Tuberculosis in pregnancy: an estimate of the global burden of disease
Tuberculosis in pregnancy: an estimate of the global burden of disease
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DOI：
10.1016/s2214-109x(14)70330-4
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发表时间：
2014-12-01
影响因子：
34.3
通讯作者：
Oxlade, Olivia
中科院分区：
文献类型：
--
作者：
Sugarman, Jordan;Colvin, Charlotte;Oxlade, Olivia
2013年全球孕产妇死亡人数估计为28.9万人，比1990年减少了45%。非产科原因，如包括结核病在内的传染病，目前占孕产妇死亡的28%。2013年，全球估计有330万例结核病发生在妇女身上。在怀孕期间，结核病与不良结局有关，包括新生儿和孕妇的死亡率增加。我们研究的目的是估计孕妇结核病的负担，并描述如何将孕产妇保健服务作为提高病例发现率的平台。方法我们使用可公开获得的国家级总人口估计数、总人口年龄和性别分布、粗出生率、活动性结核病估计患病率、以及按年龄和性别分列的病例通知数据，以估计217个国家中患有活动性结核病的孕妇人数。然后，我们使用卫生系统的访问和结核病诊断检测性能从已发表的文献中获得的指标，以确定有多少这些案件最终可以detected.Findings我们估计，216500（95%的不确定性范围192100 - 247000）活动性结核病病例存在于全球孕妇在2011年。负担最大的是世卫组织非洲区域，有89 400例，世卫组织东南亚区域有67 500例孕妇。通过孕产妇保健服务提供的胸部X线摄影或Xpert RIF/MTB，估计分别检测出多达114 100例和120 300例结核病病例。孕产妇保健服务可以为结核病的检测、治疗启动和后续跟踪提供一个重要平台。
Background The estimated number of maternal deaths in 2013 worldwide was 289 000, a 45% reduction from 1990. Non-obstetric causes such as infectious diseases including tuberculosis now account for 28% of maternal deaths. In 2013, 3.3 million cases of tuberculosis were estimated to occur in women globally. During pregnancy, tuberculosis is associated with poor outcomes, including increased mortality in both the neonate and the pregnant woman. The aim of our study was to estimate the burden of tuberculosis disease among pregnant women, and to describe how maternal care services could be used as a platform to improve case detection.Methods We used publicly accessible country-level estimates of the total population, distribution of the total population by age and sex, crude birth rate, estimated prevalence of active tuberculosis, and case notification data by age and sex to estimate the number of pregnant women with active tuberculosis for 217 countries. We then used indicators of health system access and tuberculosis diagnostic test performance obtained from published literature to determine how many of these cases could ultimately be detected.Findings We estimated that 216 500 (95% uncertainty range 192 100-247 000) active tuberculosis cases existed in pregnant women globally in 2011. The greatest burdens were in the WHO African region with 89 400 cases and the WHO South East Asian region with 67 500 cases in pregnant women. Chest radiography or Xpert RIF/MTB, delivered through maternal care services, were estimated to detect as many as 114 100 and 120 300 tuberculosis cases, respectively.Interpretation The burden of tuberculosis disease in pregnant women is substantial. Maternal care services could provide an important platform for tuberculosis detection, treatment initiation, and subsequent follow-up.