By Tahani al-Sabri
For years, Yemenis have suffered from such terrible diseases as tuberculosis, malaria, and AIDS. Recently, however, a troubling new ailment has been spreading through the country. Toxoplasmosis is generally non-harmful for adults, but when pregnant women are infected, the effects on her offspring can be incredibly dangerous, and sometimes even lethal.
Salma was married four years ago; she is 23 years old. She has miscarried more than 3 times. “At the beginning of my pregnancy everything was good, but everything began to change in the fourth month. I began feeling light contractions, and sometimes I would feel pain in my lower abdomen. In the end, I miscarried. This has happened in every pregnancy I have had,” she said. After a long diagnosis she discovered that the culprit was toxoplasmosis.
A related story took place in Saw’an, a district of Sana’a.. “I can’t see, and I won’t see any more.” Yousef begins his story with these tragic words. At the age of five, he was just a normal boy. But soon afterward his situation made a turn for the worse, and then worse still.
Yousef’s mother noticed her son had a fever and occasional pain and inflammation in his eyes. After two years of treatment he lost his vision completely. When his mother sought out another doctor for a second opinion, the doctor requested a blood test. The test revealed that behind his blindness was toxoplasma. “The disease does not significantly impact adults, but has its worst effects on young and unborn children,” said Dr. L.A., a gynecologist working in al-Sabin hospital. Yousef had almost escaped the grips of the disease, but a weak immune system meant that the disease was bound to strike eventually.
“In most cases, the disease does not require extensive treatment unless the patient is a chronic sufferer. …Toxoplasmosis patients need approximately 20,000 YR over the course of three months, though sometimes more than this depending on the duration of treatment. The cure is available in every pharmacy, and there are no dedicated hospitals or centers for the disease,” said Dr. L.A..
A study was held in Sana’a during 2007 and to evaluate the prevalence rate of Toxoplasmosa gondii among pregnant women. The study focused on environmental and lifestyle factors that could lead to infection.
This study tested 384 pregnant women between the ages of 15 and 45 who attended a number of hospitals and gynecology clinics across Sana’a. Blood samples were taken from the women and tested for specific anti-Toxoplasma antibodies. These samples were statistically analyzed and then linked to epidemiological data collected through a standard questionnaire.
According to Ahlam Ahmed Ali Katina, a Master’s degree candidate in the Faculty of Medical and Health Sciences in 2009, the study found that all pregnant women in Yemen were threatened by toxoplasmosis. Another study conducted by Thobahani Laboratories found that toxoplasmosis was more common in men than women, said Dr. Adel al-Thobhani.
Dr. L.A explained that the prevalence of the disease among women may be a result of their greater exposure to cats, which is also why toxoplasmosis infection is more common in rural than urban areas. Women are similarly at greater risk due to lower immunity to disease.
Unfortunately, even the high numbers of toxoplasmosis cases in Yemen has failed to attract the interest of Yemen’s Ministry of Health or international organizations. Dr. Mohammed A. Khalil, director of studies and research in the Ministry of Health, said, ” We don’t have a specific number for this disease because there’s no study or survey discussing it, except for research projects conducted by students in the medical faculty.” Dr. Khalil added that he had not heard of the study before that moment.
Dr. Abd al-Hakeem al-Kholani, General Director of Control and Epidemiological Disease Surveillance in Ministry of Health responded to questions on Yemen’s response to the disease in a similar manner. “No complaints or reporting calls have been submitted to the committee on monitoring that would lead us to initiate a survey.” He stated that doctors shared the responsibility of preventing the spread of disease in Yemen, announcing that doctors are the messengers of the Ministry ot the Yemeni people.”
The World Health Organization in Yemen declared that they do not prioritize toxoplasmosis, instead focusing on diseases they consider most dangerous, including AIDS, tuberculosis, diarrhea and cholera.
The first instances of toxoplasmosis were discovered by French bacteriologists Charles Nicolle and Louis Manceaux in 1908, when they discovered a new species of protozoa in certain North African rodents. The first case of toxoplasmosis in children was observed in 1923, though the life cycle of the disease was not understood until 1970. The disease manifests itself in congenital malformations (also known as ascites palsy) in children, and it has continued to spread in abnormal ratios up to today.
In Yemen we don’t have any statistical or aware of the emergence of this disease, that what has been said by the Ministry of Health.
Toxoplasmosis is a parasitic disease caused by the protozoan Toxoplasma gondii (named in part after the rodent carriers in which the organism was first discovered). The parasite infects most genera of warm-blooded animals, including humans, but the primary host is the felid (cat) family.
This disease is transferable; humans can contract the disease simply through eating anything infected with the parasite. This includes raw and undercooked meat from infected animals (particularly lamb and pork, but also beef and venison), raw cured meat, unwashed fruit and vegetables, unpasteurized goats’ milk and goats’ milk products. It also includes any product contaminated with infected cat feces. Person-to-person infection is not possible, except from mother to unborn child.
The incubation period for the disease is 5–23 days after coming into contact with the parasite. However, toxoplasmosis does not usually have any obvious symptoms and many people do not know they are infected. The only conclusive method of detecting infection is a blood test. The symptoms generally present themselves as a mild flu. In some cases, the disease will cause long-term illness similar to glandular fever and swollen lymph nodes.
The disease does not significantly impact adults, but does pose a serious danger to young children and fetuses during the first months of pregnancy.
Toxoplasmosis in infants can cause enlargement of the liver and spleen, diarrhea or vomiting, eye damage from inflammation of the retina or other parts of the eye, feeding problems, hearing loss, jaundice (yellow skin), low birth weight, skin rash (tiny red spots or bruising) at birth, vision problems, and brain or nervous system damage ranging from mild to severe. These brain problems can lead to seizures and mental retardation, said Dr. L.A..
To protect yourself from toxoplasmosis, it is important to follow these simple guidelines:
• Wash your hands and all cooking utensils and surfaces after preparing raw meat.
• Do not eat rare meat with any pinkness or blood in it. Eating raw or undercooked meat is the most common means of contracting toxoplasmosis.
• Wash all fruit and vegetables, including ready-prepared salads; thoroughly to remove all traces of soil.
• Do not drink unpasteurized goats’ milk or products made from it.
• Always wear gloves when gardening. Take care not to put your hands or gloves to your mouth, and wash your hands and gloves when finished to remove all traces of soil.
• Always wear rubber gloves when handling dirty cat litter. Take care not to put your hands or gloves near your mouth and wash your hands and gloves when finished. Better still, get someone else to do this job.
• Cover children’s sandboxes to prevent cats from using them as litter boxes.
• Take care when visiting farms and wash hands thoroughly after any contact with sheep. Avoid handling newborn lambs.
• Cats are the only animals that can shed the parasite in their feces. To be completely safe, cats should be kept away from the house.