882-9153 / 3882-9151 - Rio de Janeiro - RJ - Brazil
E-mail: cienciasaudecoletiva@fiocruz.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Collaborations

IPS Moura helped design the study, field work, data tabulation, analyses and drafting. CNC Bichara helped design, analyze and draft the article, and approved the version for publication. IP Ferreira and AN Pontes did a critical review of the article.