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7/28/2019 TB in Pregnancy
http://slidepdf.com/reader/full/tb-in-pregnancy 1/15
TB in Pregnancy – A Forgotten
Risk
In collaboration with
NTP
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Millennium Development Goals
Goal 5 – Improve maternal health
Goal 6 – Combat AIDS, malaria and other diseases
Target 5A: Reduce by three quarters, between 1990 and 2015, thematernal mortality ratio
Target 8: Have halted by 2015, and begun to reverse, the incidence of
malaria and other major diseases
Indicators
23. Prevalence and death rates associated with TB
24. Proportion of TB cases detected and cured under DOTS
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Percentages of Regional case notification rates
GAR
14%
ASHANTI
9%
EAST
14%
WEST
13%CENTRAL
14%
VOLTA
13%
NORTH
4%
UW
5%
UE
8%
BA
6%
2009 :Case notifcation per 100,000 pop.
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Comparison of Male and Female TB patients in
Ghana 2009
-
200
400
600
800
1,000
1,200
1,400
1,600
0-14 15-24 25-34 35-44 45-54 55-64 65--
MALE FEMALE
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Treatment Outcome
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
31.9
45.850.6
55.350.3
56.060.5
66.971.7 72.6
76.184.1 84.5
111.2
54.249.4
44.749.7
44.039.5
33.128.3 27.4
23.915.9 15.5
P e r c e n t a g e s
Year
Trend on Treatment Success vrs Adverse Outcome (1996-
2008)
Treatment Success Adverse Outcomes
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The TB Burden• TB is endemic in Ghana
• 353/100,000 pop estimated to have TB with
88/100,000 estimated as smear positives
• TB affects the reproductively active age group:
15 –
54 age group
• Male : Female ratio is 2:1
• Women constitute up to 33% of cases notified
• Not much data accumulated in TB in pregnancy
• High mortality rate – co-morbid patients
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Diagnosing TB in Pregnancy
• Cough –
>1 week
• Weight loss and maternal wasting
• Fever
• Sputum production
• Haemoptysis
• Exposure to TB patient
Diagnosis• Sputum for AFB – 2 samples
• AFB scanty or more
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Treatment of TB
• Same treatment as adult patients
– 2(HRZE) + 4(HR) + 6(Pyridoxine) 25mg daily
• Streptomycin is contraindicated as it causes
fetal hearing loss
•
All other drugs are safe –
cross placenta butdo not cause teratogenic effects
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Complications
• Untreated TB leads to
– Maternal wasting and poor health
– Spontaneous abortions
– Perinatal mortality
– Small for gestational age & low birth weight
– Above are worsened by delay in diagnosis
– Infection of the new born during breast feeding
• TB can cause infertility when ovaries affected
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Complications
• Congenital TB through haematogenous spread
is rare!
– Difficult to diagnose
– Not differentiable from other congenital infections
– Symptoms arise in 2 – 3 weeks
– Symptoms: hepato-splenomegaly, respiratory
distress, fever, abnormal X-ray
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Challenges to Identifying TB in Pregnancy
• Lack of knowledge of the extent of the problem
• TB in pregnancy is often ignored with a focus on thepregnancy alone
• When identified termination of pregnancy is offered
the mother instead of comprehensive treatment• National data systems do not capture co-morbidities
associated with TB
• Clinicians often lack capacity to manage the condition
• Delayed diagnosis –
often a diagnosis of exclusion• Non implementation of active TB case finding
• Almost 60% of TB cases are not detected.
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Strategies• Implementing the policy of active TB case finding for early
detection focusing on:
– HOSPITAL BASED CASE DETECTION
– Contact tracing and investigations among index TB cases
– Active TB case finding among clinical risk groups
– Involving community service providers – pharmacists,
chemical sellers, traditional healers etc.
• Management of co-morbidities
• Implementing innovative approaches for TB case finding
• Extensive use of NGOs, community and civil society groups
• Improve supervision, M&E, data management & research.