tb in pregnancy

7/28/2019 TB in Pregnancy

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TB in Pregnancy – A Forgotten

Risk

In collaboration with

NTP



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



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.



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



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



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



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



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



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



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



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.



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.

tb in pregnancy

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