Seroprevalence of TORCH Infections and Associated Influential Factors among Pregnant Women in Khost Province, Afghanistan: A Cross-Sectional Study
Main Article Content
Abstract
Background: TORCH infections (Toxoplasma gondii, Rubella virus, Cytomegalovirus, and Herpes simplex virus) are major causes of adverse outcomes in pregnancy. Data on seroprevalence and associated risk factors are limited in Afghanistan. We aimed to assess the seroprevalence of TORCH infections (IgG/IgM) and associated risk factors among pregnant women in Khost Province, Afghanistan.
Methods: This cross-sectional study was performed on 369 pregnant women attending antenatal services in Khost Province, Afghanistan, from 01 January 2024 to 30 December 2024. All participants answered a questionnaire on demographic, behavioral, and obstetric data. Sera were tested for IgG and IgM antibodies for current or past TORCH infections. Significant associations between risk factors and seropositivity were tested with Chi-square and Mann-Whitney U tests, and predictors of IgM seropositivity were identified by binary logistic regression.
Results: Overall, IgG seropositivity was 62.6%, IgM positivity 49.6%. Toxoplasma was the most prevalent (IgG 38.5%; IgM 22.2%), followed by CMV (IgG 19.0%; IgM 19.2%) and rubella (IgG 5.1%; IgM 6.5%). Significant factors for IgG seropositivity: cat presence, poor hygiene, raw meat consumption (all P<0.05). For IgM positivity, significant associations were cat presence and husband’s occupation (P<0.05). Logistic regression identified cat ownership (OR=0.64, 95%CI [0.42–0.98], P=0.039) and raw meat consumption (OR=0.62, 95%CI [0.40–0.95], P=0.029) as independent predictors of lower likelihood of recent IgM positivity. There was a correlation with age and parity with regard to history of abortion, but none with TORCH serology.
Conclusion: TORCH infections (especially toxoplasmosis and CMV) were common among the pregnant women in Khost, driven by environment, feeding habits, and living standards. Maternal age and parity mattered, but abortion history did not. Combating these infections in southeastern Afghanistan calls for hygiene/food safety education, improved living conditions, and better antenatal screening.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Konopka A, Szczepaniak Z, Wdowiak N, Lissak K, Komarów M, Choinka M, et al. A Comprehensive Review of TORCH Syndrome: Characterization and Prevention Strategies. Qual Sport. 2024;21:53987.
Neu N, Duchon J, Zachariah P. TORCH infections. Clin Perinatol. 2015;42(1):77–103.
Megli CJ, Coyne CB. Infections at the maternal--fetal interface: an overview of pathogenesis and defence. Nat Rev Microbiol. 2022;20(2):67–82.
Wilson CB, Nizet V, Maldonado Y, Remington JS, Klein JO. Remington and Klein’s infectious diseases of the fetus and newborn infant. Elsevier Health Sciences; 2015.
Arora N, Sadovsky Y, Dermody TS, Coyne CB. Microbial vertical transmission during human pregnancy. Cell Host Microbe. 2017;21(5):561–7.
Paquet C, Yudin MH, Allen VM, Bouchard C, Boucher M, Caddy S, et al. Toxoplasmosis in pregnancy: prevention, screening, and treatment. J Obstet Gynaecol Canada. 2013;35(1):78–9.
Das S, Ramachandran VG, Arora R. Cytomegalovirus and rubella infection in children and pregnant mothers--a hospital based study. J Commun Dis. 2007;39(2):113–7.
Mosawi SH, Zarghona Z, Dalimi A, Jokelainen P, Safa AH, Mohammadi MR, et al. Particularly neglected in countries with other challenges: High Toxoplasma gondii seroprevalence in pregnant women in Kabul, Afghanistan, while a low proportion know about the parasite. PLoS One. 2019;14(10):e0223585.
