Screening for pulmonary tuberculosis: an acceptable intervention for antenatal care clients and providers?
METHODS
Five purposively sampled health facilities in Kasungu District, Malawi.


OBJECTIVE
To explore 1) the acceptability of introducing pulmonary tuberculosis (PTB) screening into antenatal care (ANC) clinics amongst ANC clients and ANC service providers; and 2) the acceptability of tuberculosis (TB) treatment during and after pregnancy among women registered for TB treatment.


METHODS
Fourteen focus group discussions and 40 in-depth interviews with ANC clients (15), ANC service providers (10) and women registered for TB treatment (15).


RESULTS
Most clients found the introduction of PTB screening into ANC clinics acceptable. Some expressed concern at submitting a second sputum specimen, citing transportation/distance as the main obstacle. Other concerns were stigma and fear relating to the human immunodeficiency virus and the acquired immune-deficiency syndrome (HIV/AIDS) and taking TB treatment during pregnancy and breast-feeding. All ANC service providers supported the idea, but were concerned about increased workload.


CONCLUSIONS
PTB screening in the ANC setting would be an acceptable intervention and could serve to increase PTB case notification in Malawi. However, alternative diagnostic strategies need to be explored. The negative associations with HIV/AIDS and some of the misconceptions surrounding TB treatment need to be addressed to avoid PTB screening becoming a potential barrier to seeking ANC. The main challenge will be whether over-stretched staff will be able to cope with this additional service.
Sangala
W T
WT
Equi-TB Knowledge Programme Malawi (REACH Trust), Lilongwe, Malawi. winasangala@bigfoot.com
Briggs
P
P
Theobald
S
S
Squire
S B
SB
Kemp
J
J
D001942:Breast Feeding; D005239:Fear; D005260:Female; D017144:Focus Groups; D006282:Health Personnel; D006801:Humans; D008295:Malawi; D011247:Pregnancy; D011295:Prenatal Care / Q000458:organization & administration*; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy