4 Key Steps to Integrate TB/FANC (Focused Antenatal Care)
In FANC (Focused Antenatal Care), TB is one of the danger signs in pregnancy a healthcare provider needs to identify.
We may not readily suspect TB in a pregnant woman but if we integrate these two (TB/FANC), we can help fight TB and reduce cases like premature babies as well as babies born with congenital TB.
Pregnancy also increases the risk of developing Tuberculosis. In addition, Tuberculosis (TB) in pregnancy costs lives of many women of child bearing age.
However, TB is the major Opportunistic Infection (O.I) in HIV/AIDS and the leading killer of all PLWHA.
As a matter of fact, more than 50% of TB clients in Kenya are also HIV positive.
At least 1 out of 8 HIV pregnant women could also have TB.
Intensified TB case finding
As health workers, you should screen all pregnant women for TB during FANC. Those you suspect to be having TB have their sputum collected and tested for TB.
In case you have found pregnant women with TB, make sure you refer them to the TB clinic for treatment.
NOTE: Not all negative sputum exclude TB
4 Key Steps to Integrate TB Case Finding into FANC
- Assess your client
- Refer to the laboratory.
- If need be refer to the TB clinic.
- Make sure you do your follow up visits and in all the steps, make sure you document the results.
If a pregnant woman is confirmed to have TB, the treatment will last for 4-6 months. We have 2 phases :-
a.) Intensive phase (2 months)- Isoniazid, Rifampicin, Ethambutol, Pyrazinamide.
b.) Continuous phase– The pregnant woman has to avoid ethambutol. RHZ+In (4 months)
For pregnant women who are HIV positive and have TB, the TB treatment should continue and be sent to the CCC (Comprehensive Care Clinic).
All co-infected patients i.e HIV+TB, should be started on Cotrimoxazole or septrin prophylaxis as it reduces mortality.
DOT (Directly Observed Treatment)
Initial phase– The first 2 months of TB treatment should be administered under DOTs of either a health worker in the facility or a member of the household or community. If a client is too sick or DOT is not possible, client should be admitted to hospital.
Continuation phase– The client collects a supply every 4 weeks for daily self-administration at home.
In conclusion, integrating TB services in FANC brings value to primary health care services. Women of child bearing age need to go for antenatal care. Generally, we should be made aware why we need access to health services because everyone has a right to these services.