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Published in: BMC Public Health 1/2010

Open Access 01-12-2010 | Research article

Gender-related factors influencing tuberculosis control in shantytowns: a qualitative study

Authors: Dami A Onifade, Angela M Bayer, Rosario Montoya, Marie Haro, Jessica Alva, Jessica Franco, Rosario Sosa, Betty Valiente, Enit Valera, Carolyn M Ford, Colleen D Acosta, Carlton A Evans

Published in: BMC Public Health | Issue 1/2010

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Abstract

Background

There is evidence that female gender is associated with reduced likelihood of tuberculosis diagnosis and successful treatment. This study aimed to characterize gender-related barriers to tuberculosis control in Peruvian shantytowns.

Methods

We investigated attitudes and experiences relating gender to tuberculosis using the grounded theory approach to describe beliefs amongst key tuberculosis control stakeholders. These issues were explored in 22 semi-structured interviews and in four focus group discussions with 26 tuberculosis patients and 17 healthcare workers.

Results

We found that the tuberculosis program was perceived not to be gender discriminatory and provided equal tuberculosis diagnostic and treatment care to men and women. This contrasted with stereotypical gender roles in the broader community context and a commonly expressed belief amongst patients and healthcare workers that female health inherently has a lower priority than male health. This belief was principally associated with men's predominant role in the household economy and limited employment for women in this setting. Women were also generally reported to experience the adverse psychosocial and economic consequences of tuberculosis diagnosis more than men.

