Risk Factors and their Contributions to the Development of Toxoplasma gondii among Pregnant Women Attending ANC Services in Northwest Ethiopia: Structural Equation Modelling

Background: Toxoplasmosis, caused by Toxoplasma gondii, is a significant health concern for pregnant women in Ethiopia due to its high prevalence and complex risk factors. Limited understanding of these factors hinders effective prevention efforts, making targeted interventions necessary. Objectives: This study used Structural Equation Modeling (SEM) to analyze socio-environmental risk factors associated with T. gondii infection in pregnant women in Northwest Ethiopia, aiming to inform preventive strategies. Methods: A cross-sectional study of 554 pregnant women attending antenatal care clinics used a structured questionnaire to assess latent constructs. SEM analysis was performed using AMOS version 18, with model fit evaluated through indices like 𝜒2, RMSEA, CFI, TLI, IFI, and NFI. Findings: SEM analysis indicated acceptable model fit (𝜒2 = 131.493, df = 7, RMSEA = 0.176, CFI = 0.866, TLI = 0.139, IFI = 0.871, NFI = 0.865). Education and residence were positively associated with exposure to cat feces (p < 0.05), residence correlated with dust exposure, and education showed an inverse link to dog contact. Regression analysis confirmed significant relationships between residence, dust exposure, and water-related factors (p < 0.05). Novelty: This study is the first in Ethiopia to use SEM to explore indirect and mediating effects of environmental and behavioral risk factors for T. gondii infection in pregnant women. Findings provide critical insights for targeted educational and intervention programs to reduce maternal exposure to toxoplasmosis. Keywords: Toxoplasma gondii; Risk factors; Structural equation model; Pregnant women; Ethiopia