Cultural epidemiology of TB with reference to gender in Bangladesh, India and Malawi.

Weiss, M.G.; Somma, D.; Karim, F.; Abouihia, A.; Auer, C.; Kemp, J.; Jawahar, M.S .

International Journal of Tuberculosis and Lung Disease; 2008; 12; 837–847.

Setting: TB control programmes in Bangladesh, India and Malawi.

Objective: To identify and compare socio-cultural features of tuberculosis (TB) and the distribution of TB-related experiences, meanings and behaviours with reference to gender across cultures in three high-endemic low-income countries.

Design: Approximately 100 patients at three sites were interviewed with in-depth semi-structured Explanatory Model Interview Catalogue (EMIC) interviews inquiring about patterns of distress, perceived causes and help-seeking behaviours in the context of illness narratives.

Results: Female patients reported more diverse symp­toms and men more frequently focused on financial con­cerns. Most patients reported psychological and emo­tional distress. Men emphasised smoking and drinking alcohol as causes of TB, and women in Malawi reported sexual causes associated with HIV/AIDS. In Bangladesh, exaggerated concerns about the risk of spread despite treatment contributed to social isolation of women. Pub­lic health services were preferred in Malawi, and private doctors in India and Bangladesh.

Conclusion: Cross-site analysis of these studies has ide n tified features of TB that influence the burden of dis­ease and are likely to affect timely help seeking and ad­herence to treatment. Health systems benefit from sex-disaggregated epidemiological data complemented by cultural epidemiological study, which together clarify the role of gender and contribute to the knowledge base for TB control at various levels.

Keywords: tuberculosis; gender; cultural epidemiol­ogy; TB control; DOTS treatment

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