Gender-Related Barriers and Delays in Accessing Tuberculosis Diagnostic and Treatment Services: A Systematic Review of Qualitative Studies

Abstract

Background. Tuberculosis (TB) remains a significant global public health problem with known gender-related (male versus female) disparities. We reviewed the qualitative evidence (written/spoken narrative) for gender-related differences limiting TB service access from symptom onset to treatment initiation. Methods. Following a systematic process, we searched 12 electronic databases, included qualitative studies that assessed gender differences in accessing TB diagnostic and treatment services, abstracted data, and assessed study validity. Using a modified “inductive coding” system, we synthesized emergent themes within defined barriers and delays limiting access at the individual and provider/system levels and examined gender-related differences. Results. Among 13,448 studies, 28 studies were included. All were conducted in developing countries and assessed individual-level barriers; 11 (39%) assessed provider/system-level barriers, 18 (64%) surveyed persons with suspected or diagnosed TB, and 7 (25%) exclusively surveyed randomly sampled community members or health care workers. Each barrier affected both genders but had gender-variable nature and impact reflecting sociodemographic themes. Women experienced financial and physical dependence, lower general literacy, and household stigma, whereas men faced work-related financial and physical barriers and community-based stigma. Conclusions. In developing countries, barriers limiting access to TB care have context-specific gender-related differences that can inform integrated interventions to optimize TB services.

Delay in Tuberculosis Diagnosis among Tuberculosis Patients at the Three Hospitals: Asella, Robe and Abomsa of Arsi Zone, Oromia Regional State, March, 2015

“…Different studies used different definitions of delay. Delay was defined as any time period from the onset of symptoms to presentation, to diagnosis, to treatment initiation; or from presentation to diagnosis or treatment initiation; or else from diagnosis to treatment initiation based on their objective of study [14]. Almost all studies reviewed used "patient delay" contextually as the time interval between the onset of major symptoms of TB to the first presentation to formal health care facility [2] [5] [7] [8] [15]- [18].…”

Implementation of the Active TB Case Finding in Nigeria; Processes, Lessons Learnt and Recommendations

“…The passive approach therefore becomes less effective in such settings because of limited access to TB services as a result of poor treatment coverage. Also, poor health seeking behavior has been identified as a barrier to accessing TB services and this is further escalated by stigma and poor attitude of health workers [17] [18] [19]. These limitations that are often found in low resource settings translate to the inadequacy of the passive case finding approaches to curb the spread of TB particularly in crowded urban populations commonly referred to as slums.…”

TB: Barrier in access, diagnosis and treatment completion

“…Even though females nutrition and health is considered not as important as males and family feels reluctant to invest in their health the awareness regarding the disease is found more in females as they are the ones who primarily assists children and elderly to the health facilities so they directly receive the information about the disease [6]. Females are afraid of being stigmatized and isolated, they fear of not get married and can have possible negative impacts in their present relationship and social status that's the possible reason for women to not access the health facility [7].…”