Kancheya N, Luhanga D, Harris J B, Morse J, Kapata N, Bweupe M, Henostroza G, Reid S E
Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Int J Tuberc Lung Dis. 2014 Dec;18(12):1466-72. doi: 10.5588/ijtld.14.0920.
Three out-patient antenatal care (ANC) clinics in Lusaka, Zambia.
To estimate tuberculosis (TB) prevalence in human immunodeficiency virus (HIV) infected and symptomatic, non-HIV-infected pregnant women and explore the feasibility of routine TB screening in ANC settings.
Peer educators administered TB symptom questionnaires to pregnant women attending their first ANC clinic visit. Presumptive TB patients were defined as all HIV-infected women and symptomatic non-HIV-infected women. Sputum samples were tested using smear microscopy and culture to estimate TB prevalence.
All 5033 (100%) women invited to participate in the study agreed, and 17% reported one or more TB symptoms. Among 1152 presumed TB patients, 17 (1.5%) had previously undiagnosed culture-confirmed TB; 2 (12%) were smear-positive. Stratified by HIV status, TB prevalence was 10/664 (1.5%, 95%CI 0. 7-2.8) among HIV-infected women and 7/488 (1.4%, 95%CI 0.6-2.9) among symptomatic non-HIV-infected women. In HIV-infected women, the only symptom significantly associated with TB was productive cough; symptom screening was only 50% sensitive.
There is a sizable burden of TB in pregnant women in Zambia, which may lead to adverse maternal and infant outcomes. TB screening in ANC settings in Zambia is acceptable and feasible. More sensitive diagnostics are needed.
赞比亚卢萨卡的三家门诊产前保健（ANC）诊所。
估计感染人类免疫缺陷病毒（HIV）且有症状的未感染HIV的孕妇中的结核病（TB）患病率，并探讨在ANC环境中进行常规TB筛查的可行性。
同伴教育者向首次到ANC诊所就诊的孕妇发放TB症状问卷。疑似TB患者定义为所有感染HIV的妇女和有症状的未感染HIV的妇女。使用涂片显微镜检查和培养对痰标本进行检测以估计TB患病率。
所有受邀参与研究的5033名（100%）妇女均表示同意，17%的妇女报告有一项或多项TB症状。在1152名疑似TB患者中，17名（1.5%）此前有未经诊断的经培养确诊的TB；2名（12%）涂片阳性。按HIV感染状况分层，感染HIV的妇女中TB患病率为10/664（1.5%，95%CI 0.7 - 2.8），有症状的未感染HIV的妇女中为7/488（1.4%，95%CI 0.6 - 2.9）。在感染HIV的妇女中，与TB显著相关的唯一症状是咳痰；症状筛查的敏感性仅为50%。
赞比亚孕妇中TB负担相当大，这可能导致母婴不良结局。在赞比亚的ANC环境中进行TB筛查是可接受且可行的。需要更敏感的诊断方法。
