Integrating tuberculosis screening into antenatal visits to improve tuberculosis diagnosis and care: Results from a pilot project in Pakistan
Integrating tuberculosis screening into antenatal visits to improve tuberculosis diagnosis and care: Results from a pilot project in Pakistan
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DOI：
10.1016/j.ijid.2021.05.072
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发表时间：
2021-06-23
影响因子：
8.4
通讯作者：
Chandir, Subhash
中科院分区：
文献类型：
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作者：
Ali, Rozina Feroz;Siddiqi, Danya Arif;Chandir, Subhash
背景：妊娠期活动性结核病（TB）对孕产妇和新生儿预后有不良影响。本研究分析了在结核病高负担、低资源环境中将结核病筛查纳入产前保健（ANC）访问的试点项目的结果。方法：从2017年4月至12月在巴基斯坦卡拉奇6家三级医疗机构的妇产科诊所进行的结核病筛查试点中提取数据。通过评估筛查的人数、孕妇和新生儿的推定患者和活动性结核病诊断，分析了在每次ANC就诊时对所有妇女进行的口头症状筛查和对所有有症状妇女进行的Xpert MTB/RIF检测以调查结核病产量的数据。结果：对113078名孕妇进行了症状筛查，其中2965名（2.6%）报告了至少一种结核病症状。对2896例（97.7%）有症状的妇女采集痰液样本。在27例（0.9%）新诊断细菌学阳性结核病患者中，25例（93%）开始了结核病治疗。在26例活产中未报告结核垂直传播病例。讨论：结核病筛查是可行的，应在高结核负担地区的常规ANC就诊期间实施。有必要探索包括临床检查和胸部x光检查在内的多方面方法来诊断孕妇的结核病。(c) 2021作者。由爱思唯尔有限公司代表国际传染病学会出版。这是一篇基于CC BY-NC-ND许可（http://creativecommons.org/licenses/by-nc）的开放获取文章
Background: Active tuberculosis (TB) during pregnancy has an adverse effect on maternal and neonatal outcomes. This study analysed the results of a pilot project integrating TB screening into antenatal care (ANC) visits in a high-TB-burden, low-resource setting. Methods: Data were extracted from the TB screening pilot in obstetrician-gynaecologist clinics of six tertiary care facilities in Karachi, Pakistan from April to December 2017. 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 were analysed 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 TB 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-TBburden settings. There is a need to explore a multi-faceted approach with inclusion of clinical examination and chest X-rays to diagnose TB in pregnant women. (c) 2021 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc