Study area and period
A institutional based cross-sectional study design was done at Asella Teaching and Referral) Hospitals from December 01, 2018 to February 30, 2019. Asella Teaching and Referral Hospital found in Assela town, Arsi Zone, at 175 kilometers to the east of Addis Ababa, the capital city of Ethiopia.
Study design and period
An institutional based quantitative cross-sectional study design was conducted from December 01, 2018 up to February 30, 2019 to determine the sero-prevalence of toxoplasmosis, awareness and its associated risk factors in Asella Teaching and Referral Hospital,
Source population
All pregnant women in Asella referral and teaching Hospital catchment area.
Study population
All pregnant women following antenatal care in Asella referral and teaching Hospital.
Eligibility Criteria
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Inclusion criteria: A pregnant woman who was come to selected Hospitals for the first time for antenatal care during sample collection period for current pregnancy.
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Exclusion criteria: Mothers who can’t respond because of serious illness and who was come more than once during sample collection period to selected Hospital for antenatal service.
Sample Size Determination
The sample size was calculated to estimate the prevalence of toxoplasma antibodies in this population. For the calculation, prevalence was assumed to be 50% because there is no previous research done on this parasite among pregnant women in Arsi zone by considering a confidence interval of 95% and the acceptable difference to be 5%, the minimum required sample size was 384. The sample was collected by recruiting all consenting pregnant woman at their first visit to the antenatal clinic of Asella Teaching and Referral Hospital.
Sample size =(Z α/2)2 p (1-p)
d2
Where:
P: An estimate of the prevalence rate for the population (P= 50%)
d: absolute precision(d= 5%=0.05)
Zα/2: The standard normal variable at 95% confidence level when α =5 %.( Z α/2 = 1.96)
So, n = Z α/2)2 p (1-p) = 2(1.96)2x 0.5(1-0.5) = 384
d2 (0.05)2
Sampling Techniques
All pregnant women who were come to Asella Teaching and Referral Hospital for the 1st time for antenatal care and willing to participate in the study were included until required sample size was achieved.
Data Collection Procedures
Socio demographic and clinical features
After clear training was given for five midwifes, five medical laboratory technologists and five facilitators from who were selected from Asella teaching and referral hospitals data collection was started. To collect Socio demographic and clinical features a pretested questionnaire was administered by Midwifes and trained research assistants’ information from pregnant women at selected hospitals antenatal care unit was gathered. The questions was produced information on four major areas: (a) socio-demographic information of the participants such as age, ethnicity, level of education, employment status, marital status, area of residence; (b) details of prior adverse birth outcomes, from multigravida i.e. miscarriages, still births, children with delayed milestones; (c) disease-related risk factors such as cat ownership, personal hygiene (frequency of hand washing), kitchen hygiene (frequency of washing utensils, cutting board and knife after preparation of meat), consumption of raw meat, cooking of meat, frequency of consuming unwashed raw vegetables and fruits, frequency of having non-homemade meals and exposure to soil; and finally, (d) the awareness of toxoplasmosis and sources of information. After implementation the questionnaire, each subject will be educated on significance and prophylactic actions against toxoplasmosis using an information sheet.
Laboratory tests
Two milliliters of blood was collected aseptically from each participant into sterile containers and centrifuged in the collected Hospitals and serum was separated by trained laboratory technologist at Arsi University Asella Teaching and Referral Hospital laboratory department. At Arsi University Asella Teaching and Referral Hospital laboratory department, the serum was tested on the day of receipt for T. gondii-specific antibodies using a commercial kit (On Site Toxo IgG/IgM Rapid Test-Dip Strip® CTK Biotech. Inc.USA) according to the manufacturer’s instructions by two senior laboratory technologists. The participants were made aware of the results of the serological investigations and its interpretation.
Data Analysis procedures
Data generated from questionnaire survey and laboratory investigations was recorded and coded using Microsoft Excel spreadsheet (Microsoft Corporation) and was analyzed using STATA version 13.0 for Windows (Stata Corp. College Station, TX, USA) by researchers. The sero-prevalence was calculated as the number of seropositive samples divided by the total number of samples tested. To identify predictors of seropositivity, first the association of the potential risk factors (age, gestational age, educational status, contact with cats’ feces, presence of domestic cat, way of life of domestic cats, etc) was analyzed by univariable logistic regression. Then all non- collinear variables with P-value ≤ 0.25 in univariable logistic regression analysis was included in the final multivariable logistic regression model to construct the likely model (P < 0 .05). The model will be reduced by backwards elimination of non-significant variables (P > 0.05) based on likelihood ratio test to define the model that would best fit the data.
Dissemination of Research finding
The research findings will be presented to the Arsi University and other stake holders, shared to Arsi Zonal Health Bureau, Regional Health Bureau, Federal Minister of Health (FMOH) and organizations/partners working on human health in the country. Finally effort will be made to publish the findings on peer reviewed scientific journal.
Significance and beneficiary of the study
The finding will be significant both for researcher, communities and government in adding information regarding Toxoplasmosis sero-prevalence, awareness, and risk behavior among pregnant women following antenatal care in Arsi zone, Ethiopia. Nationally it develops the understanding of relationship between having cat, eating raw meat and vegetables, blood transfusion, organ transplantation, drinking contaminated water, eating soil and so on with congenital toxoplasmosis.
Expected Outcome
A wide range of data based on which rigorous generalizations and recommendations can be made based on the data was obtained from the diversity score survey and laboratory analysis of sample.
Quality assurance
Strict measures were taken throughout the analytic process. Five percent of the Questionnaire was pre-tested among pregnant women attending at Asella Referal and teaching Hospital (Asella town), and Questionnaire was revised accordingly. Data collectors were trained for 3 days on how to con duct the interview and the sampling process. Completed questionnaires were reviewed immediately to ensure accuracy and legibility. Quality control samples were tested parallel with the research samples and standard operating procedures were followed during the laboratory investigation.