PLoS ONE (Jan 2022)

Prevalence, acceptability, and cost of routine screening for pulmonary tuberculosis among pregnant women in Cotonou, Benin.

  • Mênonli Adjobimey,
  • Serge Ade,
  • Prudence Wachinou,
  • Marius Esse,
  • Lydia Yaha,
  • Wilfried Bekou,
  • Jonathon R Campbell,
  • Narcisse Toundoh,
  • Omer Adjibode,
  • Geoffroy Attikpa,
  • Gildas Agodokpessi,
  • Dissou Affolabi,
  • Corinne S Merle

DOI
https://doi.org/10.1371/journal.pone.0264206
Journal volume & issue
Vol. 17, no. 2
p. e0264206

Abstract

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ObjectivesWe sought to evaluate the yield, cost, feasibility, and acceptability of routine tuberculosis (TB) screening of pregnant women in Cotonou, Benin.DesignMixed-methods, cross-sectional study with a cost assessment.SettingEight participating health facilities in Cotonou, Benin.ParticipantsConsecutive pregnant women presenting for antenatal care at any participating site who were not in labor or currently being treated for TB from April 2017 to April 2018.InterventionsScreening for the presence of TB symptoms by midwives and Xpert MTB/RIF for those with cough for at least two weeks. Semi-structured interviews with 14 midwives and 16 pregnant women about experiences with TB screening.Primary and secondary outcome measuresProportion of pregnant women with cough of at least two weeks and/or microbiologically confirmed TB. The cost per pregnant woman screened and per TB case diagnosed in 2019 USD from the health system perspective.ResultsOut of 4,070 pregnant women enrolled in the study, 94 (2.3%) had a cough for at least two weeks at the time of screening. The average (standard deviation) age of symptomatic women was 26 ± 5 years and 5 (5.3%) had HIV. Among the 94 symptomatic women, 2 (2.3%) had microbiologically confirmed TB for a TB prevalence of 49 per 100,000 (95% CI: 6 to 177 per 100,000) among pregnant women enrolled in the study. The average cost to screen one pregnant woman for TB was $1.12 USD and the cost per TB case diagnosed was $2271 USD. Thematic analysis suggested knowledge of TB complications in pregnancy was low, but that routine TB screening was acceptable to both midwives and pregnant women.ConclusionEnhanced screening for TB among pregnant women is feasible, acceptable, and inexpensive per woman screened, however in this setting has suboptimal yield even if it can contribute to enhance TB case finding.