Email this article 
Hide
Show all
Original Research
Detecting tuberculosis in pregnant and postpartum women in Eswatini
Submitted: 19 May 2018 | Published: 30 July 2020
About the author(s)
Munyaradzi Pasipamire, Research and Evaluation, Eswatini National AIDS Programme, Ministry of Health, Mbabane, EswatiniEdward Broughton, Research and Evaluation, University Research Co. LLC, Chevy Chase, Maryland, United States; and, International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
Mandzisi Mkhontfo, University Research Co. LLC, Mbabane, Eswatini
Gugu Maphalala, Eswatini Health Laboratory Services, Mbabane, Eswatini
Batsabile Simelane-Vilane, University Research Co. LLC, Mbabane, Eswatini
Samson Haumba, University Research Co. LLC, Mbabane, Eswatini
Abstract
Background: Tuberculosis diagnosis in pregnancy is complex because tuberculosis symptoms are often masked by physiological symptoms of pregnancy. Untreated tuberculosis in pregnant and postpartum women may lead to maternal morbidity and low birth weight. Tuberculosis in HIV-positive pregnant women increases the risk of maternal and infant mortality.
Objective: This study aimed to determine tuberculosis prevalence stratified by HIV status and identify screening algorithms that maximise detection of active tuberculosis among pregnant and postpartum women in Eswatini.
Methods: Women were enrolled at antenatal and postnatal clinics in Eswatini for tuberculosis screening and diagnostic investigations from 01 April to 30 November 2015 in a cross-sectional study. Sputum samples were collected from all participants for tuberculosis diagnostic tests (smear microscopy, GeneXpert, MGIT culture). Blood and urine samples were collected from HIV-positive women for cluster-of-differentiation-4 cell count, interferon gamma release assay and tuberculosis lateral flow urine lipoarabinomannan tests.
Results: We enrolled 990 women; 52% were pregnant and 47% were HIV-positive. The prevalence of tuberculosis among HIV-positive pregnant women was 5% (95% confidence interval [CI]: 2–7) and among postpartum women it was 1% (95%CI: -1–3). Tuberculosis prevalence was 2% (95%CI: 0–3) in HIV-negative pregnant women and 1% (95%CI: -1–2) in HIV-negative postpartum women. The national tuberculosis symptom screening tool failed to identify women who tested tuberculosis-culture positive.
Conclusion: Routine tuberculosis symptom screening alone is insufficient to rule out tuberculosis in pregnant and postpartum women. Only sputum culture maximised the detection of tuberculosis, indicating a need to balance access and cost in developing countries.
Keywords
Metrics
Total abstract views: 6038Total article views: 7652
Crossref Citations
1. Lipoarabinomannan as a Point-of-Care Assay for Diagnosis of Tuberculosis: How Far Are We to Use It?
Julio Flores, Juan Carlos Cancino, Leslie Chavez-Galan
Frontiers in Microbiology vol: 12 year: 2021
doi: 10.3389/fmicb.2021.638047
2. Prevalence, acceptability, and cost of routine screening for pulmonary tuberculosis among pregnant women in Cotonou, Benin
Mênonli Adjobimey, Serge Ade, Prudence Wachinou, Marius Esse, Lydia Yaha, Wilfried Bekou, Jonathon R. Campbell, Narcisse Toundoh, Omer Adjibode, Geoffroy Attikpa, Gildas Agodokpessi, Dissou Affolabi, Corinne S. Merle, Emma K. Kalk
PLOS ONE vol: 17 issue: 2 first page: e0264206 year: 2022
doi: 10.1371/journal.pone.0264206
3. Chest X-ray predicts cases of pulmonary tuberculosis among women of reproductive age with acute respiratory symptoms: A multi-center cross-sectional study
Tesfahunegn Hailemariam, Getnet Yimer, Hussen Mohammed, Haileleul Bisrat, Tigist Ajeme, Merga Belina, Lemessa Oljira, Kedir Teji Roba, Fekadu Belay, Tsion Andrias, Esther Ngadaya, Tsegahun Manyazewal
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases vol: 32 first page: 100383 year: 2023
doi: 10.1016/j.jctube.2023.100383
4. The clinical presentation and detection of tuberculosis during pregnancy and in the postpartum period in low- and middle-income countries: A systematic review and meta-analysis
Grace Simpson, Moira Philip, Joshua P. Vogel, Michelle J. L. Scoullar, Stephen M. Graham, Alyce N. Wilson, Veena Jayaraman Iyer
PLOS Global Public Health vol: 3 issue: 8 first page: e0002222 year: 2023
doi: 10.1371/journal.pgph.0002222
5. Association of in vitro fertilization with maternal and perinatal outcomes among pregnant women with active tuberculosis: A retrospective hospital-based cohort study
Lu Xia, Peierdun Mijiti, Xu-Hui Liu, Zhi-Dong Hu, Xiao-Yong Fan, Shui-Hua Lu
Frontiers in Public Health vol: 10 year: 2022
doi: 10.3389/fpubh.2022.1021998
6. Symptom- and chest-radiography screening for active pulmonary tuberculosis in HIV-negative adults and adults with unknown HIV status
Anja van't Hoog, Kerri Viney, Olivia Biermann, Bada Yang, Mariska MG Leeflang, Miranda W Langendam
Cochrane Database of Systematic Reviews vol: 2022 issue: 5 year: 2022
doi: 10.1002/14651858.CD010890.pub2
7. Pregnant women and healthcare workers’
perceptions on tuberculosis and screening: a cross-sectional study in Indonesia
Dzerlina Syanaiscara Rahari, Detty Siti Nurdiati, Jarir At Thobari, Suyanto Suyanto, Tippawan Liabsuetrakul
International Health vol: 17 issue: 3 first page: 334 year: 2025
doi: 10.1093/inthealth/ihae069
8. Enhanced Integration of TB Services in Reproductive Maternal Newborn and Child Health (RMNCH) Settings in Eswatini
Kieran Hartsough, Chloe A. Teasdale, Siphesihle Shongwe, Amanda Geller, Eduarda Pimentel De Gusmao, Phumzile Dlamini, Arnold Mafukidze, Munyaradzi Pasipamire, Trong Ao, Caroline Ryan, Surbhi Modi, Elaine J. Abrams, Andrea A. Howard, Sabine Hermans
PLOS Global Public Health vol: 2 issue: 4 first page: e0000217 year: 2022
doi: 10.1371/journal.pgph.0000217
9. Infant Exposure to Antituberculosis Drugs via Breast Milk and Assessment of Potential Adverse Effects in Breastfed Infants: Critical Review of Data
Engi Abdelhady Algharably, Reinhold Kreutz, Ursula Gundert-Remy
Pharmaceutics vol: 15 issue: 4 first page: 1228 year: 2023
doi: 10.3390/pharmaceutics15041228
10. African laboratory medicine in the time of COVID-19
Iruka N. Okeke
African Journal of Laboratory Medicine vol: 9 issue: 1 year: 2020
doi: 10.4102/ajlm.v9i1.1447