• <tr id="yyy80"></tr>
  • <sup id="yyy80"></sup>
  • <tfoot id="yyy80"><noscript id="yyy80"></noscript></tfoot>
  • 99热精品在线国产_美女午夜性视频免费_国产精品国产高清国产av_av欧美777_自拍偷自拍亚洲精品老妇_亚洲熟女精品中文字幕_www日本黄色视频网_国产精品野战在线观看 ?

    Sero-prevalence and associated risk factors of Toxoplasma gondii infection among pregnant women attending antenatal care at Felege Hiwot Referral Hospital, northwest Ethiopia

    2015-12-23 03:42:50KefaleAwokeEndalkachewNibretAbainehMunshea

    Kefale Awoke, Endalkachew Nibret, Abaineh Munshea

    Biology Department, Bahir Dar University, P.O.Box 79, Bahir Dar, Ethiopia

    Sero-prevalence and associated risk factors of Toxoplasma gondii infection among pregnant women attending antenatal care at Felege Hiwot Referral Hospital, northwest Ethiopia

    Kefale Awoke, Endalkachew Nibret*, Abaineh Munshea

    Biology Department, Bahir Dar University, P.O.Box 79, Bahir Dar, Ethiopia

    ARTICLE INFO

    Article history:

    Received 15 April 2015

    Received in revised form 20 May 2015

    Accepted 15 June 2015

    Available online 20 July 2015

    Pregnant women

    Seroprevalence

    Toxoplasma gondii

    Bahir Dar

    Ethiopia

    Objective: To determine the prevalence of toxoplasmosis and to assess the possible risk factors associated with the infection among pregnant women attending antenatal care center at Felege Hiwot Referral Hospital, Bahir Dar town, northwest Ethiopia. Methods: A hospital based cross-sectional study was designed to determine the prevalence of toxoplasmosis among pregnant women. Three hundred eighty four serum samples were collected from November 2013 to January 2014. Data on socio-demographic and predisposing factors were collected from each study participant with simple random sampling technique. The serum samples were examined for anti- Toxoplasma gondii (T. gondii) antibodies using latex agglutination test. Results: The overall seroprevalence of T. gondii among the pregnant women was 18.5%. All of T. gondii positive cases found to be positive only for IgG antibody. Significant association was observed between seroprevalence and presence of domestic cats [AOR=2.85, 95% CI: 1.66-4.90, P=0.000], consumption of raw or undercooked meat [AOR=1.98, 95% CI: 1.15-2.43, P=0.014] and history of abortion [AOR=2.47, 95% CI: 1.40-4.34, P=0.002]. No significant association was observed between seroprevalence and socio-demographic characters, gestational age, gravidity, consumption of raw vegetable, and blood transfusion. Conclusions: The seroprevalence of toxoplasmosis among pregnant women in Bahir Dar town was relatively high. Presence of domestic cats at home and consumption of raw or undercooked meat were identified as main risk factors for T. gondii infection. Therefore, health education towards avoiding eating raw or undercooked meat and avoiding contact with cats are recommended for prevention of miscarriage or defects during pregnancy.

    1. Introduction

    Toxoplasmosis is caused by an obligate intracellular tissue protozoan parasite Toxoplasma gondii, (T. gondii) which is able to infect humans as well as other warm blooded domestic and wild animals. The infection has a worldwide distribution with approximately one-third of the world population estimated to be exposed to this parasite[1]. T. gondii is transmitted to humans by eating raw or inadequately cooked infected meat, through ingestion of oocysts that cats have passed in their feces and women can transmit the infection transplacentally to their unborn fetus. Other infection pathways are transfusion, transplantation and direct contamination[2].

    The importance of this parasite is mainly in pregnancy as it can cross the placental barrier to infect the foetal tissues and thereby cause congenital deformities. If acquired during pregnancy as a primary infection, the parasite can cross the placenta, leading to spontaneous miscarriage, death of the foetus in utero or severe congenital defects such as hydrocephaly, mental retardation or chorioretinitis[3,4]. Antenatal serological screening of T. gondii infection based on IgG and IgM detection is the mainstay in monitoring the risk for congenital toxoplasmosis. Maternal-fetal intervention for toxoplasmosis can be achieved through the use of drugs such as spiramycine which prevents congenital infection bymore than 60%[5].

    The global status of T. gondii seroprevalence varied between regions and is a measure of the accumulated exposure to T. gondii in a particular social setting as well as being an indicator of the relative protection for a woman in the population against primary infection during pregnancy[6]. Seroprevalence in Europe is high, up to 54% in Southern European countries[7], whereas in sub-Saharan Africa the overall seroprevalence of T. gondii infection as high as 92.5% has been reported[8]. Recent evaluation of the epidemiology of T. gondii in different towns of Ethiopia has shown 83.6% among pregnant women in Jimma, 93.3% among HIV/AIDS patients in Addis Ababa and 60% among general population of Nazareth, Ethiopia[9-11].

    The chance of acquiring acute infection with T. gondii is high during pregnancy and the infection would have potential tragic outcomes for the mother, the fetus and newborn despite the fact that it can be prevented[12]. In spite of the wide practice of keeping cats as domestic animals and presence of stray cats around, and suitable climatic conditions favoring survival of the parasite in the study area, to our knowledge, there is no regular serological screening of pregnant women for T. gondii infection. Moreover, there is no documented data about the prevalence of the disease and associated risk factors in the study area. It is believed that antenatal data on the prevalence of infectious diseases in the study area would give baseline information about the prevalence of T. gondii in pregnant women and also for planning and implementation of T. gondii control and prevention strategies.

    2. Materials and methods

    2.1. Study design and area

    Hospital based cross–sectional study was conducted from November 2013 to January 2014 to determine the prevalence of toxoplasmosis and assess the possible risk factors associated with the infection among pregnant women attending antenatal care at Felege Hiwot Referral Hospital (FHRH), Bahir Dar, northwest Ethiopia. Bahir Dar is the capital of Amhara National Regional state, located approximately 578 km Northwest of Addis Ababa, capital city of Ethiopia. It is located at 11036' latitude N and 37023' longitude E and an elevation of 1 800 meter above sea level. Based on the 2014 Bureau of Finance and Economics Development of Amhara National Regional State, the population of Bahir Dar including rural kebeles is 284 020 of which 134 818 are males and 149 202 are females. Among females, 93 174 of them are between 15-49 years of age (reproductive age groups)[13].

