Tbday

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Tuberculosis: A Killer of Women,Underestimated.

Dr Sujnanendra Mishra

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FACTS

Tuberculosis (TB) is a contagious and airborne disease. Globally, it is the

second leading cause of death from a single infectious agent, after the

human immunodeficiency virus(HIV)

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BURDEN OF TUBERCULOSIS IN WOMEN

• In 2013, an estimated 3.3 million women fell ill with TB, of which the African and South East Asia regions accounted for nearly 70% of cases.

• TB is among the top killers of women of reproductive age. 510,000 women died from TB in2013.

• Of all HIV-related TB deaths globally, around a half (180,000) were among women.

• Almost 90% of the HIV-associated TB deaths among women were in Africa, where TB is estimated to have claimed more female lives than male lives.

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Pregnant women are at much higher risk of tuberculosis,

A major study has found that expectant mothers or those who have given birth within the past six months are 69 per cent more likely to get the illness.The researchers from the Health Protection Agency warned midwives and GPs to look out for the symptoms of TB because it can be fatal if not treated.Their study – published in the American Journal of Respiratory and Critical Care Medicine – examined the medical records of more than 190,000 women over 12 years.They found the rate of TB among pregnant women or those who had given birth within the past six months was 15.4 per 100,000 compared with 9.1 per 100,000 among the general population.They believe pregnancy may weaken a woman’s immune system, making her more susceptible to respiratory illnesses.Professor Ibrahim Abubakar, head of TB surveillance at the HPA and a specialist in infectious diseases at the University of East Anglia, said: 'This study clearly shows that future guidance to healthcare workers, especially midwives and health visitors, should take into account that the risk of TB may be increased during pregnancy or shortly after giving birth

http://www.dailymail.co.uk/health/article-2071839/Pregnant-women-new-mothers-70-times-likely tuberculosis.html#ixzz3VEX3leXA

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IMPACT OF TB ON MATERNAL HEALTH

• TB among mothers is associated with – six-fold increase in perinatal deaths and – two-fold risk of premature birth and low birth-weight.

• TB in pregnant women living with HIV increases the risk of maternal and infant mortality by almost 300%.

• In Africa, TB rates are up to 10 times higher in pregnant women living with HIV than in pregnant women without HIV infection.

• Facility-based studies in a number of high HIV burden• Settings found TB accounted for 15-34% of indirect causes of obstetric mortality. • Genital TB, which is challenging to diagnose, has been identified as an important cause of

infertility in high TB-incidence settings. • Evidence from India has found that TB among mothers living with HIV, is associated with

more than double the risk of vertical transmission of HIV to the unborn child.

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Nature and Magnitude of TB Among Women.

• TB is the third leading cause of death among women of reproductive age (15-44), – disproportionately affects the poor pregnant women. – Poverty is a major factor for developing active TB disease– TB places pregnant women and their babies at risk. – Women with TB are

• twice as likely to give birth to a premature or low-birth-weight baby and • four times more likely to die in childbirth. • The risk of infant death also greatly increases.

• Pregnant women with HIV and active TB face higher risks of maternal mortality.• Mother to child transmission of TB is estimated to be 15% within three weeks of birth.

Women living with HIV and TB stand an increased risk of transmitting HIV in utero.• TB progresses more quickly in women of reproductive age then in men of the same age

group.

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Risk factors specific to women

• Women with TB are more likely to develop infectious TB disease than men, but are less likely to access a qualified health provider causing significant delays in the diagnosis and treatment of TB in women . Contributing Factors are stigma, low socio-economic status, and lack of education.

• Social factors contribute to the disparity in case detection between men and women. – Women either feel uncomfortable or misunderstood how to produce the sputum sample needed

for a TB diagnosis.

• In developing countries, women often cook indoors in very confined spaces using biomass fuel (wood or animal dung). These fuels are more likely to cause active TB.

• Women living in poverty are at an increased risk of being sold into the sex trade. • Increasing risk of contracting TB from clients. • Risk is exacerbated by their confined living conditions and susceptibility to HIV.

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Social and Economic Consequences

• Socially, the stigma of having TB falls more heavily on women than men. In some communities, a positive diagnosis may force women into divorce or, if unmarried, create difficulty in finding a marriage partner.

• TB mostly affects in economically and reproductively active years, causing substantial burden on women and their families. Women suffering from TB are often unable to care for their children and have trouble performing household chores. Children are often forced to leave school to care for ailing parents and relatives.

• Women with TB are often too ill to engage in work outside the home, leading to a loss of wages.

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AIDS AND TUBERCULOSIS—DEADLY PARTNERS

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What must be done?

• TB programs must remove barriers to access, reduce delays, and improve the diagnosis and treatment of TB in women.

• Further research and investigation is needed to understand the inadequacies of diagnosing and treating TB in women, including research on gender sensitive treatment options.

• Everybody must work together to eliminate stigma, impact policies and programming, mobilize resources, and ultimately eliminate TB's impact on women.

• TB screening, prevention, and treatment should be part of HIV, reproductive health, and maternal and child health services.

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REACHING THE MDGS

• Millennium Development Goals 4 and 5 aim to reduce deaths among children and pregnant women,

• While MDG 6 focuses on turning around the TB, HIV and malaria epidemics.

• These goals cannot be achieved without additional efforts on TB diagnosis and treatment in children as well as pregnant women.

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WHAT CAN BE DONE?

• COMMITMENT

• COLLABORATION

• INTEGRATION

• DATA COLLECTION

• MONITORING SYSTEMS

• DIAGNOSTIC SCALE-UP

• RESEARCH AND DEVELOPMENT

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