Impact of health education for the primary prevention of Toxoplasma infection in pregnancy: lessons from the ERIS study

Abstract number: p876

Wallon  M., Nguyen Hoang Hanh  D.T., Peyron  F., Chêne  G.

Objectives: 

Our study was designed to assess the ability of health education to improve knowledge and preventive behaviour of susceptible pregnant women regarding toxoplasmosis.

Methods: 

An intervention trial was initiated in the French Rhone Alpes region in 1993. Pregnant women seronegative for Toxoplasma gondii were enrolled in the first trimester of gestation by physicians randomly allocated to two groups according to their city of practice. Physicians in the intervention cities (group A) were asked to give their patients a booklet and an audiotape including advices on how to avoid toxoplasmosis mixed with global information regarding pregnancy while physicians in the control cities (group B) were not instructed to change anything from their usual practice. Physicians and participants were blinded to the study question. Knowledge and risk behaviour for toxoplasmosis and other topics related to pregnancy were measured through two questionnaires completed at inclusion and at delivery. Analysis was limited to 2790 women (56%) for whom both questionnaires were available.

Results: 

No difference was found between arms regarding socio-demographic indices. At baseline no significant difference was found between group A and B regarding (a) knowledge or (b) behaviour: (a) 64% and 66% respectively knew all answers regarding consumption of raw meat or unwashed salad as risk factors; 44% and 46%, respectively, correctly answered all questions on the preventive effect of hand washing before eating or after handling raw meat (b) 88% and 89%, respectively, reported washing vegetables eaten raw; 26% and 27% reported always washing hands before eating or after handling potential sources of contamination; among the 97% who ate meat in the 60 days preceding inclusion, 44–45% did not eat undercooked meat. Comparison between delivery and baseline showed a moderate gain in knowledge that was significantly associated with assignment to group A. Better habits regarding meat consumption and hand washing were also reported at delivery, significantly associated with good baseline knowledge and behaviour but not with assignment to group A.

Conclusion: 

Education can improve knowledge of risk factors for Toxoplasma infection but no evidence was found regarding changes in behaviour. Additional anthropological studies are needed to identify effective ways to reduce risk behaviours in an attempt to prevent acute maternal infections in pregnancy and consequently congenital toxoplasmosis.