INTRODUCTION

1.1. Background

Toxoplasmosis is a parasitic disease caused by the protozoan Toxoplasma gondii, which infects approximately 30-40% of the global population (Tenter, 2000; Montoya and Liesenfeld, 2004). The parasite was first identified in 1908 by Nicolle and Manceaux in Tunis, North Africa (Nicolle and Manceaux, 1908).

The definitive hosts of T. gondii are members of the Felidae family, including domestic cats and wild cats (Dubey, 1988). However, the parasite can infect a wide range of intermediate hosts, including humans, birds, and mammals (Tenter, 2000).Cats shed oocysts, the environmentally resistant stage of the parasite, in their feces, which can then infect other hosts (Hill et al., 2016). Intermediate hosts, such as humans, animals, and birds, can become infected through the ingestion of oocysts or tissue cysts, and can harbor the parasite for extended periods, sometimes for life, without showing symptoms (Wang et al., 2017). Accidental hosts, such as humans, can become infected through the ingestion of contaminated food or water, organ transplantation, or blood transfusion, and the parasite may not complete its life cycle, but can still cause disease (Cohen et al., 2018).

Toxoplasmosis is most commonly found in tropical and subtropical regions, particularly in areas with poor sanitation and hygiene (Montoya and Liesenfeld, 2004).Toxoplasma gondii is a widespread parasite that can be found in many parts of the world, including countries in Central and South America, such as Brazil, Argentina, and Mexico (Wang et al., 2017). Its distribution and prevalence also vary greatly in Africa, where countries such as Nigeria, South Africa, and Egypt have reported high seroprevalence rates (Cohen et al., 2018). In Asia, countries such as China, India, and Indonesia have also reported significant prevalence rates (Pappas et al., 2018). In Europe, the seroprevalence of Toxoplasma gondii infection ranges from 20% to 80% in countries such as France, Germany, and the United Kingdom (Di Mario et al., 2018). In the United States, the seroprevalence is estimated to be around 10% to 30% (Hill et al., 2016). The presence of domestic cats and other members of the Felidae family is a significant factor in the distribution of Toxoplasma gondii, as they are the definitive hosts of the parasite (Dubey et al., 2017). Human behavior, such as eating undercooked meat, consuming contaminated food and water, and having contact with infected cats, can also contribute to the transmission of the parasite (Pappas et al., 2018).

Toxoplasma gondii manifests differently in various individuals (Wang et al., 2017). In normal women, for instance, the infection typically causes a mild, self-limiting illness, which means that the symptoms are usually not severe and will resolve on their own with time (Pappas et al., 2018). The symptoms associated with this illness may include fever, headache, muscle pain, and swollen lymph nodes, which are usually manageable with rest and over-the-counter medication (Wang et al., 2017). However, in pregnant women, the situation is more complex, as the infection can pose a significant risk to the unborn child, potentially causing miscarriage, stillbirth, and birth defects (Di Mario et al., 2018). This is because the parasite can cross the placenta and infect the fetus, leading to serious complications (Cohen et al., 2018). Immunocompromised individuals, such as those with HIV/AIDS or undergoing chemotherapy, are also at risk of developing severe and life-threatening toxoplasmic encephalitis, a condition characterized by inflammation of the brain, which can cause seizures, confusion, and even death (Cohen et al., 2018). Furthermore, compromised people, including those with underlying medical conditions, may experience symptoms like fever, headache, muscle pain, and swollen lymph nodes, as well as complications like pneumonia, heart problems, and eye inflammation (Pappas et al., 2018).

