Prevention, Diagnosis, and Treatment of Tuberculosis in Children and Mothers: Evidence for Action for Maternal, Neonatal, and Child Health Services
Prevention, Diagnosis, and Treatment of Tuberculosis in Children and Mothers: Evidence for Action for Maternal, Neonatal, and Child Health Services
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DOI：
10.1093/infdis/jis009
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发表时间：
2012-05-15
影响因子：
6.4
通讯作者：
Raviglione, Mario
中科院分区：
文献类型：
--
作者：
Getahun, Haileyesus;Sculier, Delphine;Raviglione, Mario
2010年，全球约有880万人感染结核病，140万人死亡，其中包括50万妇女和至少64 000名儿童。它还导致近1 000万名儿童因父母死亡而成为孤儿。此外，它造成的产妇死亡率占所有产妇死亡率的6%-15%，如果只考虑间接原因，则增加到15%-34%。在人体免疫缺陷病毒（艾滋病毒）高流行率的环境中，越来越多的妇女被告知患有结核病，而孕产妇结核病增加了艾滋病毒的垂直传播。应将结核病预防、诊断和治疗服务作为关键干预措施纳入妊娠和儿童健康综合管理。结核病筛查采用简单的临床算法，依赖于目前没有咳嗽，发烧，体重减轻，盗汗，应用于确定合格的孕妇感染艾滋病毒的异烟肼预防性治疗或进一步调查结核病作为预防艾滋病毒垂直传播服务的一部分。在实施这些简单、低成本、有效的干预措施作为孕产妇、新生儿和儿童保健服务的一部分的同时，应解决儿童、孕妇和哺乳期妇女未得到满足的基本和业务结核病研究需求。国家政策制定者、项目管理者和从事孕产妇、新生儿和儿童健康工作的国际利益攸关方（如联合国机构、捐助者和实施者），特别是在艾滋病毒流行的环境中，应给予应有的重视，并将结核病预防、诊断和治疗服务作为其核心职能的一部分，并在其项目和服务中解决结核病对公共卫生的影响。
Tuberculosis affected an estimated 8.8 million people and caused 1.4 million deaths globally in 2010, including a half-million women and at least 64 000 children. It also results in nearly 10 million cumulative orphans due to parental deaths. Moreover, it causes 6%-15% of all maternal mortality, which increases to 15%-34% if only indirect causes are considered. Increasingly, more women with tuberculosis are notified than men in settings with a high prevalence of human immunodeficiency virus (HIV), and maternal tuberculosis increases the vertical transmission of HIV. Tuberculosis prevention, diagnosis, and treatment services should be included as key interventions in the integrated management of pregnancy and child health. Tuberculosis screening using a simple clinical algorithm that relies on the absence of current cough, fever, weight loss, and night sweats should be used to identify eligible pregnant women living with HIV for isoniazid preventive therapy or for further investigation for tuberculosis disease as part of services for prevention of vertical HIV transmission. While implementing these simple, low-cost, effective interventions as part of maternal, neonatal, and child health services, the unmet basic and operational tuberculosis research needs of children, pregnant, and breastfeeding women should be addressed. National policy makers, program managers, and international stakeholders (eg, United Nations bodies, donors, and implementers) working on maternal, neonatal, and child health, especially in HIV-prevalent settings, should give due attention and include tuberculosis prevention, diagnosis, and treatment services as part of their core functions and address the public health impacts of tuberculosis in their programs and services.