Tuberculosis in Women

Abstract

Over three million women currently develop tuberculosis (TB) annually. In 2018, 34% of TB notifications were in women, 58% in men and 8% in children. The global male:female (M:F) ratio for TB notifications was 1.7 (regional range 1.1–2.1). A few countries, with histories of recent unrest or emigration or both, notify more women than men. Prevalence surveys confirm that, in most countries, women do get TB less than men, but women with TB are more likely to be notified. TB is still a massive burden for women, who generally have a lower social, economic and cultural standing in many societies. Health infrastructures are often women-unfriendly. More than TB in men, the consequences of a woman with TB spill over to families and children, even the unborn. Although long-suspected, TB was recently shown to be significantly more common in pregnancy and the post-partum period, combined, and both TB-affected mothers and their infants suffer poor outcomes. TB in pregnant women with HIV significantly increases obstetric mortality and doubles the risk of vertical transmission of HIV to the unborn child. Recently, isoniazid has been associated with poor outcomes of pregnancy when used for treating latent TB infection in HIV-positive pregnant women, presenting a problem for clinicians. Recommendations focus on correcting the neglect of collaboration and coordination between national TB programmes and mother and child health services.