Bieńkowski C, Aniszewska M, Kowalczyk M, Popielska J, Zawadka K, Ołdakowska A, Pokorska-Śpiewak M. Analysis of preventable risk factors for Toxoplasma gondii infection in pregnant women: case-control study. Journal of Clinical Medicine. 2022 Feb 19;11(4):1105.
Belluco S, Simonato G, Mancin M, Pietrobelli M, Ricci A. Toxoplasma gondii infection and food consumption: a systematic review and meta-analysis of case-controlled studies. Critical reviews in food science and nutrition. 2018 Dec 12;58(18):3085-96.
Ducrocq J, Simon A, Lemire M, De Serres G, Lévesque B. Exposure to Toxoplasma gondii through consumption of raw or undercooked meat: a systematic review and meta-analysis. Vector-Borne and Zoonotic Diseases. 2021; 21(1):40-9.
Polanunu NFA, Wahyuni S, Hamid F. Seroprevalence and associated risk factors of Toxoplasma gondii infection among pregnant mother in Makassar, Indonesia. PLoS One. 2021;16(6):e0245572.
Bartlett AW, McMullan B, Rawlinson WD, Palasanthiran P. Hearing and neurodevelopmental outcomes for children with asymptomatic congenital cytomegalovirus infection: a systematic review. Rev Med Virol. 2017;27(5):e1938.
Zenebe MH, Mekonnen Z, Loha E, Padalko E. Seroprevalence and associated factors of maternal cytomegalovirus in Southern Ethiopia: a cross-sectional study. BMJ Open. 2021;11(10):e051390.
Harvey J, Dennis CL. Hygiene interventions for prevention of cytomegalovirus infection among childbearing women: systematic review. J Adv Nurs. 2008;63(5):440–50.
Barbosa, Nayara G., Aparecida Y. Yamamoto, Geraldo Duarte, Davi C. Aragon, Karen B. Fowler, Suresh Boppana, William J. Britt and MMMP. Cytomegalovirus shedding in seropositive pregnant women from a high-seroprevalence population: the Brazilian cytomegalovirus hearing and maternal secondary infection study. Clin Infect Dis. 2018;67(5):743–50.
Tastad KJ, Schleiss MR, Lammert SM, Basta N. Awareness of congenital cytomegalovirus and acceptance of maternal and newborn screening. PLoS One. 2019;14(8):e0221725.
Rodriguez-Cartes SA, Zhang Y, Mayorga ME, Swann JL, Allaire BT. Evaluating the potential impact of rubella-containing vaccine introduction on congenital rubella syndrome in Afghanistan, Dem. Republic of Congo, Ethiopia, Nigeria, and Pakistan: A mathematical modeling study. PLOS Glob Public Heal. 2024;4(1):e0002656.
De Santis M, Cavaliere AF, Straface G, Caruso A. Rubella infection in pregnancy. Reprod Toxicol. 2006;21(4):390-398.
Whitley RJ. Herpes simplex virus infections of the central nervous system. Neuroinflammation Neurodegener. 2014;16(4):263–90.
Robert-Gangneux F, Dardé ML. Epidemiology of and diagnostic strategies for toxoplasmosis. Clin Microbiol Rev. 2012;25(2):264–96.
AJC C. Sources of Toxoplasma infection in pregnant women: European multicentre case-control study. BMJ. 2000;321:142–7.
Pereboom MTR, Manniën J, Spelten ER, Schellevis FG, Hutton EK. Observational study to assess pregnant women’s knowledge and behaviour to prevent toxoplasmosis, listeriosis and cytomegalovirus. BMC Pregnancy Childbirth. 2013;13(1):98.
Sepkowitz KA, Eisenberg L. Occupational deaths among healthcare workers. Emerg Infect Dis. 2005;11(7):1003.
Kuhnt J, Vollmer S. Antenatal care services and its implications for vital and health outcomes of children: evidence from 193 surveys in 69 low-income and middle-income countries. BMJ Open. 2017;7(11):e017122.
Davis NL, King CC, Kourtis AP. Cytomegalovirus infection in pregnancy. Birth defects Res. 2017;109(5):336–46.