Integrating active tuberculosis case finding in antenatal services in Zambia

Area of Science:

• Public Health
• Infectious Diseases
• Maternal Health

Background:

• Tuberculosis (TB) poses a significant risk to maternal and infant health, particularly in high-burden settings.
• Antenatal care (ANC) clinics offer a critical opportunity for TB screening among pregnant women.

Purpose of the Study:

• To estimate TB prevalence in HIV-infected and symptomatic non-HIV-infected pregnant women in Zambia.
• To assess the feasibility of integrating routine TB screening into ANC services.

Main Methods:

• A cross-sectional study was conducted in three ANC clinics in Lusaka, Zambia.
• Peer educators administered TB symptom questionnaires, and sputum samples were analyzed using microscopy and culture.
• Presumptive TB cases included all HIV-infected women and symptomatic non-HIV-infected women.

Main Results:

• Of 5033 women, 17% reported TB symptoms. Among 1152 presumptive TB patients, 1.5% had undiagnosed culture-confirmed TB.
• TB prevalence was 1.5% in HIV-infected women and 1.4% in symptomatic non-HIV-infected women.
• Symptom screening for TB in HIV-infected women had 50% sensitivity, with productive cough being the only significant symptom.

Conclusions:

• A substantial burden of undiagnosed TB exists among pregnant women in Zambia.
• Routine TB screening within ANC settings is acceptable and feasible.
• Development of more sensitive diagnostic tools for TB in this population is crucial.