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Tuberculosis Infection in Women of Reproductive Age : A Cross-sectional Study at Antenatal Care Clinics in an Ethiopian City

Walles, John LU orcid ; Tesfaye, Fregenet ; Jansson, Marianne LU ; Balcha, Taye Tolera LU ; Sturegård, Erik LU ; Kefeni, Mestawet ; Merga, Gadissa LU ; Hansson, Stefan R. LU orcid ; Winqvist, Niclas LU and Björkman, Per LU orcid (2021) In Clinical Infectious Diseases 73(2). p.203-210
Abstract

Background: Knowledge on tuberculosis (TB) infection epidemiology in women of reproductive age living in TB-endemic areas is limited. We used a composite definition of TB infection in a cohort of pregnant women recruited in an Ethiopian city as a model for TB exposure patterns, and to identify factors associated with TB infection. Methods: Women seeking antenatal care at public health facilities underwent structured interviews, physical examination, and QuantiFERON-TB Gold-Plus (QFT) testing. Women with symptoms compatible with TB disease, and all human immunodeficiency virus (HIV)-positive women, were investigated for active TB by sputum bacteriological testing. TB infection (TB+) was defined as either positive QFT (≥ 0.35 IU/mL),... (More)

Background: Knowledge on tuberculosis (TB) infection epidemiology in women of reproductive age living in TB-endemic areas is limited. We used a composite definition of TB infection in a cohort of pregnant women recruited in an Ethiopian city as a model for TB exposure patterns, and to identify factors associated with TB infection. Methods: Women seeking antenatal care at public health facilities underwent structured interviews, physical examination, and QuantiFERON-TB Gold-Plus (QFT) testing. Women with symptoms compatible with TB disease, and all human immunodeficiency virus (HIV)-positive women, were investigated for active TB by sputum bacteriological testing. TB infection (TB+) was defined as either positive QFT (≥ 0.35 IU/mL), self-reported previous active TB, or current active TB. Associations between TB infection and clinical, demographic, and socioeconomic characteristics were tested in multiple logistic regression analysis. Results: Among 1834 participants, 679 (37.0%) met criteria for TB+ (80 [4.4%] previous active TB, 5 [0.3%] current active TB, and 594 [32.4%] QFT-positive without previous or current active TB). Age (annual adjusted odds ratio [AOR], 1.069 [95% confidence interval {CI}, 1.045-1.093]) and HIV infection (AOR, 1.43 [95% CI, 1.033-1.988]) were independently associated with TB+. The relationship with increasing age was only observed in HIV-negative women, and translated to an estimated annual risk of TB infection of 2.1% in HIV-negative women. Conclusions: TB infection in women of reproductive age in Ethiopia was independently associated with HIV infection and increasing age, suggesting exposure to contagious TB and continuous acquisition of TB infection in this population.

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author
; ; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Ethiopia, HIV, pregnancy, QuantiFERON, tuberculosis
in
Clinical Infectious Diseases
volume
73
issue
2
pages
8 pages
publisher
Oxford University Press
external identifiers
  • scopus:85112125279
  • pmid:32412638
ISSN
1058-4838
DOI
10.1093/cid/ciaa561
language
English
LU publication?
yes
id
f016487d-c2f3-43c4-8fed-f037fda8735c
date added to LUP
2022-02-08 12:26:10
date last changed
2024-06-14 13:07:41
@article{f016487d-c2f3-43c4-8fed-f037fda8735c,
  abstract     = {{<p>Background: Knowledge on tuberculosis (TB) infection epidemiology in women of reproductive age living in TB-endemic areas is limited. We used a composite definition of TB infection in a cohort of pregnant women recruited in an Ethiopian city as a model for TB exposure patterns, and to identify factors associated with TB infection. Methods: Women seeking antenatal care at public health facilities underwent structured interviews, physical examination, and QuantiFERON-TB Gold-Plus (QFT) testing. Women with symptoms compatible with TB disease, and all human immunodeficiency virus (HIV)-positive women, were investigated for active TB by sputum bacteriological testing. TB infection (TB+) was defined as either positive QFT (≥ 0.35 IU/mL), self-reported previous active TB, or current active TB. Associations between TB infection and clinical, demographic, and socioeconomic characteristics were tested in multiple logistic regression analysis. Results: Among 1834 participants, 679 (37.0%) met criteria for TB+ (80 [4.4%] previous active TB, 5 [0.3%] current active TB, and 594 [32.4%] QFT-positive without previous or current active TB). Age (annual adjusted odds ratio [AOR], 1.069 [95% confidence interval {CI}, 1.045-1.093]) and HIV infection (AOR, 1.43 [95% CI, 1.033-1.988]) were independently associated with TB+. The relationship with increasing age was only observed in HIV-negative women, and translated to an estimated annual risk of TB infection of 2.1% in HIV-negative women. Conclusions: TB infection in women of reproductive age in Ethiopia was independently associated with HIV infection and increasing age, suggesting exposure to contagious TB and continuous acquisition of TB infection in this population.</p>}},
  author       = {{Walles, John and Tesfaye, Fregenet and Jansson, Marianne and Balcha, Taye Tolera and Sturegård, Erik and Kefeni, Mestawet and Merga, Gadissa and Hansson, Stefan R. and Winqvist, Niclas and Björkman, Per}},
  issn         = {{1058-4838}},
  keywords     = {{Ethiopia; HIV; pregnancy; QuantiFERON; tuberculosis}},
  language     = {{eng}},
  month        = {{07}},
  number       = {{2}},
  pages        = {{203--210}},
  publisher    = {{Oxford University Press}},
  series       = {{Clinical Infectious Diseases}},
  title        = {{Tuberculosis Infection in Women of Reproductive Age : A Cross-sectional Study at Antenatal Care Clinics in an Ethiopian City}},
  url          = {{http://dx.doi.org/10.1093/cid/ciaa561}},
  doi          = {{10.1093/cid/ciaa561}},
  volume       = {{73}},
  year         = {{2021}},
}