Knowledge of Prenatal Care Nurses toward Management of Toxoplasmosis in Pregnant Women

Objective: This study aims to assess the level of nurse's knowledge regarding toxoplasmosis management in pregnant women. Methodology: A descriptive analytic study was carried out from January 2012 to March 2012. A sample of (70)nurses who provide prenatal care to pregnant women at primary health care centers of AL-Adala,AL-Hindia,AL-Askary,AL-Jamea,AL-Ansar and AL-Salam in AL-Najaf city. The questionnaire was self-completed and included questions on sociodemographic characteristics and toxoplasmosis aspects. Results: The findings of the study indicated that (44.3%) of nurses have moderate level of knowledge. (32.9%) of nurses was with age ranging from 31-36 years. (74.3%) were male. (52.9%) were secondary graduate,(31.4) were institute graduates, regarding the training sessions the majority of nurses (84.3%)have no training sessions, (34.3%) of nurses who were included in the study have duration of experience ranging from 7-13 years. Highly significant relation between nurse‘s level of knowledge and their age and years of experience (0.009, 0.024) respectively Recommendations: The study recommended that: it is necessary to join all nurses who work in prenatal care units in workshop training, continuing education sessions regarding toxoplasmosis aspects and other mother –child issues to improve health awareness. Another study should be conducted to investigate the association between the prevalence of toxoplasmosis and affectivity of prenatal care in preventing toxoplasmosis.


Introduction:
oxoplasma gondii was initially described in 1908 in Tunis by Nicolle and Manceaux (1908) and in Brazil by Splendore (1908) (1) . Toxoplasmosis is considered to be a leading cause of death attributed to foodborne illness in the United States. More than 60 million men, women, and children in the U.S. carry the Toxoplasma parasite, but very few have symptoms because the immune system usually keeps the parasite from causing illness (2) Congenital toxoplasmosis is a potentially severe infection and its prevention is most often based on serological screening in pregnant women. Many cases could be prevented by simple precautions during pregnancy (3) . Physicians and other health care professionals have a critical role in the prevention and control of food-related disease outbreaks (4) . After confirmation of the pregnancy, the goal of the first prenatal contact is to exchange information and identify existing risk factors that may impact the pregnancy. This initial contact may be accomplished in a group setting or during a oneon-one visit. This encounter provides an opportunity early in the pregnancy to obtain general short-term risk stratification. In this visit, the nurse should identify women who: 1.Need immediate referral to an advanced prenatal care provider (e.g., high risk for ectopic pregnancy); 2. Need to see an advanced prenatal care provider at the first provider visit; 3. Can have the first provider visit with a low-risk prenatal care provider (5) .

Methodology:
A descriptive analytic study was carried out from January 2012 to March 2012 to assess the level of nurse's knowledge regarding toxoplasmosis management in pregnancy. A disproportional randomization of (70)nurses who provide prenatal care to pregnant women at primary health care centers of AL-Adala, AL-Hindia, AL-Askary,AL-Jamea ,AL-Ansar and AL-Salam in AL-Najaf city. The questionnaire was self-completed and included questions on sociodemographic characteristics of age, level of education, gender, training sessions, years of experience and nurses , knowledge about aspects of causes, diagnosis, clinical manifestation, and modes of transmission, treatment complication and prevention of toxoplasmosis in pregnant women. The questionnaires were distributed on nurses to fill it. The total scores ranged from (0-25) then these scores were divided on three levels, subjects with scores ranged from (0-8) were considered to have poor knowledge. While others ranging from (9-17) had fair knowledge and subjects with scores ranging from (18-25) had good knowledge. Data were analyzed through the application of the descriptive data analysis approach (frequency and percentage) and the inferential data analysis approach of correlation coefficient and chi -square. This table shows the demographic characteristics of nurses who were included in the study. (32.9%) of nurses were with age ranging from 31-36 years. (74.3%) of them were male. (52.9%) were secondary graduates and (31.4) were institute graduates, regarding the training sessions the majority of nurses (84.3%) have no training sessions, (34.3%) of nurses who were included in the study have duration of experience ranging from 7-13 years.  This table shows that there is highly significant relation between nurse's level of knowledge and their age and years of experience (0.009, 0.024) respectively. On the other hand there is no significant relation between nurses' knowledge and their demographic characteristics of education, gender and training session Discussion:

Nurse's demographic characteristics.
Throughout the course of the data analysis It is noted about one third of nurses (32.9%) were with age ranging from 31-36 years. More than two third of them were males (74.3%). The age of those subjects considered as an appropriate age to play an important role in providing their female clients with the information that improve pregnancy and birth outcomes so it is noted in this study the majority of nurses who provide prenatal care were males(74.3%)and the women in our society prefer female nurses to work beside them in preparing them for safe pregnancy ,the birth of their baby, for caring their newborn and to be ready for motherhood .relative to the nurses education, (52.9%) were secondary graduates and one third was institute graduates. This distribution was coming to corresponding their age and years of experience ranging from 7-13 years. Regarding the training sessions the majority of nurses (84.3%) have no training sessions .This finding reflects the weakness of continuous nursing education in PHCs. In general our study highlights the weakness of the literatures in the area of nurses' knowledge about toxoplasmosis and demographic characteristics of nurses who included in such investigation.

Nurses level of knowledge toward management of toxoplasmosis.
Nurses are the principal group of health personnel providing primary health care at all levels and maintaining links between individuals, families, communities and the rest of the health care system (6) .The findings had reported that (44.3%) of nurses have moderate level of knowledge and about one third of them (35.7%) was with good . The nurses who work in prenatal care units have a wide work area. Therefore, it is necessary those nurses have a general education as the proper conduct of health problems. Only 44% of total answers were corrected (3) . As congenital toxoplasmosis is a mother-to-child (MTC) transmitted disease, early diagnosis and treatment can prevent serious and irreversible fetal damage. Thus, doctors and nurses who provide prenatal care must be appropriately trained on prophylactic, diagnostic, and clinical aspects of toxoplasmosis (7,8) . Awareness creation on the modes of transmission and prevention of T. Gondi should be made to women of child bearing age in general and pregnant women in particular during their antenatal care follow up (9) .

The relationship between nurses 'level of knowledge and their sociodemographic
In the present study, it was observed that there is highly significant relation between nurse's level of knowledge and their age and years of experience in contrast with the literature that indicates an inverse correlation between knowledge and years of professional practice, justifying the need for recertification exams in some countries ( 10,11) .

Recommendations:
Based on the early derived conclusions, the study recommends that: It is necessary to join all nurses who work in prenatal care units in workshop training, continuing education sessions regarding toxoplasmosis aspects and other mother -child issues to improve health awareness, knowledge, and behavior or health outcomes for mothers and babies .Educate pregnant women about preventive measures such as hygiene practices to prevent congenital toxoplasmosis. Conduct other study to investigate the association between the prevalence of toxoplasmosis and affectivity of prenatal care in preventing toxoplasmosis.