The factors positively associated to the preventive behavior for toxoplasmosis was the age group between 12 and 14 years old and two or more prenatal consultations. The preventive behavior may show a strong relation with eating habits, such as washing fruits and vegetables by immersing them into water with sodium hypochlorite (bleach) before eating them and cleaning kitchen utensils (cutting boards, dishes, kitchen counters), washing hands with warm water and soap after handling raw meat and unwashed fruits and vegetables and also having direct contact with kittens [36
]. The data of our study and its cross-sectional methodological design are not enough to conclude what caused this association.
Unfortunately, we are not able to identify the hotspot of toxoplasmosis occurrence, because we did not study the patients from all the sanitary regions of Fortaleza. Indeed we included eight health services and four sanitary regions from the city.
The pregnant adolescents eat meat an average of 2.3 times a week. The preventive behavior for toxoplasmosis of the pregnant adolescents can be associated to eating changes that occur during pregnancy, involving subjective values essential to adolescence and pregnancy [38
The behaviors of the pregnant adolescents to prevent toxoplasmosis in pregnancy are often associated to behavioral factors, such as, consumption of fresh and undercooked meat and raw vegetables (17.6%) and having kittens as pets (21.8%). This study was dissimilar to the findings of another study [18
], which showed the consumption of these foods by 58.2% of the 127 pregnant girls who were studied. The contact with kittens is a factor associated with toxoplasmosis in pregnant adolescents [39
In Northeast Brazil, particularly in the state of Ceara, two studies conducted with pregnant girls identified the consumption of homemade frozen sugar water in Brazil, known as "dindin" [41
], implying that the contamination of the water used in the homemade preparation by oocysts is the most probable infection source. Thus, it is emphasized the importance of adequate treatment of water for human consumption, mainly in places where the water supply is not treated. The information about the correct freezing and boiling of water must be given to the pregnant women facing these situations in order to prevent a possible infection.
The adequate cleaning of kitchen utensils and washing of hands after having contact with raw meat and unwashed fruits and vegetables presented a low frequency, resulting in a higher risk of acquiring the T. gondii.
The prevalence (45.3%) of anti-Toxoplasma gondii
IgG antibodies observed in this study is similar to the results of positive IgG found in pregnant adolescents from some regions of Brazil, such as, Belo Horizonte, Minas Gerais; [43
] Araraquara, state of São Paulo; [44
] and Londrina, state of Paraná [45
]. This finding differs from other studies done in Fortaleza, Ceara, which has a high prevalence of previous infections in pregnant adolescents (91.7%, from 12 to 15 years old and 63.5% from 16 to 18 years old) probably because Susan Sroka [42
], the researcher, studied a sample of a maternity of reference in the state of Ceara. Our study group could be considered a primary health care population and not a hospital based group [42
]. Thus, we must consider public health care programs that contemplate a systematic screening of pregnant adolescents and neonates for prevention, diagnosis and early treatment of the affected neonates, generally asymptomatic at birth and also stimulate preventive behaviors by the pregnant adolescent during prenatal care [46
In Brazil, the serologic triage for toxoplasmosis is recommended in the first prenatal consultation, since it is available in the health care service, what is not usually performed in the primary health care, although the pregnant adolescents under 15 years old must be considered [47
], according to the Ministry of Health guidelines, as a risky pregnancy. Considering this, they are directed to specialized services and some of them establish assistential guidelines for toxoplasmosis from the detection to the treatment [47
The occurrence of five IgG and IgM seropositivity pregnant adolescents was similar to the results found in another study. As a new serology and IgG Avidity Assay Tests were not performed, the interpretation of IgM results had to be cautious in order to avoid the exposure of the mother and fetus to unnecessary procedures [48
], showing the importance of the diagnostic confirmation. The Avidity Assay was not performed because this study does not perform serum prevalence analysis.
The importance of a serologic follow-up for the pregnant adolescents with clearer and precise information about the risk factors and the importance of adopting preventive behaviors, is noteworthy. Thus, it is necessary to establish more global preventive measures considering social, economic and cultural matters.
The high percentage of pregnant adolescents with non-preventive behavior stands out, which shows the lack of information about preventive care. We add to this the greater proportion of low family income and little formal schooling among the pregnant adolescents observed in the study that can contribute to increase the risk for infection and contamination of the fetus. It has been estimated that the number of pregnant adolescents in specialized hospitals is increasing.
Moreover, it is understood that the information regarding preventive measures for toxoplasmosis are not exclusive to health professionals. But include a set of actions developed by global public policies of health and education, along with the professional training on the study theme.