Pregnancy data in tuberculosis surveillance: Practices, priorities and perspectives from national TB programs in the Western Pacific and South-East Asia

Objectives: Tuberculosis (TB) is the leading cause of death from an infectious disease, with the Western Pacific (WPR) and South-East Asia (SEAR) regions accounting for almost two-thirds of the global burden. Despite TB being a major cause of maternal mortality and adverse neonatal outcomes, no consensus exists on routine pregnancy-related data collection in national TB programmes (NTPs). This study aimed to map current practices, priorities, and perspectives regarding pregnancy data collection in TB surveillance across WPR and SEAR.

Study design: We conducted a cross-sectional, mixed-methods survey of NTPs across WPR and SEAR.

Methods: The survey assessed the landscape of pregnancy data collection, including existing and recommended practices, perceived importance and impact, barriers, and resource needs. Prioritization of indicators was evaluated using 5-point Likert scales. Quantitative data were analysed as categorical variables, and qualitative responses were thematically analysed.

Results: Of 47 countries/territories invited, 31 (66.0%) responded: 26 from WPR (26/36; 72.2%) and five from SEAR (5/11; 45.5%). Seven (22.6%) routinely collect pregnancy status in TB surveillance. Indicators most recommended were pregnancy/postpartum status at TB diagnosis (80.6%) and TB treatment (61.3%), as well as pregnancy (61.3%), neonatal (61.3%), and maternal outcomes (61.3%). Perceived importance of pregnancy data collection was high (median 4, IQR 3-5), as was anticipated impact on policy change (median 4, IQR 3-4). Key barriers identified included absence of international guidelines, insufficient training, and resource constraints.

Conclusions: Despite broad recognition of its importance, routine collection of pregnancy-related data in TB surveillance remains uncommon. Addressing barriers through development of international guidelines, targeted training, and strengthened health information systems could better quantify the burden of TB in pregnant and postpartum women and drive solutions to improve maternal and neonatal outcomes.