Integrating tuberculosis screening in Kenyan Prevention of Mother-To-Child Transmission programs

Abstract

SUMMARY Background Tuberculosis (TB) screening in prevention of mother-to-child transmission (PMTCT) programs is important to improve TB detection, prevention and treatment. Methods As part of a national PMTCT program evaluation, mother-infant pairs attending 6-week and 9-month immunization visits were enrolled at 141 maternal and child health clinics throughout Kenya. Clinics were selected using population-proportion-to-size sampling with oversampling in a high HIV prevalence region. The World Health Organization (WHO) TB symptom screen was administered to HIV-infected mothers and associations with infant cofactors were determined. Results Among 498 HIV-infected mothers, 165 (33%) had a positive TB symptom screen. Positive maternal TB symptom screen was associated with prior TB (p=0.04). Women with a positive TB symptom screen were more likely to have an infant with HIV infection (p=0.02) and non-specific TB symptoms, including cough (p=0.003), fever (p=0.05), and difficulty breathing (p=0.01). TB exposure was reported by 11% of women, and 15% of TB-exposed women received isoniazid preventive therapy. Conclusions Postpartum HIV-infected mothers frequently had a positive TB symptom screen. Mothers with a positive TB symptom screen were more likely to have infants with HIV or non-specific TB symptoms. Integration of maternal TB screening and prevention into PMTCT programs may improve maternal and infant outcomes.

Retrospective Analysis of 28 Cases of Tuberculosis in Pregnant Women in China

“…A study of infant outcomes in TB-infected mothers in Cape Town suggests that 65% were premature and 59% had small birth weights 22 . Indeed, integration of TB screening in pregnant women may improve maternal and neonatal outcomes 23 .…”