title: Screening for tuberculosis in pregnancy: do we need more than a symptom screen? Experience from western Kenya.
abstract: OBJECTIVE
  1) To explore the utility of tuberculosis (TB) symptom screening for symptoms of ≥2 weeks' duration in a routine setting, and 2) to compare differences in TB diagnosis between human immunodeficiency virus (HIV) infected and non-HIV-infected pregnant women in western Kenya.
  
  
  METHODS
  Comparative cross-sectional study among pregnant women with known HIV status screened for TB from 2010 to 2012, in Eldoret, western Kenya.
  
  
  RESULTS
  Of 2983 participants, respectively 34 (1%), 1488 (50.5%) and 1461 (49.5%) had unknown, positive and negative HIV status. The median age was respectively 30 years (interquartile range [IQR] 26-35) and 26 years (IQR 24-31) in HIV-infected and non-infected participants. A positive symptom screen was found in respectively 8% (119/1488) and 5% (67/1461) of the HIV-infected and non-infected women. The median CD4 count at enrolment was 377 cells/μl (IQR 244-530) for HIV-infected women. One non-HIV-infected patient was sputum-positive. For HIV-infected women, TB was presumptively treated in 1% (16/1488) based on clinical symptoms and chest X-ray. Cumulatively, anti-tuberculosis treatment was offered to 0.6% (17/2949) of the participants.
  
  
  CONCLUSIONS
  This study does not seem to demonstrate the utility of TB symptom screening questionnaires in a routine setting among pregnant women, either HIV-infected or non-infected, in western Kenya.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya.
authors.forename: R J
authors.initials: RJ
authors.lastname: Kosgei
authors.affiliation: AMPATH, Eldoret, Kenya ; The Memorial Hospital of Rhode Island Brown Family Medicine Residency Program, Pawtucket, Rhode Island, USA.
authors.forename: D
authors.initials: D
authors.lastname: Szkwarko
authors.affiliation: University of Ghent School of Medicine, Ghent, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Callens
authors.affiliation: Department of Human Anatomy, University of Nairobi, Nairobi, Kenya.
authors.forename: P
authors.initials: P
authors.lastname: Gichangi
authors.affiliation: University of Ghent School of Medicine, Ghent, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Temmerman
authors.affiliation: Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya.
authors.forename: A-B
authors.initials: AB
authors.lastname: Kihara
authors.affiliation: AMPATH, Eldoret, Kenya ; Moi University School of Public Health, Eldoret, Kenya.
authors.forename: J J
authors.initials: JJ
authors.lastname: Sitienei
authors.affiliation: Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya.
authors.forename: E J
authors.initials: EJ
authors.lastname: Cheserem
authors.affiliation: Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya.
authors.forename: P M
authors.initials: PM
authors.lastname: Ndavi
authors.affiliation: Operational Research Unit, Médecins Sans Frontières Operational Centre Brussels, Luxembourg.
authors.forename: A J
authors.initials: AJ
authors.lastname: Reid
authors.affiliation: AMPATH, Eldoret, Kenya ; Alpert School of Medicine at Brown University, Providence, Rhode Island, USA.
authors.forename: E J
authors.initials: EJ
authors.lastname: Carter
keywords: HIV; TB diagnosis; TB symptom screening questionnaire