    The source population was all pregnant women who came to antenatal care center at Felege Hiwot Referral Hospital, Bahir Dar, Ethiopia. The study participants were those pregnant women who attended antenatal service at Felege Hiwot Referral Hospital during sample collection period were considered as a study population. Pregnant women who were critically ill, unable to communicate and those who were not willing to provide vital information and blood sample were excluded from the study.

    2.2. Sample size determination and sampling technique

    In the estimation of the sample size, statistical formula for sample size calculation was considered as a basis[14]. As seroprevalence of T. gondii is not known in the study area, the sample size was calculated with a prevalence of 50% and a total of 384 pregnant women were included in the study.

    n= Z2P (1-P) ∕ d2

    Where n=sample size

    Z=critical value at 5% level (1.96) P= prevalence (50%)

    d= margin of error (5%) The method for selecting study participants was simple random sampling in which study subjects were picked during the time of data collection until the required sample size was reached.

    2.3. Data collection procedure and laboratory investigation

    Information on socio-demographic data, history of exposure for the possible associated factors, and other valuable information were collected by trained antenatal care nurses using structured questionnaire.

    A full verbal explanation about the study was given by the investigators to all voluntary participants. After obtaining informed consent, 5 mL of venous blood was drawn from each of the study participant using labeled test tubes by trained medical laboratory technician. Then serum was separated from the whole blood by centrifugation at 3 000 rpm for 5 minutes and transported with ice box from Hospital to Biomedical and Microbiology Laboratory, Biology Department, Bahir Dar University, for investigation. The serum samples were kept at -20 ℃ till serological test was done.

    2.4. Principle and performance of the test

    Toxo-latex test is a rapid slide agglutination procedure, developed to detect more than 10 IU/mL anti-Toxoplasma antibodies in human serum. The assay was performed by testing a suspension of latex particles coated with antigenic extract of T. gondii against unknown samples. The presence or absence of a visible agglutination indicates the presence or absence of anti-Toxoplasma antibodies in the sample tested [Tulip diagnostics (p) Ltd. Verna, Goa-403722, India].

    2.5. Quality control

    To assure the quality of the data, half day training was given for data collectors on procedures, techniques, and ways of expressing the questionnaires to collect the necessary information. Every day, the collected data was reviewed and checked for completeness by the principal investigator. For laboratory investigations standardized operating procedures and manufacturer’s instructions were strictly followed. The quality of latex agglutination kits for anti-T. gondii were checked by both positive and negative controls.

    2.6. Data analysis and interpretation

    Information recorded in the questionnaire and laboratory resultswere entered into computer and analyzed using Statistical Package for the Social Sciences (SPSS version 20.0). The groups were characterized according to the target variables using descriptive statistical analysis methods. Prevalence of toxoplasmosis was defined as the percentage of positive cases for serological tests. Associations between toxoplasmosis and possible risk factors were tested with Chi-square test. The magnitude of associations was assessed using odds ratio (OR) at 95% CI, and multivariate logistic regression models was used to identify the explanatory variables among the confounding risk variables that would explain the occurrence of toxoplasmosis. P-value less than 0.05 was considered statistically significant.

    2.7. Ethical considerations

    The study was ethically cleared by ethical review board of Bahir Dar University and Amhara Regional Health Bureau. The study subjects were informed about the study and written informed consents were obtained from all of the participants before collecting blood samples. Participation in the study was on voluntary basis and study subjects were free to withdraw from the study before and after collection of blood samples without losing any of the benefits they were supposed to obtain from the hospital. While collecting venous blood, the participants might experience pain and therefore maximum effort was taken to minimize the pain and/or associated complications. All blood samples were collected using new disposable tubes, syringes and needles.

    3. Results

    3.1. Socio-demographic characteristics

    A total of 384 pregnant women were included in this study. The mean age of the study participants was 26.96 ± 4.56. One hundred seventy-six (45.8%) of the study subjects belonged to 25-29 years of age. Majority of the study participants, 340 (88.5%), were urban residents. Two hundred nine (54.4%) of the pregnant women were in their 1st trimester. Regarding their educational status, 122 (31.8%) of the respondents educated in college and above, and followed by secondary school 116 (30.2%). Occupation wise, majority of them 162 (42.2%) were housewives. Of the total study subjects, 167 (43.5%) belonged to primigravidae. With regard to pregnancy related problem, nearly a quarter 95 (24.7%) of the total study subjects had history of abortion (Table 1).

    3.2. History of exposures to different risk factors of T. gondii infection

    Nearly half of pregnant women, 178 (46.4%), had a habit of eating raw/under cooked meat. Only 126 (32.8%) of the study subjects had cat in their houses. More than half of the pregnant women (59.9%) had a habit of eating raw/under cooked vegetables. Majority of the study participants, 363 (94.5%), reported to use pipe water as a source of drinking. Only 9 (2.3%) of the pregnant women had history of blood transfusion (Table 1).

    Table 1 Seroprevalence of T. gondii infection in relation to different characteristics among pregnant women at FHRH, Bahir Dar town, from November 2013 to January 2014.

    3.3. Seroprevalence of T. gondii

    The overall seroprevalence of T. gondii among the pregnant women was 18.5%. All of toxoplasmosis cases were positive only for IgG antibody. Five (71.4%) of pregnant women who were positive for T. gondii were in the age group of 40–44 years. Among T. gondii positive cases, 12 (27.3%) study participants were from rural setting. With regard to educational background, illiterates accounted 11 (25.6%) of all positive cases. From the total 71 T. gondii positive cases, 31 (19.1%) of them were housewives. Comparable results of seropositivity were obtained among 1st, 2nd and 3rd trimesters withprevalence of 17.9%, 20.6% and 17.2%, respectively. With regard to gravidity, 27 (27.3%) positive cases were from multigravidae category (Table 1).

