Magnitude of the Cytomegalovirus infection among pregnant women attending antenatal clinics in the city of Mwanza, Tanzania

Abstract

BackgroundDespite, Cytomegalovirus (CMV) infection being associated with a potential risk to the fetus, there is limited data from Tanzania and many other developing countries regarding the epidemiology and the impact of CMV infections. This cross-sectional study was conducted between December 2014 and June 2015 among pregnant women attending antenatal clinics in the city of Mwanza, Tanzania to investigate the magnitude and associated factors of CMV infection.MethodsThe specific CMV IgM and IgG antibodies were detected using indirect enzyme linked immunosorbent assay (ELISA). Demographic and clinical data were collected using pre-tested data collection tool. Data were analysed using STATA version 13.ResultsA total of 261 pregnant women with median age of 20 (IQR 19–25) years and mean gestation age of 17 ± 7.8 weeks were enrolled. The seroprevalence of CMV IgG antibodies was 193(73.9%; 95% CI 67.2–79.6) while that of CMV IgM antibodies was 0.4%. As the age increased by one unit the IgG seroprevalence was found to increase by 0.3% (95% CI 0.13–0.47, p = 0.001) whereas the risk of being IgG positive increased by 24%. On multivariable logistic regression analysis only urban residence (OR 6.329, 95% CI 2.885–13.887, p < 0.001) was found to independently predict CMV IgG seropositivity. Regarding the outcomes of previous pregnancies the history of miscarriage independently predicted IgG seropositivity (OR 5.6, 95% CI 1.29–24.178, p = 0.021). The IgM seropositive woman had fatal outcome of the term delivery of the baby with microcephaly and spinal-bifida.ConclusionCytomegalovirus seroprevalence among pregnant women residing in urban areas of Mwanza city, Tanzania is high and is associated with poor pregnancy outcomes. There is a need to emphasize routine screening of CMV in order to establish the impact of CMV during pregnancy.

Epidemiology of Cytomegalovirus among pregnant women in Africa

“…We accessed 11 full articles reporting the prevalence of CMV in pregnancy in Africa. Of the 11 studies, two were conducted in North Africa (both in Egypt [29,30]), four in West Africa (one in each of Gambia [31] and Ghana [32], two in Nigeria [33,34]), four in East Africa (one in each of the following countries; Ethiopia [35], Kenya [36], Sudan [37] and Tanzania [38]); and one in Southern Africa (Malawi) [39].…”

“…Studies done in Kenyan and Nigerian women did not report any association between maternal age and risk of CMV seropositivity [34,36]. Higher parity was found to be significantly associated with a higher risk of CMV infection in the studies carried out in Tanzanian (OR = 2.9, 95% CI 1.6-5.4, p < 0.001), Kenyan (OR = 3.8, 95% CI 3-7, p < 0.0001) and Sudanese (OR = 15, 95% CI 2-123, p = 0.01) pregnant women [34,[36][37][38].…”

“…Zaki and Goda [29] reported a significantly (p < 0.001) higher median age among IgG seropositive (median = 25, IQR 19-27) compared to that of IgG seronegative (median = 20, IQR 18-20) Egyptian women. Among Tanzanian women, a one-year age increase resulted in a 0.3% (95% CI 0.13-0.47, p = 0.001) increase in seroprevalence while at the same time the risk of being CMV IgG positive increased by 24% [38]. Hamdan et al [37] observed that advanced maternal age was associated with a higher risk of CMV seropositivity in Sudanese pregnant women.…”

“…However, the study carried out among Sudanese women did not report odds ratios or 95% confidence intervals. A study done on a Tanzanian cohort reported urban residence to be a risk factor for CMV IgG seropositivity (OR = 6.329, 95% CI 2.885-13.887, p < 0.001) [38].…”

“…Four of the 11 studies investigated CMV seropositivity as a risk factor for history of recurrent spontaneous abortion [29,35,[37][38]. CMV seropositivity was reported to be significantly associated with history of spontaneous abortion in the Tanzanian study, both in univariate (OR = 5.6, 95% CI 1.3-24.2, p < 0.02) and multivariate analysis (OR = 5.2, 95% CI 1.1-24.4, p = 0.038) [38].…”