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Free Content A gender-focused qualitative study of barriers to accessing tuberculosis treatment in The Gambia, West Africa

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SETTING: The Medical Research Council unit in Fajara, The Gambia.

OBJECTIVE: To explore gender differences in care seeking behaviour, access to treatment, and knowledge and perceptions about tuberculosis.

DESIGN: Fifteen government health workers were interviewed to define the scope of the issues involved, then 15 male and 15 female tuberculosis patients were interviewed. Qualitative semi-structured questionnaires were used in health worker and patient interviews. Data were analysed using the thematic framework method. The main themes were compared between male and female patients.

RESULTS: Patients often initially consulted traditional healers and pharmacies. Women used traditional healers more, probably because of stronger traditional beliefs, time constraints and increased confidentiality. Regardless of sex, most patients acknowledged problems affording the transport costs to access treatment. Health workers and patients highlighted negative perceptions of tuberculosis. Lack of knowledge about tuberculosis and stigma were widely reported, and were worst in female patients.

CONCLUSIONS: Tuberculosis is a stigmatised disease in The Gambia, particularly in women, and its management is associated with access problems. Health education is required to provide basic knowledge about the disease and to reduce stigma, and further decentralisation of tuberculosis services is needed to improve access.
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Keywords: The Gambia; access; diagnostic delay; gender; stigma; traditional healers; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Department of Medicine, University of Birmingham, Birmingham, United Kingdom 2: Department of Tuberculosis, Medical Research Council Labs, Banjul, Western Division, The Gambia

Publication date: 2004-01-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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