Barriers and Delays in Tuberculosis Diagnosis and Treatment Services: Does Gender Matter?

Abstract

Background. Tuberculosis (TB) remains a global public health problem with known gender-related disparities. We reviewed the quantitative evidence for gender-related differences in accessing TB services from symptom onset to treatment initiation. Methods. Following a systematic review process, we: searched 12 electronic databases; included quantitative studies assessing gender differences in accessing TB diagnostic and treatment services; abstracted data; and assessed study validity. We defined barriers and delays at the individual and provider/system levels using a conceptual framework of the TB care continuum and examined gender-related differences. Results. Among 13,448 articles, 137 were included: many assessed individual-level barriers (52%) and delays (42%), 76% surveyed persons presenting for care with diagnosed or suspected TB, 24% surveyed community members, and two-thirds were from African and Asian regions. Many studies reported no gender differences. Among studies reporting disparities, women faced greater barriers (financial: 64% versus 36%; physical: 100% versus 0%; stigma: 85% versus 15%; health literacy: 67% versus 33%; and provider-/system-level: 100% versus 0%) and longer delays (presentation to diagnosis: 45% versus 0%) than men. Conclusions. Many studies found no quantitative gender-related differences in barriers and delays limiting access to TB services. When differences were identified, women experienced greater barriers and longer delays than men.

Delays and Pathways to Final Tuberculosis Diagnosis in Patients from a Referral Hospital in Urban China

“…25 Stigma among women of TB has been one proposed source of these gender discrepancies. 9,26,27 In some settings, women with TB are more likely to conceal their disease, 28,29 are at risk for social and community isolation, 28,30 or are not screened for TB by health-care professionals despite having TB symptoms. 31 Causes for these gender differences, specifically in Nanjing, China, should be further investigated through qualitative studies.…”

Complex relation among Health Belief Model components in TB prevention and care

“…In this study, the influence of gender on other correlative factors has not been found, and it is almost same with Yang's review on quantitative studies assessing gender differences in accessing TB diagnostic and treatment services. 23 What is more, health insurance and awareness of policy have positive impact on active health seeking behavior, which shows that medical security and less/free policy have significant meaning to TB prevention and cure. Li's study on delay of initial health-seeking in new pulmonary tuberculosis cases among migrants population in East China concluded that interventions to improve health seeking behavior among the migrant population in China must focus on strengthening their labor, medical security and health education.…”

Searching for sex- and gender-sensitive tuberculosis research in public health: finding a needle in a haystack

“…However, the scope note associated with this descriptor is “Care that is sensitive to sex-specific needs. General only; consider also MEN’S HEALTH and WOMEN’S HEALTH”,36 further demonstrating the lack of clear differentiation between sex and gender.…”

“…Stigma is often gendered with blame and shame apportioned to women and can result in isolation and psychosocial consequences for women which, in turn, affect access to care and health outcomes 20,24. Although the gendered social consequences of TB are, therefore, context specific, they compound, exacerbating each other, resulting in individuals experiencing different forms of delay (access and referrals) to complete lack of access to medical care 22,36…”

“…For example, the CINAHL Headings scope note for the descriptor (Subject label, abbreviated MH) “Sex Factors” reads: “Use when gender is discussed as a factor in relation to some specific subject or problem, usually a statistical concept.”39 The intent of distinguishing sex from gender is lost in this case when gender is absorbed into a sex-related statistical concept. This is contrary to the scope note of the descriptor (MH “Sex Role”), which validates the socially constructed understanding of gender by stating: “The behavior and appearance that one presents in terms of what the culture considers to be masculine or feminine.”36 The gender-related term (MH “Gender Identity”) is clearly differentiated from sex-related terms being defined as: Those aspects of appearance and behavior which are attributed to masculinity or femininity and determined by cultural and familial factors to which the individual is exposed. Differentiate from biologically determined sex characteristics 39…”