    Thirty eight (30.2%) of pregnant women who had cats in their households were found to be positive for T. gondii. Among the study participants who had a habit of eating raw or under cooked meat, 41 (23%) of them were seropositive for T. gondii infection. Seroprevalence among women who used pipe water as a source of drinking water was 64 (17.6%). The result of this study revealed that 41 (17.8%) of T. gondii positive cases were from those who had a habit of eating raw or under cooked vegetables. Among pregnant women who had history of blood transfusion, 4 (44.4%) of them were positive for anti-T. gondii antibody (Table 1).

    3.4. Factors associated with seropositivity

    The univariate analysis indicated that almost all socio-demographic variables such as age, residence, education, occupation, gestational period and majority of possible risk factors did not show significant association with T. gondii seropositivity. However, gravidity (multigravidae) (COR= 2.35, 95% CI: 1.26-4.38), history of abortion (COR=2.58, 95% CI: 1.50-4.46), having domestic cat at home (COR=2.94, 95% CI: 1.74-4.99) and having a habit of eating raw or under cooked meat (COR=1.76, 95% CI: 1.04-2.96) were significantly associated with T. gondii seropositivity (Table 2).

    In multivariate analysis, stepwise logistic regression technique was used and the relative effect of the independent variable on the outcome variable was determined. In doing so, to avoid an excessive number of variables and unstable estimates in the subsequent model, only variables that reached a p-value less than 0.3 were kept in the subsequent analyses[15]. Finally, only three possible risk factors namely history of abortion (AOR=2.47, 95% CI: 1.40-4.34), having domestic cat at home (AOR=2.85, 95% CI: 1.66-4.90) and having a habit of eating raw/undercooked meat (AOR=1.98, 95% CI: 1.15-2.43) remained significant in the final step of multivariate analysis. But, pregnant women who were in multigravidae category was significantly associated with seropositivity of T. gondii during crude analysis was turned to be insignificant after it was adjusted for some of the significant explanatory variables (Table 2).

    Table 2 Univariate and multivariate analysis of characteristics in pregnant women and their association with T. gondii infection at FHRH, Bahir Dar town, from November 2013 to January 2014.

    4. Discussion

    A wide variability in the prevalence of toxoplasmosis among pregnant women has been reported worldwide. The present study demonstrated that prevalence of anti-Toxoplasma antibodies in pregnant women was 18.5%. None of the study subjects found to be positive for anti-Toxoplasma IgM antibodies. IgM antibody is usually detected within the first two weeks of infection and reduces to negligible levels within 6 months after exposure[16]. Thus, the absence of IgM antibodies in this study may indicate the absence of acute toxoplasmosis infection.

    The prevalence of anti-T. gondii antibody observed in this study is in agreement with the studies that have been conducted in South Africa and Italy, which reported prevalence of 18.1% and 19.1%, respectively[17,18]. However, our finding is lower than seroprevalence reported among pregnant women in Jimma town (83.6%) and among general population in Nazareth town (60%), Ethiopia[9,11]. The observed difference in the rates of infection may be due to the commitment of Ministry of Health of Ethiopia to reduce maternal mortality through awareness creation about the infection using health extension workers or it could be due to the difference in diagnostic method used. It may also be the varied prevalence of the parasite in animals and the type of animals consumed. This is further corroborated by the fact that varied seroprevalence of the disease was reported among domestic animals in Ethiopia with prevalence of 22.9% in sheep, 11.6% in goats, and 6.6% in cattle[19]. However, the present finding is higher than prevalence rates which were reported from China 10.6%, USA 11% and Japan 10.3%[6,20,21]. This variability could be attributed to differences in climatic conditions, feeding habits, socio-economic and literacy status of the study subjects.

    The finding of the present study showed significant association between T. gondii infection and presence of domestic cats at home, which was one of the predictors for T. gondii infection in this study. This finding is in agreement with studies reported from Jimma, Ghana and Taiwan[8,9,22]. In contrast, some studies reported absence of association between Toxoplasma infection and presence of domestic cats in the household in Nigeria and in Tanzania[23-25]. This variation among different studies could be the risk of contracting T. gondii infection might not just be the presence of cats in the households but it could be contact of cats’ fecal material while gardening.

    The study results showed that Toxoplasma infection may result from consumption of raw or undercooked meat. That means having a habit of eating raw or under cooked meat was found to be a major factor contributing to maternal infection in the study area, which is consistent with studies conducted by Elnahas et al and Mohamed et al in Sudan[26,27]. However, other studies reported from Jimma town, Ethiopia, Ghana and Turkey did not find significant association of raw or undercooked meat consumption with Toxoplasma infection[8,9,28]. The possible reason for the variation could be difference in feeding habits of the study participants.

    In relation to histories of abortion, there was significant association between occurrences of previous abortions and seroprevalence for toxoplasmosis. This association does not mean that previous abortion is a risk factor predisposing to infection, but it may indicate that premature termination of pregnancy may expose the women to T. gondii infection. Similar results were also reported from Sudan and India[29,30]. In contrast, some studies reported the absence of significant association between seroprevalence of T. gondii infection and histories of abortion in pregnant women of Jimma town, Ethiopia and that of Assam town, India[9,31]. The possible reason for the cause of variation may be induced abortion in contrast to the findings of the present study.

    Some of the risk factors examined, such as blood transfusion, consumption of raw/under cooked vegetable and drinking water source have been documented in different parts of the world to have influence on Toxoplasma transmission[32]. The absence of a statistically significant relationship between the seroprevalence of Toxoplasma infection and these potential factors does not mean that they have no influence on the transmission of toxoplasmosis. However, it may suggest that such factors play a limited role in the study area for the transmission of the parasite in the studied subjects. In the present study, there was a higher seroprevalence of T. gondii in those aged above 35 years than those below 35 years of age. Nevertheless, there was no significant association between toxoplasmosis and mother's age. Statistical association does not necessarily mean that older age is a risk factor predisposing to infection but it might be explained by the fact that the older persons can be exposed to the causative agent for longer time and consequently they may retain a steady level of anti-Toxoplasma IgG in serum for years. Unlike the present study, results that have been reported from Jimma, Nigeria and Brazil have shown statistically significant association between age of pregnant women and seroprevalence of T. gondii infection[9,24,33]. The observed difference in the rates of infection could be due to variation in age classification of the study participants in the present study.

