Screening for tuberculosis in pregnancy: do we need more than a symptom screen? Experience from western Kenya

Abstract

Objectives: 1) To explore the utility of tuberculosis (TB) symptom screening for symptoms of ⩾2 weeks’ duration in a routine setting, and 2) to compare differences in TB diagnosis between human immunodeficiency virus (HIV) infected and non-HIV-infected pregnant women in west- ern Kenya. Design: Comparative cross-sectional study among preg- nant women with known HIV status screened for TB from 2010 to 2012, in Eldoret, western Kenya. Results: Of 2983 participants, respectively 34 (1%), 1488 (50.5%) and 1461 (49.5%) had unknown, positive and negative HIV status. The median age was respectively 30 years (interquartile range [IQR] 26–35) and 26 years (IQR 24–31) in HIV-infected and non-infected participants. A positive symptom screen was found in respectively 8% (119/1488) and 5% (67/1461) of the HIV-infected and non-infected women. The median CD4 count at en- rolment was 377 cells/μl (IQR 244–530) for HIV-infected women. One non-HIV-infected patient was sputum- p ositive. For HIV-infected women, TB was presumptively treated in 1% (16/1488) based on clinical symptoms and chest X-ray. Cumulatively, anti-tuberculosis treatment was offered to 0.6% (17/2949) of the participants. Conclusion: This study does not seem to demonstrate the utility of TB symptom screening questionnaires in a rou- tine setting among pregnant women, either HIV-infected or non-infected, in western Kenya.