Feasibility and effect of integrating tuberculosis screening and detection in postnatal care services: an operations research study

Abstract

BackgroundTuberculosis still remains a major cause of maternal and newborn morbidity and mortality. Integrating tuberculosis screening and detection into postnatal care services ensures prompt and appropriate treatment for affected mothers and their babies. This study therefore examined the feasibility and effect of screening and referral for tuberculosis within postnatal care settings from the perspective of providers.MethodsThis operations research study used a pre- and post-intervention design without a comparison group. The study was implemented between March 2009 and August 2010 in five health facilities located in low-income areas of Nairobi, Kenya, which were suspected to have relatively high prevalence of both tuberculosis and HIV. Descriptive statistics and significance tests were employed to determine changes in the indicators of interest between baseline and endline.ResultsAmong the 12,604 postnatal care clients screened, 14 tuberculosis cases were diagnosed. The proportion of clients screened for at least one cardinal sign of tuberculosis rose from 4% to 66%, and 21% of clients were screened for all six tracer signs and symptoms. A comparison of 10 quality of postnatal care and tuberculosis screening components at baseline and endline showed a highly significant effect on all 10 components.ConclusionsThe findings demonstrate that using postnatal care services as a platform for tuberculosis screening and detection is acceptable and feasible. In addition, linking clients identified through screening to further treatment significantly improved. However, the actual number of cases detected was low. A policy debate on whether to link tuberculosis screening with reproductive health services is recommended before full scale-up of this intervention.

Implementation of postnatal care for HIV-positive mothers in the Free State: Nurses’ perspectives

“…The practice is in line with the guidelines. 5 This is supported by Ndwinga et al, 20 who posit that PNC offers a platform for TB screening and increased treatment of TB-infected patients. Ndwinga et al 20 also found that the integration of TB screening enhanced the quality of PNC.…”

Effect of tuberculosis screening and retention interventions on early antiretroviral therapy mortality in Botswana: a stepped-wedge cluster randomized trial

“…The recommendation is based on a high sensitivity of the 4symptom screening rule (89.4%) in detecting culturepositive pulmonary TB disease among ART-naïve PLHIV [24]. However, low compliance in implementing the 4-symptom TB screen at or prior to ART initiation has been consistently observed in many high burden TB-HIV countries in sub-Saharan Africa, including South Africa (59%) [23], Mozambique (61%) [25], Kenya (4%) [26], and Cote d'Ivoire (36%) [22]. Similarly, in XPRES, failure to implement TB screening before ART was the most "leaky" part of the ICF cascade in the SOC phase, with only 30% screened before ART.…”

Tuberculosis transmission in a hospitalised neonate: Need for optimised tuberculosis screening of pregnant and postpartum women

“…Studies have demonstrated that active screening for TB in antenatal and postnatal care settings is beneficial to both mothers and babies. [2] However, several local studies have demonstrated missed or delayed diagnosis of TB in pregnant SA women, with devastating consequences for them and their babies. [3,4] Despite antenatal TB screening being recommended by the 2014 National Tuberculosis Management Guidelines, [5] routine implementation of screening in busy antenatal clinics is uncommon.…”