    Despite the non-statistical significant association, the present study showed that whenever there is an increase in gravidity, there could be an increase of the probability of T. gondii infection in pregnant women. This situation shows that as the age of the women and the number of pregnancy increases this would in turn lead to an increment of exposure time to an infection. In this study, gravidity, socio-demographic variables such as residence, education, occupation, and gestational age did not show significant association with seroprevalence of T. gondii infection.

    It can be concluded that the seroprevalence of T. gondii infection among pregnant women in Bahir Dar town was relatively high. This finding revealed that exposure to T. gondii infection may increase the risk of premature termination of pregnancy. Presence of domestic cats at home and consumption of raw or under-cooked meat were also identified as main risk factors for T. gondii infection. Therefore, implementation of regular serological testing during pregnancy, health education towards avoiding eating undercooked or raw meat, and avoiding contact with cats fecal material during cleaning and gardening should be emphasized by health extension workers and other public health professionals for prevention of the disease.

    Conflict of interest statement

    We declare that we have no conflict of interest.

    [1] Dubey JP. Toxoplasmosis of animals and humans. Beltseville: CRC Press; 2010.

    [2] Galvan Ramirez ML, Rodríguez Pérez LR, Ledesma Agraz SY, Sifuentes ávila LM, Armenta Ruíz AS, Corella DB, et al. Sero- epidemiology of toxoplasmosis in high-school students in the metropolitan area of Guadalajara, Jalisco, Mexico. Sci Med 2010; 20: 59–63.

    [3] Tenter AM, Heckeroth AR, Weiss LM. Toxoplasma gondii: from animals to humans. Int J Parasitol 2000; 30: 1217–1258.

    [4] Sukthana Y. Toxoplasmosis: beyond animals to humans. Trends in Parasitol 2006; 22: 137–142.

    [5] Montoya JG, Remington JS. Management of Toxoplasma gondii infection during pregnancy. Clin Infect Dis 2008; 47: 554–566.

    [6] Pappas G, Roussos N, Falagas ME. Toxoplasmosis snapshots: Global status of Toxoplasma gondii seroprevalence and implications for pregnancy and congenital toxoplasmosis. Int J Parasitol 2009; 39: 1385–1394.

    [7] Cook AJ, Gilbert RE, Buffolano W, Zufferey J, Petersen E, Jenum PA, et al. Sources of Toxoplasma infection in pregnant women: European multicentre case-control study. European Research Network on Congenital toxoplasmosis. BMJ 2000; 321: 142–147.

    [8] Ayi I, Edu A, Apea-Kubi K. Sero-epidemiology of toxoplasmosis amongst pregnant women in the greater Accra region of Ghana. Gh Med J 2009; 43: 107–114.

    [9] Zemene E, Yewhalaw D, Abera S, Belay T, Samuel A, Zeynudin A. Seroprevalence of Toxoplasma gondii and associated risk factors among pregnant women in Jimma town, Southwestern Ethiopia. BMC Infect Dis 2012; 12: 337.

    [10] Shimelis T, Tebeje M, Tadesse E, Tegbaru B, Terefe A. Sero-prevalence of latent Toxoplasma gondii infection among HIV-infected and HIV-uninfected people in Addis Ababa Ethiopia: a comparative cross-sectional study. BMC Res Notes 2009; 2: 213.

    [11] Negash T, Tilahun G, Medhin G. Seroprevalence of Toxoplasma gondii in Nazareth town Ethiopia. East Afr J Public Health 2008; 5: 211–214.

    [12] Rorman E, Zamir CS, Rilkis I, Ben-David H. Congenital toxoplasmosisprenatal aspects of Toxoplasma gondii infection. Reprod Toxicol 2006; 21: 458–472.

    [13] Bureau of Finance and Economics Development (BOFED). Population size by sex and age Group and Urban Rural, Bahir City Administration 2014.

    [14] Naing L, Winn T, Rusil BN. Practical issues in calculating sample size for prevalence studies. Arch Orofacial Sci 2006; 1: 9–14.

    [15] Victoria CG, Huttly SR, Fuchs SC, Olinto MTA. The role of conceptual frameworks in epidemiological analysis: A hierarchical approach. Int J Epidemiol 1997; 26: 224–227.

    [16] Wilson M, McAuley JM. Toxoplasma. In: Murray PR. Manual of clinical microbiology. 7th edition. American Society for Microbiology; 1999:1374–1382.

    [17] Bessong PO, Mathomu LM. Seroprevalence of HTLV1/2, HSV1/2 and Toxoplasma gondii among chronic HIV-1 infected individuals in rural northeastern South Africa. Afr J Microbiol Res 2010; 4: 2587–2591.

    [18] Thaller R, Tammaro F, Pentimalli H. Risk factors for toxoplasmosis in pregnant women in central Italy. Infez Med 2011; 19: 241–247.

    [19] Bekele T, Kasali O.B. Toxoplasmosis in sheep, goats and cattle in central Ethiopia. Vet Res Commun 1989; 13: 371–375.

    [20] Liu Q, Wei F, Gao S, Jiang L, Lian H. Toxoplasma gondii infection in pregnant women in China. Trans R Soc Trop Med Hyg 2009; 103: 162–166.

    [21] Sakikawa M, Noda S, Hanaoka M, Nakayama H, Hojo S, Kakinoki S. Anti-Toxoplasma antibody prevalence, primary infection rate, and risk factors in a study of toxoplasmosis in pregnant women in Japan. Clin Vaccine Immunol 2012; 19: 365–367.

    [22] Lin YL, Liao YS, Liao LR, Chen FN, Kuo HM, He S. Seroprevalence and sources of Toxoplasma infection among indigenous and immigrant pregnant women in Taiwan. Parasitol Res 2008; 103: 67–74.

