A community-based survey of Toxoplasma gondii infection among pregnant women in rural areas of Taiz governorate,Yemen:the risk of waterborne transmission

Background:Toxoplasma gondii is a zoonotic coccidian parasite causing morbidity and mortality.In Yemen,T.gondii infection has been reported among pregnant women seeking healthcare in the main cities.However,no data are available on the prevalence of T.gondii infection and its associated risk factors among pregnant women in the rural communities of the country.Thus,the present study aimed to determine the seroprevalence of T.gondii and identify its risk factors among pregnant women in the rural communities of Taiz governorate,Yemen.Methods:A total of 359 pregnant women living in the rural communities of Taiz governorate were enrolled in this study by house-to-house visits.Data were collected using a pre-designed questionnaire,and blood samples were collected and tested for the detection of anti-T.gondii IgM and IgG antibodies by enzyme-linked immunosorbent assay.Results:The prevalence of T.gondii infection among pregnant women in this study was 46.2%(166/359).Bivariate analysis identified the age of≥30 years(odds ratio[OR]=1.7;95%confidence interval[CI]=1.09-2.65,P=0.019)and unimproved water sources(OR=2.2;95%CI=1.10-4.55,P=0.023)as factors associated with T.gondii infection among pregnant women.The multivariable analysis,however,identified unimproved water sources as an independent risk factor(adjusted OR=2.4;95%CI=1.16-5.0,P=0.018)associated with T.gondii infection among pregnant women.Conclusions:Pregnant women in the rural communities of Taiz,Yemen are at high risk of contracting T.gondii infection.Unimproved water sources(wells,water streams and water tanks)are significantly associated with T.gondii infection and should be considered in prevention and control strategies,especially among pregnant women.

Hidden reservoir of resistant parasites:the missing link in the elimination of falciparum malaria

Background:To successfully eliminate malaria,an integrated system that includes a number of approaches and interventions-aimed at overcoming the threat of antimalarial drug resistance-is required.Significant progress has been made in reducing malaria incidence through large-scale use of artemisinin-based combination therapies and insecticide-treated nets.To consolidate these gains,attention should be paid to the missing links in the elimination of malaria.One of these gaps is the residual reservoir of submicroscopic resistant parasites,which remains after case management or other control measures have been carried out.Therefore,the present opinion piece highlights the importance of exploring the role that submicroscopic resistant parasites could play in hindering malaria elimination by allowing the persistence of transmission,particularly in areas of low transmission or in the pre-elimination and/or elimination phase.Discussion:If malaria elimination interventions are to be effective,the relative role of the hidden reservoir of resistant parasites needs to be assessed,particularly in regions that are low-transmission settings and/or in pre-elimination and/or elimination phases.Various ongoing studies are focusing on the role of submicroscopic malaria infections in malaria transmission but overlook the possible build-up of resistance to antimalarial drugs among submicroscopic parasite populations.This is an important factor as it may eventually limit the effectiveness of malaria elimination strategies.Conclusions:An evidence-based estimation of the“true”reservoir of resistant parasites can help target the existing and emerging foci of resistant parasites before they spread.Emergence and spread of artemisinin-resistant Plasmodium falciparum malaria in Southeast Asia underline the need to contain drug resistance.