Rozina Feroz Ali1, Danya Arif Siddiqi2, Amyn A Malik2, Mubarak Taighoon Shah1, Aamir Javed Khan3, Hamidah Hussain2, Subhash Chandir4. 1. Maternal & Child Health Program, IRD Pakistan, 4th Floor Woodcraft Building, Korangi Creek, Karachi 75190, Pakistan. 2. IRD Global, 15 Beach Road #02-01, Singapore 189677, Singapore. 3. IRD Global, 15 Beach Road #02-01, Singapore 189677, Singapore; Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA. 4. IRD Global, 15 Beach Road #02-01, Singapore 189677, Singapore; Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA. Electronic address: Subhash.chandir@ird.global.
Abstract
BACKGROUND: Active tuberculosis [TB] during pregnancy adversely affects maternal and neonatal outcomes. We analyzed the results of a pilot project integrating TB screening during antenatal care (ANC) visits in a high TB burden, low-resource setting. METHODS: We extracted data from the TB screening pilot in obstetrician-gynecologist clinics of 6 tertiary care facilities in Karachi, Pakistan, from April to December 2017. We analyzed data from the verbal symptom screening conducted at each ANC visit for all women, and the Xpert MTB/RIF testing for all symptomatic women to investigate TB yield by assessing the numbers screened, presumptive patients, and active TB diagnoses among pregnant women and neonates. RESULTS: Symptom screening was performed on 113,078 pregnant women, 2,965 (2.6%) of whom reported at least one symptom. Sputum samples were collected from 2,896 (97.7%) symptomatic women. Of the 27 (0.9%) newly diagnosed bacteriologically positive TB patients, 25 (93%) initiated TB treatment. No case of vertical TB transmission was reported among 26 live births. DISCUSSION: TB screening is feasible and should be implemented during routine ANC visits in high TB burden settings. There is a need to explore a multifaceted approach with inclusion of clinical examination, and chest x-rays to diagnose TB in pregnant women.
BACKGROUND: Active tuberculosis [TB] during pregnancy adversely affects maternal and neonatal outcomes. We analyzed the results of a pilot project integrating TB screening during antenatal care (ANC) visits in a high TB burden, low-resource setting. METHODS: We extracted data from the TB screening pilot in obstetrician-gynecologist clinics of 6 tertiary care facilities in Karachi, Pakistan, from April to December 2017. We analyzed data from the verbal symptom screening conducted at each ANC visit for all women, and the Xpert MTB/RIF testing for all symptomatic women to investigate TB yield by assessing the numbers screened, presumptive patients, and active TB diagnoses among pregnant women and neonates. RESULTS: Symptom screening was performed on 113,078 pregnant women, 2,965 (2.6%) of whom reported at least one symptom. Sputum samples were collected from 2,896 (97.7%) symptomatic women. Of the 27 (0.9%) newly diagnosed bacteriologically positive TB patients, 25 (93%) initiated TB treatment. No case of vertical TB transmission was reported among 26 live births. DISCUSSION: TB screening is feasible and should be implemented during routine ANC visits in high TB burden settings. There is a need to explore a multifaceted approach with inclusion of clinical examination, and chest x-rays to diagnose TB in pregnant women.