    [23] Ishaku BAI, Umoh J, Lawal I, Randawa A. Seroprevalence and risk factors for Toxoplasma gondii infection among antenatal women in Zaria, Nigeria. Res J Med & Med Sc 2009; 4: 483–488.

    [24] Deji-Agboola OS, Busari OA, Osinupebi OJ Amoo. Seroprevalence of Toxoplasma gondii Antibodies among pregnant women attending antenatal clinic of federal medical center, Lagos, Nigeria. Int J Biol Med Res 2011; 2: 1135–1139.

    [25] Mwambe B, Stephen E, Benson R, Anthony N. Sero-prevalence and factors associated with Toxoplasma gondii infection among pregnant women attending antenatal care in Mwanza, Tanzania. Parasit Vec 2013; 6: 222.

    [26] Elnahas AGA, Elbashir MI, Eldien ES, Adam I. Toxoplasmosis in pregnant Sudanese women. Saudi Med J 2003; 24:868–870.

    [27] Mohamed K, Ahmed A, Intisar E, Rayah L. Prevalence and risk factors for Toxoplasma gondii infection in humans from Khartoum State, Sudan. Int J Public Health Epid 2013; 2: 60–66.

    [28] Ertug SOP, Tukmen M, Yuksel H. Seroprevalence and risk factors for Toxoplasma infection among pregnant women in Aydin province, Turkey. BMC Public Health 2005; 5: 66.

    [29] Mohamed K, Kodym P, Maly M, Intisar E, Rayah L. Environmental and food habitat risk factors associated with Toxoplasma gondii infection in rural women in Sudan. Int J Curr Microbiol App Sci 2014; 3: 208–222.

    [30] Anna T, Sucilathangam G, Velvizhi G. Seroprevalence of Toxoplasma gondii in pregnant women with bad obstetric history. Indian J Res 2013; 2: 11.

    [31] Borkakoty BJ, Borthakur AK, Gohain M. Prevalence of Toxoplasma gondii infection amongst pregnant women in Assam, India. Indian J Med Microbiol 2007; 25: 431-432.

    [32] Jones JL, Kruszon-Moran D, Wilson M, McQuillan G, Navin T, McAuley JB. Toxoplasma gondii infection in the United States: seroprevalence and risk factors. Am J Epidemiol 2001; 154: 357–365.

    [33] Fernanda L, Maria R, Otílio M. Prevalence and risk factors for Toxoplasma gondii infection among pregnant and postpartum women. Med Tropical 2013; 46: 200–207.

    *Corresponding author: Endalkachew Nibret, Biology Department, Bahir Dar University, P.O.Box 79, Bahir Dar, Ethiopia.

