Tuberculosis (TB)

Tuberculosis and gender

TB among women

In most of the world, more men than women are diagnosed with TB and die from it. TB is nevertheless a leading infectious cause of death among women. Annually, about 700 000 women die of TB, and over three million contract the disease, accounting for about 17 million Disability Adjusted Life Years (DALY). As tuberculosis affects women mainly in their economically and reproductively active years, the impact of the disease is also strongly felt by their children and families. The mortality, incidence, and DALY indicators do not reflect this hidden burden of social impact.

What is gender?

The term gender encompasses features of males and females that are socially constructed, distinct from those features that are biologically determined (sex-linked). Higher tuberculosis notification rates in men may partly reflect epidemiological differences - differences in exposure, risk of infection, and progression from infection to disease. Some studies indicate that women may have higher rates of progression from infection to disease and a higher case fatality in their early reproductive ages.

The strategy

Gender-related barriers to TB care may vary greatly in diverse settings. Based on a literature review and field visits [1], TBS proposed the following strategy to systematically study the issue of gender differentials in TB:

  • Re-examine age and sex-disaggregated data from past surveys and data maintained by TB programmes to clarify the magnitude and nature of gender disparities. Undertake new epidemiological surveys to establish a "gold standard" of sex-ratios.
  • Develop a generic protocol incorporating appropriate epidemiological and social science methods to identify barriers and to confront gender-related problems of access to and care within TB programmes.
  • Adapt the protocol for comparative study in multiple and diverse settings with a functioning TB programme, willing programme staff, and local research capacity. Opportunities for comparison in diverse social and cultural settings will clarify the context and variability of gender-related barriers, and indicate practical solutions.
  • Pilot proposed interventions for gender-sensitive TB control, and compare experiences in different settings.
  • Develop guidelines and tools for TB programmes to help minimise any gender disparities.

Activities

Age and Sex related data are routinely collected from the National TB Programmes and presented in the annual Global TB Control report of the Stop TB Department. The Tuberculosis Strategy and Operations (TBS) team collaborates with TDR (UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases) and WHO's Department of Gender and Women's Health. In a workshop organized by TDR, generic protocols to study gender differentials in TB control were developed. TDR then supported projects in India, Bangladesh, Malawi and Colombia which adapted and implement the generic protocols. Analysis and pooling of results from these diverse settings has been undertaken and a draft report is currently under preparation. This report will be a useful addition to the knowledge-base and may help national TB programmes to address gender-related concerns. TBS is also assisting the Department of Gender and Women's Health in preparing a "Resource Tool" to help study and identify interventions to tackle gender issues in TB control.

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