a Department of Preventive and Social Medicine , Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Puducherry , India.
b Center for Operational Research , International Union Against Tuberculosis and Lung Disease , Paris , France.
Glob Health Action. 2019;12(1):1564488. doi: 10.1080/16549716.2018.1564488.
The national tuberculosis (TB) programme in India recommends screening all pregnant women for TB, but this is rarely implemented. We carried out systematic TB screening among women attending the antenatal clinic of a tertiary care hospital in Puducherry, South India, during February to April 2018.
To assess the number screened and number (proportion) with presumptive and active TB, and understand potential implementation from the healthcare providers' perspective.
We conducted a mixed-methods study. The quantitative phase was a cross-sectional study including 4203 pregnant women. Data were captured using a structured proforma. Any of the following symptoms constituted 'presumptive TB': any cough, haemoptysis, fever, weight loss, night sweats, neck swellings, joint pains, neck stiffness and disorientation. Those screening positive were referred for investigations and evaluation by a chest physician. The qualitative phase involved seven one-to-one interviews with healthcare providers. Manual thematic analysis was performed to generate themes.
Among 4203 women (two HIV-positive) screened, 77 (1.8%) had presumptive TB. Cough was the predominant symptom (n = 75). Only 12 women could produce a sputum sample, of whom one (0.02%) was diagnosed with active TB by the Xpert MTB/RIF assay. Challenges cited by healthcare providers were lack of awareness among clients and providers, high case load, lack of dedicated staff, perception that TB screening is a low-yield, low-priority activity and losses in the referral process. Suggested solutions were providing dedicated staff and space for screening, educating women to self-report using posters and videos, and creating a one-stop care provision.
The TB yield among pregnant women was very low, calling into question the value of systematic screening in a low-HIV setting. However, the findings may not be generalizable. Evidence is urgently needed from primary and secondary care facilities. The challenges and solutions identified may help in optimizing the screening process.
印度国家结核病（TB）规划建议对所有孕妇进行结核病筛查，但这很少得到实施。我们在 2018 年 2 月至 4 月期间对印度南部 Puducherry 的一家三级保健医院的产前门诊的妇女进行了系统的结核病筛查。
评估筛查人数和疑似及活动性结核病人数（比例），并从医疗保健提供者的角度了解潜在的实施情况。
我们进行了一项混合方法研究。定量阶段是一项横断面研究，纳入了 4203 名孕妇。数据使用结构化表格捕获。以下任何一种症状都构成“疑似结核病”：任何咳嗽、咯血、发热、体重减轻、盗汗、颈部肿胀、关节疼痛、颈部僵硬和定向障碍。筛查阳性者被转介给胸部医生进行检查和评估。定性阶段包括对 7 名医疗保健提供者进行的 7 次一对一访谈。采用手动主题分析生成主题。
在筛查的 4203 名妇女（2 名 HIV 阳性）中，有 77 名（1.8%）患有疑似结核病。咳嗽是最常见的症状（n=75）。仅有 12 名妇女能产生痰样，其中 1 名（0.02%）经 Xpert MTB/RIF 检测确诊为活动性结核病。医疗保健提供者提到的挑战包括客户和提供者缺乏意识、工作量大、缺乏专门人员、认为结核病筛查是低收益、低优先级的活动以及转诊过程中的损失。建议的解决方案是提供专门的工作人员和筛查空间，通过海报和视频教育妇女自我报告，并创建一站式护理服务。
孕妇中的结核病发病率非常低，这使得在低 HIV 环境中系统筛查的价值受到质疑。然而，这些发现可能不具有普遍性。迫切需要从初级和二级保健设施获得证据。确定的挑战和解决方案可能有助于优化筛查过程。
