title: Integrating active tuberculosis case finding in antenatal services in Zambia.
abstract: METHODS
  Three out-patient antenatal care (ANC) clinics in Lusaka, Zambia.
  
  
  OBJECTIVE
  To estimate tuberculosis (TB) prevalence in human immunodeficiency virus (HIV) infected and symptomatic, non-HIV-infected pregnant women and explore the feasibility of routine TB screening in ANC settings.
  
  
  METHODS
  Peer educators administered TB symptom questionnaires to pregnant women attending their first ANC clinic visit. Presumptive TB patients were defined as all HIV-infected women and symptomatic non-HIV-infected women. Sputum samples were tested using smear microscopy and culture to estimate TB prevalence.
  
  
  RESULTS
  All 5033 (100%) women invited to participate in the study agreed, and 17% reported one or more TB symptoms. Among 1152 presumed TB patients, 17 (1.5%) had previously undiagnosed culture-confirmed TB; 2 (12%) were smear-positive. Stratified by HIV status, TB prevalence was 10/664 (1.5%, 95%CI 0. 7-2.8) among HIV-infected women and 7/488 (1.4%, 95%CI 0.6-2.9) among symptomatic non-HIV-infected women. In HIV-infected women, the only symptom significantly associated with TB was productive cough; symptom screening was only 50% sensitive.
  
  
  CONCLUSIONS
  There is a sizable burden of TB in pregnant women in Zambia, which may lead to adverse maternal and infant outcomes. TB screening in ANC settings in Zambia is acceptable and feasible. More sensitive diagnostics are needed.
authors.affiliation: Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
authors.forename: N
authors.initials: N
authors.lastname: Kancheya
authors.affiliation: Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
authors.forename: D
authors.initials: D
authors.lastname: Luhanga
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: J B
authors.initials: JB
authors.lastname: Harris
authors.affiliation: Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
authors.forename: J
authors.initials: J
authors.lastname: Morse
authors.affiliation: National TB Program, Ministry of Community Development Mother to Child Health, Lusaka, Zambia.
authors.forename: N
authors.initials: N
authors.lastname: Kapata
authors.affiliation: Ministry of Health, Lusaka, Zambia.
authors.forename: M
authors.initials: M
authors.lastname: Bweupe
authors.affiliation: Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
authors.forename: G
authors.initials: G
authors.lastname: Henostroza
authors.affiliation: Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
authors.forename: S E
authors.initials: SE
authors.lastname: Reid
mesh_terms: D000328:Adult; D001431:Bacteriological Techniques; D060085:Coinfection; D003371:Cough / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D019033:Delivery of Health Care, Integrated; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D008403:Mass Screening / Q000379:methods; D008427:Maternal Health Services; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011247:Pregnancy; D015995:Prevalence; D013183:Sputum / Q000382:microbiology; D011795:Surveys and Questionnaires; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult; D015024:Zambia / Q000453:epidemiology