Conclusions

There was a common perception that women's tuberculosis care was of secondary importance to that of men. This reflected societal gender values and occurred despite apparent gender equality in care provision. The greatest opportunities for improving women's access to tuberculosis care appear to be in improving social, political and economic structures, more than tuberculosis program modification.
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Literature
1.
go back to reference Dye C, Scheele S, Dolin P, Vikram P, Raviglione MC: Global Burden of Tuberculosis. Estimated incidence, prevalence and mortality by country. World Health Organisation Global Surveillance and Monitoring Project. 1999 Dye C, Scheele S, Dolin P, Vikram P, Raviglione MC: Global Burden of Tuberculosis. Estimated incidence, prevalence and mortality by country. World Health Organisation Global Surveillance and Monitoring Project. 1999
2.
go back to reference World Health Organization: Global tuberculosis control - epidemiology, startegy and financing. WHO Report. 2009 World Health Organization: Global tuberculosis control - epidemiology, startegy and financing. WHO Report. 2009
3.
go back to reference World Health Organization: The Stop Tuberculosis Initiative Country Profile. 2000 World Health Organization: The Stop Tuberculosis Initiative Country Profile. 2000
4.
go back to reference World Health Organization: Global tuberculosis control: surveillance, planning financing. 2008, Geneva: World Health Organization World Health Organization: Global tuberculosis control: surveillance, planning financing. 2008, Geneva: World Health Organization
5.
go back to reference World Health Organization: The WHO/IUATLD Global Project on Anti-tuberculosis Drug Resistance Surveillance 2002-2007. Anti-tuberculosis drug resistance in the world. Report No. 4. 2008 World Health Organization: The WHO/IUATLD Global Project on Anti-tuberculosis Drug Resistance Surveillance 2002-2007. Anti-tuberculosis drug resistance in the world. Report No. 4. 2008
6.
go back to reference Diwan VK, Thorson A: Sex, gender, and tuberculosis. Lancet. 1999, 353 (9157): 1000-1001. 10.1016/S0140-6736(99)01318-5.CrossRefPubMed Diwan VK, Thorson A: Sex, gender, and tuberculosis. Lancet. 1999, 353 (9157): 1000-1001. 10.1016/S0140-6736(99)01318-5.CrossRefPubMed
7.
go back to reference Johansson E, Long NH, Diwan VK, Winkvist A: Gender and tuberculosis control: perspectives on health seeking behaviour among men and women in Vietnam. Health Policy. 2000, 52 (1): 33-51. 10.1016/S0168-8510(00)00062-2.CrossRefPubMed Johansson E, Long NH, Diwan VK, Winkvist A: Gender and tuberculosis control: perspectives on health seeking behaviour among men and women in Vietnam. Health Policy. 2000, 52 (1): 33-51. 10.1016/S0168-8510(00)00062-2.CrossRefPubMed
8.
go back to reference Bothamley G: Sex and Gender in the pathogenesis of Infectious Tuberculosis: A perspective from Immunology Microbiology and Human Genetics. Gender and Tuberculosis. Winkvist A NHV report 1998. Edited by: Diwan V, Thorson A. 1998, 3- Bothamley G: Sex and Gender in the pathogenesis of Infectious Tuberculosis: A perspective from Immunology Microbiology and Human Genetics. Gender and Tuberculosis. Winkvist A NHV report 1998. Edited by: Diwan V, Thorson A. 1998, 3-
9.
go back to reference Kurasawa T: [Tuberculin skin test of patients with active pulmonary tuberculosis and non-tuberculous pulmonary diseases]. Kekkaku. 1990, 65 (1): 47-52.PubMed Kurasawa T: [Tuberculin skin test of patients with active pulmonary tuberculosis and non-tuberculous pulmonary diseases]. Kekkaku. 1990, 65 (1): 47-52.PubMed
10.
go back to reference Shaaban MA, Abdul Ati M, Bahr GM, Standford JL, Lockwood DN, McManus IC: Revaccination with BCG: its effects on skin tests in Kuwaiti senior school children. Eur Respir J. 1990, 3 (2): 187-191.PubMed Shaaban MA, Abdul Ati M, Bahr GM, Standford JL, Lockwood DN, McManus IC: Revaccination with BCG: its effects on skin tests in Kuwaiti senior school children. Eur Respir J. 1990, 3 (2): 187-191.PubMed
11.
go back to reference Cassels A, Heineman E, LeClerq S, Gurung PK, Rahut CB: Tuberculosis case-finding in Eastern Nepal. Tubercle. 1982, 63 (3): 175-185. 10.1016/S0041-3879(82)80028-7.CrossRefPubMed Cassels A, Heineman E, LeClerq S, Gurung PK, Rahut CB: Tuberculosis case-finding in Eastern Nepal. Tubercle. 1982, 63 (3): 175-185. 10.1016/S0041-3879(82)80028-7.CrossRefPubMed
12.
go back to reference Thorson A, Hoa NP, Long NH, Allebeck P, Diwan VK: Do women with tuberculosis have a lower likelihood of getting diagnosed? Prevalence and case detection of sputum smear positive pulmonary TB, a population-based study from Vietnam. J Clin Epidemiol. 2004, 57 (4): 398-402. 10.1016/j.jclinepi.2002.11.001.CrossRefPubMed Thorson A, Hoa NP, Long NH, Allebeck P, Diwan VK: Do women with tuberculosis have a lower likelihood of getting diagnosed? Prevalence and case detection of sputum smear positive pulmonary TB, a population-based study from Vietnam. J Clin Epidemiol. 2004, 57 (4): 398-402. 10.1016/j.jclinepi.2002.11.001.CrossRefPubMed
13.
go back to reference Becerra MC, Pachao-Torreblanca IF, Bayona J, Celi R, Shin SS, Kim JY, Farmer PE, Murray M: Expanding tuberculosis case detection by screening household contacts. Public Health Rep. 2005, 120 (3): 271-277.PubMedPubMedCentral Becerra MC, Pachao-Torreblanca IF, Bayona J, Celi R, Shin SS, Kim JY, Farmer PE, Murray M: Expanding tuberculosis case detection by screening household contacts. Public Health Rep. 2005, 120 (3): 271-277.PubMedPubMedCentral
