Aspectos epidemiológicos da infecção pelo Toxoplasma gondii em gestantes do estado de Sergipe: uma abordagem descritiva e espacial

Abstract

Introduction: Toxoplasmosis is considered a systemic infectious disease, caused by the protozoan Toxoplasma gondii (T. gondii) and is characterized by being a zoonosis distributed worldwide. When it occurs during pregnancy, it constitutes a serious public health problem, due to the risk of vertical transmission, which can cause miscarriage and bring serious clinical manifestations to the fetus and newborn. In Brazil, it is estimated that there are 60 thousand new cases of T. gondii infection in pregnant women per year. Understanding the epidemiological and spatial aspects of T. gondii infection in pregnant women may favor the development of public policies that strengthen planning, prevention, promotion of perinatal health, control and surveillance of toxoplasmosis.. Objective: To analyze the epidemiological aspects and spatial distribution of the occurrence of T. gondii infection in pregnant women in the state of Sergipe, Brazil. Materials and method: Cross-sectional, retrospective study using spatial analysis techniques of reported cases of gestational toxoplasmosis (GT) in the state of Sergipe, based on data obtained from the information systems of the State Department of Health. Descriptive analysis was carried out using absolute and percentage frequencies. GT detection rates were estimated for the state's municipalities. For spatial analysis, the Kernel density estimator was used to estimate clusters of cases by municipalities, generating choropleth maps of detection rates. Results: 449 cases of gestational toxoplasmosis were reported in Sergipe, with a detection rate of 4.7 cases per 1,000 live births (LB). There was a predominance of women between 20 and 29 years old (54.1%; n=243); black race/color (83.1%; n=373); incomplete secondary education (59.7%; n=268); marital status single (67.3%; n=302); residents in urban areas (66.8%; n=300). Regarding obstetric characterization, pregnant women diagnosed in the second trimester predominated (46.8%; n=210); carrying out seven or more consultations (77.3%; n=347); multigravida (53.9%; n=53.9); nulliparous (50.3%; n=226). Regarding eating habits, most women consume raw and/or undercooked beef, fresh vegetables, in addition to using untreated water. Regarding laboratory and treatment information, 8% (n=36) underwent three or more serologies during prenatal care; 29.8% (n=85) performed IgG avidity; 53.3% (n=239) underwent at least one USG; 80.4% (n=361) did not undergo amniocentesis; 78.4% (n=352) underwent treatment. Regarding the characterization of the evolution of pregnancy, 96.7% (n=434) of births ended with LB; 96.0% (n=431) as a single pregnancy; 58.6% (n=263) underwent vaginal birth; in 2% (n=9) of LB, congenital malformations were detected. The spatial analysis revealed a concentration of cases in the region of Eastern Sergipe, mainly in the municipalities of Divina Pastora (23.3 per 1000 LB) and Santa Rosa de Lima (15.5 per 1000 LB). Conclusion: Low education and socioeconomic conditions can make women vulnerable to the risk of T. gondii infection and make preventive care difficult, and can demonstrate a direct relationship with the incidence and prevalence of GT. Spatial analysis demonstrated the occurrence of cases in all regions of the state, with clusters in certain locations.