TB-related knowledge and stigma among pregnant women in low-resource settings

Perspectives on pregnant women's educational needs to prevent TB complications during pregnancy and the neonatal period. A qualitative study

BACKGROUND

Tuberculosis (TB) during pregnancy could confer a high risk for maternal and infant morbidity. Literature indicates that the global burden of active TB disease among pregnant women is not well researched. Statistics for South Africa from WHO give an estimated incidence of 360, 000 cases of TB in 2019; 14,000 people became ill with multidrug-resistant TB in 2019, with a rate of 615 per 100,000 population, implying that the cohorts included pregnant women with and without a diagnosis of TB infection. Therefore, the study aims to increase the understanding of the educational needs required to prevent TB complications during pregnancy and the neonatal period in women diagnosed with TB infection.

METHODS

The study used cross-sectional qualitative and descriptive designs to collect data in the clinical setting of the primary health care services of Limpopo Province, South Africa. The population comprised pregnant women diagnosed with TB infection. A non-probability purposive sampling technique was used to sample 2 health centers and 5 clinics in each of the three sampled districts. The targeted sample size was 63 and it was achieved even though data saturation was observed. Individual interviews were conducted, audiotaped, and transcribed. Guided by the study questions, a thematic content analysis of the findings was used. Ethical considerations were also observed.

RESULTS

Despite that pregnant women have general knowledge about TB disease, the knowledge and awareness regarding the prevention of TB complications in pregnancy and the neonatal period, information on TB/HIV and COVID-19 co-infections, and participants' knowledge about other non-infectious diseases that may affect the mother with TB infection and foetus showed a deficit.

CONCLUSION

Pregnant women with TB disease need to be educated on the negative effects of non-adherence to TB treatment during pregnancy and the neonatal period. There is a need to educate pregnant women about the variant signs and symptoms of TB, HIV and COVID-19 infections since there is a misconception that the three diseases are similar. It is important that pregnant mothers diagnosed with TB should start treatment as soon as possible.

Association of Maternal Inflammation During Pregnancy With Birth Outcomes and Infant Growth Among Women With or Without HIV in India

IMPORTANCE

The association of elevated levels of specific inflammatory markers during pregnancy with adverse birth outcomes and infant growth could indicate pathways for potential interventions.

OBJECTIVE

To evaluate whether higher levels of certain inflammatory markers during pregnancy are associated with preterm birth (PTB), low birth weight (LBW), and infant growth deficits.

DESIGN, SETTING, AND PARTICIPANTS

In this cohort study of pregnant women with or without HIV, 218 mother-infant pairs were followed up from pregnancy through 12 months post partum from June 27, 2016, to December 9, 2019. Pregnant women aged 18 to 40 years and between 13 and 34 weeks of gestation who were receiving antenatal care were enrolled in a cohort stratified by HIV status; sampling was based on convenience sampling from women receiving antenatal care at Byramjee Jeejeebhoy Government Medical College.

EXPOSURES

Levels of multiple circulating inflammation markers during the third trimester of pregnancy.

MAIN OUTCOMES AND MEASURES

The primary study outcome was PTB (<37 weeks' gestation). Secondary outcomes were LBW (<2500 g) and repeated measures (delivery; 6 weeks post partum; and 3, 6, and 12 months post partum using multivariable generalized linear models) of infant growth outcomes (length-for-age, weight-for-age, and weight-for-length z scores).

RESULTS

The median age of the 218 women at enrollment was 23 years (IQR, 21-27 years). In multivariable models, higher pregnancy levels of interleukin 17A were associated with increased odds of both PTB (adjusted odds ratio [aOR], 2.62; 95% CI, 1.11-6.17) and LBW (aOR, 1.81; 95% CI, 1.04-3.15). Higher levels of interleukin 1β were associated with increased PTB (aOR, 1.47; 95% CI, 1.15-1.89) and infant growth deficits (lower length-for-age z score: adjusted β = -0.10; 95% CI, -0.18 to -0.01; lower weight-for-age z score: adjusted β = -0.07; 95% CI, -0.14 to 0.001).

CONCLUSIONS AND RELEVANCE

This study suggests that increased levels of certain systemic inflammatory markers, including interleukin 1β and interleukin 17A, during pregnancy were associated with adverse birth outcomes and infant growth deficits. Future studies should evaluate whether potential interventions to modulate specific inflammatory pathways during pregnancy could improve birth outcomes and infant growth.