14.
go back to reference Atre SR, Kudale AM, Morankar SN, Rangan SG, Weiss MG: Cultural concepts of tuberculosis and gender among the general population without tuberculosis in rural Maharashtra, India. Trop Med Int Health. 2004, 9 (11): 1228-1238. 10.1111/j.1365-3156.2004.01321.x.CrossRefPubMed Atre SR, Kudale AM, Morankar SN, Rangan SG, Weiss MG: Cultural concepts of tuberculosis and gender among the general population without tuberculosis in rural Maharashtra, India. Trop Med Int Health. 2004, 9 (11): 1228-1238. 10.1111/j.1365-3156.2004.01321.x.CrossRefPubMed
15.
go back to reference Bryman A: Social Research Methods. 2001, Oxford University Press Bryman A: Social Research Methods. 2001, Oxford University Press
16.
go back to reference Glaser BG, Strauss , Anselm L: The discovery of grounded theory: strategies for qualitative research. 1967, Chicago: Aldine Glaser BG, Strauss , Anselm L: The discovery of grounded theory: strategies for qualitative research. 1967, Chicago: Aldine
17.
go back to reference Glaser BG: Theoretical sensitivity: advances in the methodology of grounded theory. 1978, Mill Valley, Ca: Sociology Press Glaser BG: Theoretical sensitivity: advances in the methodology of grounded theory. 1978, Mill Valley, Ca: Sociology Press
18.
go back to reference Bates I, Fenton C, Gruber J, Lalloo D, Lara AM, Squire SB, Theobald S, Thomson R, Tolhurst R: Vulnerability to malaria, tuberculosis, and HIV/AIDS infection and disease. Part II: Determinants operating at environmental and institutional level. Lancet Infect Dis. 2004, 4 (6): 368-375. 10.1016/S1473-3099(04)01047-3.CrossRefPubMed Bates I, Fenton C, Gruber J, Lalloo D, Lara AM, Squire SB, Theobald S, Thomson R, Tolhurst R: Vulnerability to malaria, tuberculosis, and HIV/AIDS infection and disease. Part II: Determinants operating at environmental and institutional level. Lancet Infect Dis. 2004, 4 (6): 368-375. 10.1016/S1473-3099(04)01047-3.CrossRefPubMed
19.
go back to reference Long NH, Johansson E, Diwan VK, Winkvist A: Fear and social isolation as consequences of tuberculosis in VietNam: a gender analysis. Health Policy. 2001, 58 (1): 69-81. 10.1016/S0168-8510(01)00143-9.CrossRefPubMed Long NH, Johansson E, Diwan VK, Winkvist A: Fear and social isolation as consequences of tuberculosis in VietNam: a gender analysis. Health Policy. 2001, 58 (1): 69-81. 10.1016/S0168-8510(01)00143-9.CrossRefPubMed
20.
go back to reference Melhuus MS, K A: Machos, Mistresses, Madonnas: Contesting the Power of Latin American Gender Imagery. 1996, London: Verso Melhuus MS, K A: Machos, Mistresses, Madonnas: Contesting the Power of Latin American Gender Imagery. 1996, London: Verso
21.
go back to reference Johansson E, Long NH, Diwan VK, Winkvist A: Attitudes to compliance with tuberculosis treatment among women and men in Vietnam. Int J Tuberc Lung Dis. 1999, 3 (10): 862-868.PubMed Johansson E, Long NH, Diwan VK, Winkvist A: Attitudes to compliance with tuberculosis treatment among women and men in Vietnam. Int J Tuberc Lung Dis. 1999, 3 (10): 862-868.PubMed
22.
go back to reference Ford CM, Bayer AM, Gilman RH, Onifade D, Acosta C, Cabrera L, Vidal C, Evans CA: Factors associated with delayed tuberculosis test-seeking behavior in the Peruvian Amazon. Am J Trop Med Hyg. 2009, 81 (6): 1097-1102. 10.4269/ajtmh.2009.08-0627.CrossRefPubMedPubMedCentral Ford CM, Bayer AM, Gilman RH, Onifade D, Acosta C, Cabrera L, Vidal C, Evans CA: Factors associated with delayed tuberculosis test-seeking behavior in the Peruvian Amazon. Am J Trop Med Hyg. 2009, 81 (6): 1097-1102. 10.4269/ajtmh.2009.08-0627.CrossRefPubMedPubMedCentral
23.
go back to reference Zwarenstein M, Schoeman JH, Vundule C, Lombard CJ, Tatley M: Randomised controlled trial of self-supervised and directly observed treatment of tuberculosis. Lancet. 1998, 352 (9137): 1340-1343. 10.1016/S0140-6736(98)04022-7.CrossRefPubMed Zwarenstein M, Schoeman JH, Vundule C, Lombard CJ, Tatley M: Randomised controlled trial of self-supervised and directly observed treatment of tuberculosis. Lancet. 1998, 352 (9137): 1340-1343. 10.1016/S0140-6736(98)04022-7.CrossRefPubMed
24.
go back to reference Willingham FF, Schmitz TL, Contreras M, Kalangi SE, Vivar AM, Caviedes L, Schiantarelli E, Neumann PM, Bern C, Gilman RH: Hospital control and multidrug-resistant pulmonary tuberculosis in female patients, Lima, Peru. Emerg Infect Dis. 2001, 7 (1): 123-127. 10.3201/eid0701.010117.CrossRefPubMedPubMedCentral Willingham FF, Schmitz TL, Contreras M, Kalangi SE, Vivar AM, Caviedes L, Schiantarelli E, Neumann PM, Bern C, Gilman RH: Hospital control and multidrug-resistant pulmonary tuberculosis in female patients, Lima, Peru. Emerg Infect Dis. 2001, 7 (1): 123-127. 10.3201/eid0701.010117.CrossRefPubMedPubMedCentral
Metadata
Title
Gender-related factors influencing tuberculosis control in shantytowns: a qualitative study
Authors
Dami A Onifade
Angela M Bayer
Rosario Montoya
Marie Haro
Jessica Alva
Jessica Franco
Rosario Sosa
Betty Valiente
Enit Valera
Carolyn M Ford
Colleen D Acosta
Carlton A Evans
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2010
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-10-381

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