    E-mail: endtg2002@yahoo.com

    又爽又黄无遮挡网站| 宅男免费午夜| 日韩欧美国产一区二区入口| 最好的美女福利视频网| 国产真实伦视频高清在线观看 | 国产乱人视频| 天天躁日日操中文字幕| 日本一二三区视频观看| 97超级碰碰碰精品色视频在线观看| 国产淫片久久久久久久久 | 久久99热6这里只有精品| 亚洲男人的天堂狠狠| 国产久久久一区二区三区| 一卡2卡三卡四卡精品乱码亚洲| 一级av片app| 男人狂女人下面高潮的视频| 国产亚洲av嫩草精品影院| 国产精品嫩草影院av在线观看 | 国产精品爽爽va在线观看网站| 国产伦人伦偷精品视频| 中国美女看黄片| 国产欧美日韩一区二区精品| 很黄的视频免费| 女人被狂操c到高潮| 别揉我奶头 嗯啊视频| 成人一区二区视频在线观看| 国产亚洲精品av在线| 亚洲色图av天堂| 日韩人妻高清精品专区| 国产精品精品国产色婷婷| 欧美xxxx性猛交bbbb| 亚洲在线自拍视频| 日韩人妻高清精品专区| 亚洲性夜色夜夜综合| 国产成人aa在线观看| 日韩大尺度精品在线看网址| 国产精品一区二区性色av| 国产私拍福利视频在线观看| 午夜精品在线福利| 精品久久久久久久人妻蜜臀av| 12—13女人毛片做爰片一| 精品乱码久久久久久99久播| 国产欧美日韩一区二区精品| 人人妻人人看人人澡| 亚洲 国产 在线| 成年女人永久免费观看视频| 国产日本99.免费观看| 欧美高清成人免费视频www| ponron亚洲| 少妇的逼好多水| 午夜精品久久久久久毛片777| 久久久精品大字幕| 日韩人妻高清精品专区| 亚洲成人久久爱视频| 亚洲av成人不卡在线观看播放网| 午夜视频国产福利| 日日干狠狠操夜夜爽| 国产欧美日韩一区二区精品| 精品人妻熟女av久视频| 亚洲男人的天堂狠狠| 免费av观看视频| 欧美三级亚洲精品| 日韩成人在线观看一区二区三区| 日韩人妻高清精品专区| 精品人妻视频免费看| 亚洲国产欧美人成| 最近最新免费中文字幕在线| 一级av片app| 色5月婷婷丁香| 亚洲人成网站在线播放欧美日韩| 首页视频小说图片口味搜索| 免费观看的影片在线观看| 麻豆国产av国片精品| 非洲黑人性xxxx精品又粗又长| 老司机午夜福利在线观看视频| 99国产精品一区二区蜜桃av| 日日摸夜夜添夜夜添小说| 免费观看精品视频网站| 在线十欧美十亚洲十日本专区| 午夜福利在线观看免费完整高清在 | 色在线成人网| 成人毛片a级毛片在线播放| 永久网站在线| 国产免费一级a男人的天堂| 亚洲国产精品sss在线观看| 国产av不卡久久| 99久久无色码亚洲精品果冻| 亚洲成人久久爱视频| 高潮久久久久久久久久久不卡| 99视频精品全部免费 在线| 国产91精品成人一区二区三区| 高清毛片免费观看视频网站| 国产综合懂色| 麻豆久久精品国产亚洲av| 亚洲熟妇中文字幕五十中出| 国产人妻一区二区三区在| 在线国产一区二区在线| avwww免费| 99久久无色码亚洲精品果冻| 天堂网av新在线| 亚洲一区二区三区色噜噜| 欧美精品国产亚洲| 国产日本99.免费观看| 一个人看视频在线观看www免费| 在线观看一区二区三区| 亚洲成av人片免费观看| 中文资源天堂在线| 亚洲精品成人久久久久久| 色播亚洲综合网| 中文字幕人妻熟人妻熟丝袜美| 伦理电影大哥的女人| 男女做爰动态图高潮gif福利片| 欧美成人一区二区免费高清观看| 免费人成在线观看视频色| 麻豆久久精品国产亚洲av| 欧美一区二区国产精品久久精品| 国产精品亚洲av一区麻豆| 欧美日韩瑟瑟在线播放| 国产精品免费一区二区三区在线| 99热6这里只有精品| netflix在线观看网站| www日本黄色视频网| 天天躁日日操中文字幕| 午夜视频国产福利| 99久久精品热视频| 亚洲人成电影免费在线| 黄色一级大片看看| 在线免费观看的www视频| 麻豆成人午夜福利视频| 中文字幕av在线有码专区| 亚洲欧美日韩无卡精品| 日本一二三区视频观看| 欧美绝顶高潮抽搐喷水| 免费高清视频大片| 国产成人av教育| 欧美日韩国产亚洲二区| 国产精品久久久久久精品电影| 亚洲最大成人手机在线| 国产成人a区在线观看| 嫩草影视91久久| 黄色视频,在线免费观看| 极品教师在线视频| 亚洲 欧美 日韩 在线 免费| av在线天堂中文字幕| 中文字幕免费在线视频6| 全区人妻精品视频| 观看美女的网站| 久久久久精品国产欧美久久久| 亚洲精品在线美女| 在线观看美女被高潮喷水网站 | av在线观看视频网站免费| 亚洲av第一区精品v没综合| 精品人妻一区二区三区麻豆 | 窝窝影院91人妻| 波多野结衣高清无吗| 欧美成人性av电影在线观看| 免费观看精品视频网站| 久久亚洲精品不卡| 好男人在线观看高清免费视频| 亚洲午夜理论影院| 亚洲片人在线观看| 国产成人av教育| 国内精品一区二区在线观看| 国产高清视频在线观看网站| 午夜福利成人在线免费观看| 久久精品人妻少妇| 18美女黄网站色大片免费观看| 日日夜夜操网爽| 人人妻人人澡欧美一区二区| 一本久久中文字幕| 日韩欧美国产在线观看| 麻豆成人av在线观看| 久久精品夜夜夜夜夜久久蜜豆| 露出奶头的视频| 亚洲精华国产精华精| 国产日本99.免费观看| 久久久久免费精品人妻一区二区| 日本黄大片高清| 亚洲国产精品sss在线观看| 国产成人福利小说| 精品久久久久久久末码| 色av中文字幕| 亚洲国产精品合色在线| 久久国产乱子免费精品| 制服丝袜大香蕉在线| 很黄的视频免费| 99久久99久久久精品蜜桃| 99久久久亚洲精品蜜臀av| 亚洲,欧美精品.