Intensified case finding for screening tuberculosis among antenatal women in Delhi, India; A facility-based prospective observational study

Abstract

BackgroundTuberculosis (TB) during pregnancy accentuates the risk of adverse maternal and fetal outcomes, including perinatal deaths, preterm births, and low birth weight babies. Screening for active TB during pregnancy by healthcare providers can potentially allow early identification of the disease to initiate prompt treatment in this vulnerable population. ObjectivesTo determine the yield of presumptive TB using the four symptom complex screening model as an intensified case finding tool. MethodsWe conducted a prospective observational study among pregnant women attending the outpatient antenatal clinics at a secondary and tertiary care government hospital in Delhi, India from February to July 2020. The participants were symptomatically screened for presumptive TB and appropriately referred for smear examination at designated microscopy centers. ResultsWe recruited a total of 1306 participants in the study, having a mean (S.D.) age of 24.9 (3.9) years. The yield of presumptive tuberculosis among pregnant women attending the antenatal clinic was 3.0% (95% CI: 2.1–3.9) and the yield of TB was 0.23%. Multigravida mothers (aPR = 2.1, 95% CI: 1.04–4.4), Muslim religion (aPR = 2.8, 95% CI: 1.5–5.4) and mothers in the first trimester (aPR = 3.4, 95% CI: 1.6–7.4) had a statistically significant higher prevalence of presumptive TB than primigravida, non-Muslims and other trimesters respectively. ConclusionThe yield of TB obtained through systematic symptom screening was low among antenatal women attending the two antenatal health clinics of Delhi. However, the process has minimal resource requirements which advocate its implementation among pregnant mothers as per the recommendations from the collaborative framework for management of TB in pregnant women.