Gender Bias in TB Screening and Treatment
Gendered roles and stereotypes can lead to unequal access to medical diagnosis and treatment, which can introduce a gender bias in health outcomes. We consider gender inequalities in health seeking behaviour and the subsequent detection of TB by analysing data from a large TB prevalence survey.
Our analysis is based on a population prevalence survey of 31 007 adults in eight high TB prevalence communities in the Western Cape in 2010. Survey participants were asked to report TB symptoms, health seeking behaviour and demographic data. Prevalence of culture confirmed pulmonary TB was defined as M.tuberculosis (M.tb) isolated from a respiratory sample. Sputum samples were inoculated into manual mycobacterial growth indicator (MGIT BD) tubes. Individuals were considered to have a culture positive for M.tb if their MGIT tubes had growth confirmed to be M.tb by 16SrRNA sequencing.
702 culture positive TB cases were identified. 333 were male (47.4%) and 369 (52.56%) were female. Of the males 12 (3.6%) were diagnosed by health services prior to the survey, while 6 (1.6%) of the females were diagnosed by health services (p=0.349). Females who were symptomatic (coughing for two weeks or longer) reported less often that they have been to the clinic to seek care for the cough prior to the prevalence survey than males (50.7% vs. 36.1%, p=0.075). Symptomatic females visiting clinics were significantly less likely to be asked for a sputum sample than symptomatic males visiting clinics (76.4% for males vs. 63.5% for females, p=0.004). Males who reported coughing and submitted sputum samples at clinics were significantly more likely to have a positive sputum result in the survey (20.6% vs. 11.8%, p=0.009).
This work was presented as a poster at the 44th Union World Conference on Lung Health in Paris in November 2013 and has been accepted for publication in International Journal of Tuberculosis and Lung Disease.
Collaborators: Mareli Claassens, Helen Ayles, Peter Godfrey-Fausset, Nulda Beyers