Seroprevalence of Toxoplasma gondii and Its Association with Sociodemographic Factors, Awareness and Exposure Practices Among Pregnant Women Attending Pumwani Maternity Hospital, Nairobi, Kenya

Abstract

Background: Toxoplasma gondii infection during pregnancy may lead to congenital toxoplasmosis and serious pregnancy complications. In Kenya, however, toxoplasmosis is not screened during routine antenatal care, and there is limited local data on maternal seroprevalence and associated risk factors. This study determined the seroprevalence of T. gondii infections. It examined its association with socio-demographic, obstetric characteristics, awareness levels, and exposure behaviours among pregnant women visiting the antenatal clinic at Pumwani Maternity Hospital in Nairobi, Kenya. Methods: A cross-sectional study was conducted among 298 pregnant women consecutively recruited at Pumwani Maternity Hospital in Nairobi County between July and October 2025. Data on socio-demographics, obstetric characteristics, knowledge, and exposure practices were collected using a structured questionnaire. Blood specimens were obtained from consenting prenatal patients, and anti-T. gondii IgG antibodies were detected by indirect enzyme-linked immunosorbent assay (ELISA). Associations between seropositivity and risk factors were assessed using univariable logistic regression, followed by two separate multivariable models. Variables with p < 0.25 were considered for multivariable analysis, followed by backward likelihood-ratio elimination. Model calibration was assessed using the Hosmer–Lemeshow test. Results: The overall seroprevalence of anti-T. gondii IgG was 24.5% (73 of 298). In the sociodemographic model, women who were self-employed (adjusted odds ratio [AOR] = 0.26, 95% CI: 0.13–0.53) and formally employed (AOR = 0.25, 95% CI: 0.11–0.59) had lower odds of seropositivity than unemployed women. Women aged 25–33 years had higher odds than those aged 18–24 years (AOR = 2.45, 95% CI: 1.06–5.62). Having two children was associated with lower odds than a first birth (AOR = 0.40, 95% CI: 0.18–0.90), while parity of four or more showed a borderline increase in odds (AOR = 3.11, 95% CI: 0.99–9.76). In the knowledge/exposure model, good awareness of population risk groups was linked to higher odds of seropositivity (AOR = 3.34, 95% CI: 1.21–9.24), but exposure-practice variables were not independently associated. Stratified analyses showed significant demographic differences in exposure practices, such as eating undercooked meat in the third trimester of pregnancy (p = 0.021) and unwashed vegetable consumption by pregnant women from Kamkunji Sub-County (p = 0.005). Parity of three increased infection risk (p = 0.007). Conclusions: About 25% of participants showed evidence of prior T. gondii exposure. Seropositivity correlated with specific sociodemographic and obstetric factors as well as awareness of groups at risk. These results endorse targeted antenatal education that emphasises practical food safety and environmental hygiene, aligned with a One Health approach. Further longitudinal and multicenter research, including IgM and IgG avidity testing, is needed to differentiate recent from past infections and to better understand risks associated with congenital toxoplasmosis.