1.2. Problem statement

Toxoplasma gondii is a widespread parasite that can cause severe health complications in various individuals. Pregnant women are at risk of transmitting Toxoplasma gondii to their unborn children through the placenta (Di Mario et al., 2018). This can lead to serious complications such as miscarriage, stillbirth, and birth defects (Cohen et al., 2018). Pregnant women can become infected with Toxoplasma gondii through contact with contaminated soil, water, or food (Wang et al., 2017). For example, gardening or handling soil without proper hygiene can increase the risk of infection (Pappas et al., 2018). Immunocompromised individuals, such as those with HIV/AIDS or undergoing chemotherapy, are at risk of developing severe and life-threatening toxoplasmic encephalitis (Cohen et al., 2018). Toxoplasmic encephalitis is a condition characterized by inflammation of the brain, which can cause seizures, confusion, and even death (Cohen et al., 2018). Immunocompromised individuals can become infected with Toxoplasma gondii through contact with contaminated food or water, or through organ transplantation (Pappas et al., 2018). Healthy individuals can become infected with Toxoplasma gondii through contact with contaminated food or water, or through contact with infected cats (Wang et al., 2017). For example, eating undercooked meat, especially pork, lamb, or venison, can increase the risk of infection (Pappas et al., 2018). Healthy individuals can also become infected through contact with contaminated soil or water while gardening or swimming (Pappas et al., 2018). To manage and prevent Toxoplasma gondii infection, several measures can be taken. Pregnant women and immunocompromised individuals should avoid contact with contaminated soil, water, or food (Pappas et al., 2018). Healthy individuals should cook meat thoroughly, especially pork, lamb, or venison, to an internal temperature of at least 160°F (71°C) (Pappas et al., 2018). Individuals should wash their hands thoroughly after handling soil, water, or food (Pappas et al., 2018). Keeping cats As pets can increase the risk of T gondii infection, but this risk can be managed by keeping cats indoors, avoiding contact with cat feces, and washing hands thoroughly after handling cat litter (Wang et al., 2017).

1.3. Justification of study

The impact of Toxoplasma gondii infection on human health, particularly among vulnerable populations such as women with fertility issues, immunocompromised individuals, and those with compromised health status, is a pressing concern that warrants further investigation. (Wang et al., 2020). Despite its importance, there is a dearth of information on the prevalence of T.gondii infection in these populations, hindering the development of effective prevention and control strategies. (Torgerson et al., 2019). This study aims to investigate the prevalence of Toxoplasma gondii infection among women with fertility issues, immunocompromised individuals, and vulnerable populations, and to identify the risk factors associated with T gondii infection in these populations.

These study will contribute to the existing body on the prevalence of  T Gondii  infection among women. Due to the severe consequences of Toxoplasma gondii infection, including miscarriage, stillbirth, birth defects, toxoplasmic encephalitis, neurological disorders, psychiatric disorders, reproductive problems, increased risk of HIV/AIDS, increased risk of cancer, and cognitive impairment. (Yolken et al., 2019). The high burden of disease, limited understanding of transmission dynamics, and the need for targeted interventions further emphasize the importance of this study. By addressing these knowledge gaps, this study has the potential to inform the development of targeted interventions to reduce the burden of Toxoplasma gondii infection among vulnerable populations, ultimately contributing to improved reproductive health outcomes and reduced morbidity and mortality (Torgerson et al., 2019).

1.4 . Hypothesis

• Null Hypothesis (H0): There is no significant prevalence of Toxoplasma gondii infection and fertility issues among women attending the Azire integrated Health Center in Bamenda, Cameroon.
• Alternative Hypothesis (H1): There is a significant prevalence of Toxoplasma gondii infection and fertility issues among women attending the Azire integrated health center in Bamenda, Cameroon

1.5. Research Question

• What is the prevalence of Toxoplasma gondii infection among women with fertility problems attending the Azire integrated health center in Cameroon?
• How does the prevalence of T Gondii  infection vary  among different sub populations within the vulnerable population.
• What are the risk factors associated with Toxoplasma gondii Infection among women with fertility problems attending the Regional Hospital Bamenda

1.6 . Objectives

Main Objective:

The main objective of this study is to investigate the prevalence of Toxoplasma gondii infection and its associated risk factors among women with fertility problems attending the Azire integrated health centerl in Bamenda, Cameroon.

Specific Objectives:

• To determine the seroprevalence of Toxoplasma gondii infection among women with fertility problems attending the Azire integrated health center in Bamenda Cameroon.
• To compare the prevalence of Toxoplasma gondii infection among women with primary and secondary infertility.
• To determine the disposing risk factors associated with T Gondii infection among women with fertility problems attending the Azire integrated health center Bamenda Cameroon.