Factors Associated with Tuberculosis Screening and Detection within the ANC Services in Thika Level Five Hospital

Abstract

Tuberculosis (TB) remains a major cause of morbidity and mortality globally and the number of TB cases continues to rise. Passive TB screening reduces delays detection of the disease. A delay in TB detection continues to be a major impediment to TB management among the general population. Factors associated with tuberculosis diagnosis may worsen the disease and increase risk of death as well as enhance tuberculosis transmission in the community

TB during pregnancy has adverse consequences for the mother and the unborn baby as well as the immediate family members. Late TB detection during pregnancy worsens the outcome of pregnancy for the mother and the baby as well as her immediate family members. However, evidence suggests that there is inadequate screening of TB among pregnant women. This study was carried out to generate evidence on factors contributing to TB screening during pregnancy.

The study was carried out in Thika Level Five Hospital. A descriptive cross-sectional study design was employed. The study population included 7 members of the hospital management team, 477 clients attending ANC services and 12 ANC service providers. Interviews were conducted with the above study participants to elicit data related to the factors associated with TB screening among pregnant women. Records were reviewed to obtain data on TB screening during ANC services. Finally, the facility was assessed using a checklist to determine the availability of appropriate organizational structure, policies and guidelines, infrastructure, human resources, supplies and commodities that support TB screening and detection.

Data obtained were analyzed according to various sub-themes of factors associated with TB screening during pregnancy. Both providers’ and patients’ knowledge and practice are factors associated with TB screening among pregnant women. Five (5) of the 12 service providers knew that the screening for TB during pregnancy should be conducted for all mothers during all the ANC visits. This finding seems to correlate with the service providers’ practice in TB screening for ANC clients which showed that only 27% of ANC clients interviewed are screened for TB. Further findings from the service statistics record review indicate that only 33% (n= 5080) of the clients were screened of TB. All the clients were screened during the first ANC visit despite the Ministry of Health’s policy of screening all pregnant women during all the ANC visits (Division of Lung Tuberculosis and leprosy Disease (DLTLD), 2009). The referral practices for TB detection among pregnant women are adequate. Facility

preparedness in terms of supplies and commodities for TB detection were adequate and therefore could not be associated with delays in screening for TB among pregnant women.

Policy makers, health managers, service providers and community members should make efforts towards improving TB screening and detection among pregnant women in order to achieve MDG 4, 5 and 6 among other health goals.