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Free Content Sex disparities in tuberculosis suspect evaluation: a cross-sectional analysis in rural Uganda

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SETTING: Six primary health care centers in rural Uganda.

OBJECTIVE: To compare the quality of tuberculosis (TB) evaluation for men and women presenting to primary health care facilities in high-burden settings.

DESIGN: Cross-sectional study using indicators derived from the International Standards of Tuberculosis Care (ISTC) to compare the quality of TB evaluation services provided to men and women.

RESULTS: Of 161 230 patient visits between January 2009 and December 2010, 112 329 (69.7%) were women. We considered 3308 (2.1%) patients with cough ≥2 weeks as TB suspects, of whom 1871 (56.6%) were women. Female TB suspects were less likely to be referred for sputum smear examination (45.9% vs. 61.6%, P < 0.001), to complete sputum smear examination if referred (73.7% vs. 78.3%, P = 0.024) and to receive comprehensive evaluation and care as defined by the ISTC (33.0% vs. 45.6%, P < 0.001). After adjusting for age, clinic site and visit date, women remained less likely to be referred for sputum smear examination (risk ratio [RR] 0.81, 95%CI 0.74–0.89, P < 0.001) and to receive ISTC-recommended care (RR 0.79, 95%CI 0.72–0.86, P < 0.001).

CONCLUSION: Strategies to ensure that women receive appropriate TB evaluation could provide a valuable opportunity for increasing case detection while also promoting equitable and universal access to care.
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Keywords: TB diagnostics; access; equity; operational research; women

Document Type: Research Article

Affiliations: 1: Division of Pulmonary and Critical Care Medicine, Department of Medicine, San Francisco General Hospital, San Francisco, California, USA 2: Division of Pulmonary and Critical Care Medicine, and Curry International Tuberculosis Center, Department of Medicine, San Francisco General Hospital, San Francisco, California, USA; School of Medicine, University of California San Francisco, San Francisco, California, USA; and Makerere University–University of California San Francisco Research Collaboration, Kampala, Uganda 3: Makerere University–University of California San Francisco Research Collaboration, Kampala, Uganda; National Tuberculosis and Leprosy Control Programme, Uganda Ministry of Health, Kampala, Uganda; and Department of Medicine, Mulago Hospital, Makerere University, Kampala, Uganda 4: Makerere University–University of California San Francisco Research Collaboration, Kampala, Uganda

Publication date: 2013-04-01

More about this publication?
  • 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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