title: Comparative study on Toxoplasma infection between Malaysian and Myanmar pregnant women.
abstract: BACKGROUND
  Toxoplasma gondii, an obligate intracellular protozoan parasite, causes a disease called toxoplasmosis which can sometimes be acquired congenitally by a newborn from an infected mother. This study aimed to determine the seroprevalence of Toxoplasma infection and its associated risks among 219 and 215 pregnant women from Malaysia and Myanmar, respectively.
  
  
  METHODS
  Anti-Toxoplasma IgG and IgM antibodies were screened by using standard commercial ELISA kits. The socio-demographic, obstetrics and risk factors associated with Toxoplasma infection data were compared between the two countries.
  
  
  RESULTS
  The overall prevalence of Toxoplasma infection in Malaysian pregnant women (42.47%; 95% CI = 36.11-49.09) was significantly higher (p < 0.05) than Myanmar pregnant women (30.70%; 95% CI = 27.92-37.16). By univariate analysis, this study identified that age group, education, parity, awareness on toxoplasmosis and consumption of undercooked meat were significantly associated (p < 0.05) with Toxoplasma seropositive Malaysian pregnant women but none of these factors associated with Toxoplasma seropositive Myanmar pregnant women. In comparison using univariate analysis between the two countries, it was found that Toxoplasma seropositive Malaysian pregnant women was associated with aged 30 years and above, secondary or lower-secondary level of education, the third trimester of pregnancy, having one child or more, lacking awareness of toxoplasmosis, absence of bad obstetrics history, having no history of close contact with cats or soil, living on a farm and also consumption of undercooked meat, unpasterized milk or untreated water. Avidity measurement was used to confirm the stages of Toxoplasma infection in pregnant women who were positive for both IgG and IgM antibodies and found all were infected in the past.
  
  
  CONCLUSIONS
  From our study, Toxoplasma screening and its risk measurement in pregnant women is firmly recommended for monitoring purposes and assisting proper management, including diagnosis and treatment during antenatal period. Also, it is necessary to initiate preventive measures for Toxoplasma infection among reproductive-age women in general and seronegative pregnant women in particular. Avidity measurement should be incorporated in Toxoplasma routine screening, especially with the availability of a single serum sample to assist in the diagnosis.
authors.affiliation: Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia. april_hem@yahoo.com.
authors.forename: Hemah
authors.initials: H
authors.lastname: Andiappan
authors.affiliation: Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia. nissapat@gmail.com.
authors.forename: Veeranoot
authors.initials: V
authors.lastname: Nissapatorn
authors.affiliation: Department of Microbiology, Faculty of Science, Prince of Songkla University, Hat Yai, Songkhla, 90112, Thailand. nongyao.s@psu.ac.th.
authors.forename: Nongyao
authors.initials: N
authors.lastname: Sawangjaroen
authors.affiliation: Department of Medical Research (Lower Myanmar), Republic of the Union of Myanmar, Yangon, Myanmar. drmhnyunt@gmail.com.
authors.forename: Myat Htut
authors.initials: MH
authors.lastname: Nyunt
authors.affiliation: Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia. lauyeeling@um.edu.my.
authors.forename: Yee-Ling
authors.initials: YL
authors.lastname: Lau
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia. silay@ummc.edu.my.
authors.forename: Si Lay
authors.initials: SL
authors.lastname: Khaing
authors.affiliation: Department of Medical Research (Lower Myanmar), Republic of the Union of Myanmar, Yangon, Myanmar. khinmyoaye79@gmail.com.
authors.forename: Khin Myo
authors.initials: KM
authors.lastname: Aye
authors.affiliation: Department of Medical Research (Lower Myanmar), Republic of the Union of Myanmar, Yangon, Myanmar. nanchonwemon@gmail.com.
authors.forename: Nan Cho Nwe
authors.initials: NC
authors.lastname: Mon
authors.affiliation: Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia. tan_tianchye@hotmail.com.
authors.forename: Tian-Chye
authors.initials: TC
authors.lastname: Tan
authors.affiliation: Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia. thulasi.asi@gmail.com.
authors.forename: Thulasi
authors.initials: T
authors.lastname: Kumar
authors.affiliation: Department of Parasitology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia. subashinionichandran@yahoo.com.
authors.forename: Subashini
authors.initials: S
authors.lastname: Onichandran
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia. noorazmi.adenan@gmail.com.
authors.forename: Noor Azmi
authors.initials: NA
authors.lastname: bin Mat Adenan
mesh_terms: D000913:Antibodies, Protozoan / Q000097:blood*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008296:Malaysia / Q000453:epidemiology; D002052:Myanmar / Q000453:epidemiology; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D016036:Seroepidemiologic Studies; D014123:Toxoplasmosis / Q000097:blood / Q000453:epidemiology*
chemical_list: D000913:Antibodies, Protozoan; D007074:Immunoglobulin G; D007075:Immunoglobulin M