| 桃红色精品国产亚洲av| 欧洲精品卡2卡3卡4卡5卡区| 成人高潮视频无遮挡免费网站| 色在线成人网| 亚洲av一区综合| 欧美中文日本在线观看视频| 搞女人的毛片| 精品久久久久久,| 亚洲av第一区精品v没综合| 久久婷婷人人爽人人干人人爱| 琪琪午夜伦伦电影理论片6080| 一级作爱视频免费观看| 精品久久久久久久久久免费视频| 变态另类成人亚洲欧美熟女| 国产免费av片在线观看野外av| 毛片一级片免费看久久久久 | 国产亚洲精品久久久com| 99久久成人亚洲精品观看| 成年版毛片免费区| 色噜噜av男人的天堂激情| 91在线精品国自产拍蜜月| 国产精品伦人一区二区| 亚洲,欧美,日韩| 神马国产精品三级电影在线观看| av在线天堂中文字幕| 亚洲精品久久国产高清桃花| 国产在视频线在精品| 国内精品美女久久久久久| 99热只有精品国产| 99热6这里只有精品| 又紧又爽又黄一区二区| 狠狠狠狠99中文字幕| 又黄又爽又刺激的免费视频.| 国产男靠女视频免费网站| 男人的好看免费观看在线视频| 亚洲无线观看免费| 床上黄色一级片| 免费黄网站久久成人精品 | 成年女人毛片免费观看观看9| 亚洲最大成人中文| 国产野战对白在线观看| 亚洲熟妇熟女久久| 高清毛片免费观看视频网站| 十八禁国产超污无遮挡网站| 日韩中文字幕欧美一区二区| 精品乱码久久久久久99久播| 最后的刺客免费高清国语| 在线播放国产精品三级| 亚洲专区国产一区二区| 精品一区二区免费观看| 一本久久中文字幕| 精品久久久久久久久久免费视频| 三级国产精品欧美在线观看| 亚洲自偷自拍三级| 麻豆成人午夜福利视频| 中文字幕av在线有码专区| 国产精品久久久久久精品电影| 国产日本99.免费观看| 精品国产亚洲在线| 一边摸一边抽搐一进一小说| 亚洲国产精品合色在线| 深爱激情五月婷婷| 波多野结衣巨乳人妻| 亚洲激情在线av| 日本黄色片子视频| 久久欧美精品欧美久久欧美| 麻豆国产av国片精品| 亚洲经典国产精华液单 | 老熟妇乱子伦视频在线观看| 琪琪午夜伦伦电影理论片6080| 日韩欧美国产在线观看| 男女做爰动态图高潮gif福利片| 国产视频内射| 日韩欧美 国产精品| 久久午夜福利片| 内射极品少妇av片p| 亚洲av成人av| 别揉我奶头 嗯啊视频| 亚洲美女黄片视频| 欧美色欧美亚洲另类二区| 国产午夜福利久久久久久| 国产高清有码在线观看视频| 中文资源天堂在线| 噜噜噜噜噜久久久久久91| 亚洲在线自拍视频| 久久久久久久久久黄片| 亚洲第一电影网av| 最新中文字幕久久久久| 男人狂女人下面高潮的视频| 亚洲真实伦在线观看| 99在线视频只有这里精品首页| 黄色配什么色好看| 嫩草影院新地址| 99热精品在线国产| 亚洲精品色激情综合| 成熟少妇高潮喷水视频| 日本五十路高清| 午夜精品久久久久久毛片777| 精品不卡国产一区二区三区| 午夜福利在线观看吧| 啦啦啦韩国在线观看视频| 久久精品国产清高在天天线| 欧洲精品卡2卡3卡4卡5卡区| 全区人妻精品视频| 99在线人妻在线中文字幕| 欧美黑人巨大hd| 99久国产av精品| 在线播放无遮挡| 亚洲精品日韩av片在线观看| 亚洲aⅴ乱码一区二区在线播放| 国产久久久一区二区三区| 午夜福利在线观看免费完整高清在 | 久久亚洲精品不卡| 青草久久国产| 赤兔流量卡办理| 美女大奶头视频| 午夜福利视频1000在线观看| 精品久久久久久久人妻蜜臀av| 久久国产乱子免费精品| 国产精华一区二区三区| 亚洲色图av天堂| 嫩草影院新地址| 中文资源天堂在线| 18禁在线播放成人免费| 小蜜桃在线观看免费完整版高清| 成人特级av手机在线观看| 淫妇啪啪啪对白视频| 搡女人真爽免费视频火全软件 | 黄色视频,在线免费观看| 久久久久精品国产欧美久久久| 午夜精品久久久久久毛片777| 成年免费大片在线观看| 国产亚洲精品综合一区在线观看| 日韩欧美精品v在线| 最后的刺客免费高清国语| 欧美不卡视频在线免费观看| 欧美激情在线99| 日日摸夜夜添夜夜添av毛片 | 亚洲aⅴ乱码一区二区在线播放| 欧美+日韩+精品| 乱人视频在线观看| 成人永久免费在线观看视频| 欧美一区二区亚洲| 看黄色毛片网站| 久久久久久国产a免费观看| 人妻丰满熟妇av一区二区三区| 香蕉av资源在线| 亚洲av电影不卡..在线观看| 久久精品夜夜夜夜夜久久蜜豆| 特大巨黑吊av在线直播| 男女下面进入的视频免费午夜| 如何舔出高潮| 午夜影院日韩av| 亚洲黑人精品在线| 久久精品国产99精品国产亚洲性色| 久久天躁狠狠躁夜夜2o2o| 亚洲精品456在线播放app | 成人国产综合亚洲| 中文字幕熟女人妻在线| 国产aⅴ精品一区二区三区波| 美女大奶头视频| 午夜精品久久久久久毛片777| 伦理电影大哥的女人| 有码 亚洲区| 国内久久婷婷六月综合欲色啪| 91字幕亚洲| 夜夜爽天天搞| 国内精品久久久久精免费| 午夜影院日韩av| 午夜福利在线观看吧| 国产av麻豆久久久久久久| 少妇丰满av| 亚洲欧美清纯卡通| 可以在线观看毛片的网站| av国产免费在线观看| av女优亚洲男人天堂| 少妇熟女aⅴ在线视频| 哪里可以看免费的av片| 亚洲男人的天堂狠狠| 国产乱人视频| 亚洲精品影视一区二区三区av| 麻豆一二三区av精品| 久久这里只有精品中国| 一级作爱视频免费观看| 白带黄色成豆腐渣| 亚洲国产欧美人成| 国产av一区在线观看免费| 午夜福利18| 嫁个100分男人电影在线观看| 网址你懂的国产日韩在线| 日韩av在线大香蕉| 亚洲精品一卡2卡三卡4卡5卡| 欧美在线一区亚洲| 波野结衣二区三区在线| 国产亚洲精品久久久com| 一级黄色大片毛片| 制服丝袜大香蕉在线| 国产成人欧美在线观看| 99久久精品国产亚洲精品| 91狼人影院| 色吧在线观看| 首页视频小说图片口味搜索| 欧美日韩黄片免| 狠狠狠狠99中文字幕| 赤兔流量卡办理| 我的女老师完整版在线观看| 欧美中文日本在线观看视频| 国产一区二区三区视频了| 欧美成人性av电影在线观看| 日日摸夜夜添夜夜添小说| 亚洲综合色惰| 免费看日本二区| 日韩欧美 国产精品| 97热精品久久久久久| 噜噜噜噜噜久久久久久91| 精品日产1卡2卡| 男女下面进入的视频免费午夜| 精品99又大又爽又粗少妇毛片 | 在线免费观看的www视频| 真实男女啪啪啪动态图| 亚洲内射少妇av| 