title: Feasibility and effect of integrating tuberculosis screening and detection in postnatal care services: an operations research study.
abstract: BACKGROUND
  Tuberculosis 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.
  
  
  METHODS
  This 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.
  
  
  RESULTS
  Among 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.
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Population Council, Nairobi, Kenya. cndwiga@popcouncil.org
authors.forename: Charity
authors.initials: C
authors.lastname: Ndwiga
authors.forename: Harriet
authors.initials: H
authors.lastname: Birungi
authors.forename: Chi-Chi
authors.initials: CC
authors.lastname: Undie
authors.forename: Herman
authors.initials: H
authors.lastname: Weyenga
authors.forename: Joseph
authors.initials: J
authors.lastname: Sitienei
mesh_terms: D003153:Community Health Services; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007630:Kenya; D008403:Mass Screening; D009740:Nursing Staff / Q000193:education; D011181:Postnatal Care; D011204:Poverty Areas; D011787:Quality of Health Care; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000503:physiopathology