午夜免费男女啪啪视频观看 | 亚洲国产欧美人成| 欧美日韩国产亚洲二区| 啪啪无遮挡十八禁网站| 全区人妻精品视频| 欧美日韩福利视频一区二区| av天堂在线播放| 一级av片app| 午夜a级毛片| 亚洲第一电影网av| 哪里可以看免费的av片| 在线观看舔阴道视频| 嫩草影院新地址| 亚洲经典国产精华液单 | 又粗又爽又猛毛片免费看| 99热这里只有是精品在线观看 | 男女那种视频在线观看| 久久久久久国产a免费观看| 韩国av一区二区三区四区| 亚洲av第一区精品v没综合| h日本视频在线播放| 性插视频无遮挡在线免费观看| 精品不卡国产一区二区三区| 国产真实乱freesex| 99国产极品粉嫩在线观看| 国产精品亚洲av一区麻豆| 午夜a级毛片| 国产 一区 欧美 日韩| 国产国拍精品亚洲av在线观看| 小蜜桃在线观看免费完整版高清| 嫩草影院新地址| 亚洲专区国产一区二区| 别揉我奶头~嗯~啊~动态视频| 99国产极品粉嫩在线观看| 特大巨黑吊av在线直播| 在线免费观看的www视频| 丁香六月欧美| 日本a在线网址| 婷婷精品国产亚洲av| 高清毛片免费观看视频网站| 大型黄色视频在线免费观看| 91麻豆av在线| 高清日韩中文字幕在线| 99久久精品一区二区三区| 一本一本综合久久| 麻豆成人av在线观看| 精品久久国产蜜桃| 日日干狠狠操夜夜爽| 美女被艹到高潮喷水动态| 欧美午夜高清在线| 特大巨黑吊av在线直播| av天堂在线播放| 麻豆成人午夜福利视频| 日韩精品中文字幕看吧| 长腿黑丝高跟| 别揉我奶头 嗯啊视频| 无遮挡黄片免费观看| 久9热在线精品视频| 变态另类成人亚洲欧美熟女| 精品免费久久久久久久清纯| 91在线观看av| 国产不卡一卡二| 国产精品美女特级片免费视频播放器| 亚洲国产日韩欧美精品在线观看| 亚洲18禁久久av| 午夜福利成人在线免费观看| 波多野结衣高清无吗| 亚洲成a人片在线一区二区| 国产高清激情床上av| 国产色婷婷99| 免费大片18禁| 熟女电影av网| 老司机午夜十八禁免费视频| 国产伦精品一区二区三区视频9| 看免费av毛片| 少妇裸体淫交视频免费看高清| 人妻制服诱惑在线中文字幕| 久久精品国产亚洲av香蕉五月| 夜夜躁狠狠躁天天躁| 国产精品自产拍在线观看55亚洲| 免费av不卡在线播放| 好男人在线观看高清免费视频| 久久人人精品亚洲av| 精品久久久久久久久久久久久| www.999成人在线观看| 国产亚洲精品综合一区在线观看| 亚洲精品影视一区二区三区av| 日韩欧美 国产精品| 免费看日本二区| 在线免费观看的www视频| 亚洲成av人片在线播放无| 丝袜美腿在线中文| 91久久精品电影网| 一卡2卡三卡四卡精品乱码亚洲| www.999成人在线观看| 欧美乱色亚洲激情| 18禁裸乳无遮挡免费网站照片| 亚洲av成人不卡在线观看播放网| 别揉我奶头 嗯啊视频| 亚洲国产欧美人成| 国语自产精品视频在线第100页| 成人av在线播放网站| 亚洲成人中文字幕在线播放| 男女那种视频在线观看| 亚洲av一区综合| 亚洲国产高清在线一区二区三| 97超级碰碰碰精品色视频在线观看| 久久99热这里只有精品18| 国产在线男女| 亚洲欧美日韩卡通动漫| 亚洲一区二区三区色噜噜| 国产亚洲欧美98| 久久中文看片网| 人妻丰满熟妇av一区二区三区| 床上黄色一级片| 国产亚洲精品av在线| 97热精品久久久久久| 老熟妇仑乱视频hdxx| 三级毛片av免费| 最好的美女福利视频网| 天堂影院成人在线观看| 欧美性感艳星| 国产精品久久久久久久电影| 首页视频小说图片口味搜索| 男女床上黄色一级片免费看| 99国产精品一区二区三区| 欧美乱妇无乱码| 亚洲国产精品999在线| 亚洲在线自拍视频| 欧美成人性av电影在线观看| 国产高潮美女av| 免费黄网站久久成人精品 | 国内精品久久久久精免费| 日本a在线网址| 国产精品久久久久久久电影| 女人被狂操c到高潮| 在线免费观看的www视频| 特级一级黄色大片| 99在线视频只有这里精品首页| 最好的美女福利视频网| 欧美成人免费av一区二区三区| 久久精品夜夜夜夜夜久久蜜豆| 精品一区二区免费观看| 亚洲久久久久久中文字幕| 国产免费av片在线观看野外av| 乱码一卡2卡4卡精品| 国产亚洲欧美在线一区二区| 国产精品1区2区在线观看.| 一进一出抽搐动态| 精品国产三级普通话版| 免费av观看视频| 男插女下体视频免费在线播放| 精品人妻视频免费看| 欧美最黄视频在线播放免费| 欧美黑人巨大hd| 精品人妻1区二区| 99热这里只有是精品50| 久久6这里有精品| 91午夜精品亚洲一区二区三区 | 国产成+人综合+亚洲专区| 男人和女人高潮做爰伦理| 午夜福利欧美成人| 天堂av国产一区二区熟女人妻| 国产精品久久视频播放| 午夜影院日韩av| 国内精品久久久久精免费| 免费人成视频x8x8入口观看| 日本免费一区二区三区高清不卡| 欧美国产日韩亚洲一区| 日韩欧美免费精品| 1000部很黄的大片| 日本三级黄在线观看| 美女xxoo啪啪120秒动态图 | 亚洲一区高清亚洲精品| 国产av不卡久久| .国产精品久久| 国产视频内射| 天堂√8在线中文| 国产白丝娇喘喷水9色精品| 在线免费观看不下载黄p国产 | 久9热在线精品视频| 国产精品av视频在线免费观看| 日日摸夜夜添夜夜添av毛片 | 99久久精品一区二区三区| 国模一区二区三区四区视频| 亚洲欧美日韩无卡精品| 免费一级毛片在线播放高清视频| 最后的刺客免费高清国语| 18禁黄网站禁片免费观看直播| 中文字幕久久专区| 18美女黄网站色大片免费观看| 国产三级在线视频| 日日夜夜操网爽| 性色avwww在线观看| www日本黄色视频网| 国产精品人妻久久久久久| 十八禁人妻一区二区| 精品久久久久久久久亚洲 | 午夜影院日韩av| 成人欧美大片| 桃红色精品国产亚洲av| av欧美777| 9191精品国产免费久久| 最近在线观看免费完整版| 婷婷六月久久综合丁香|