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Free Content Cultural epidemiology of TB with reference to gender in Bangladesh, India and Malawi [Special section on gender and TB]

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SETTING: TB control programmes in Bangladesh, India and Malawi.

OBJECTIVE: To identify and compare socio-cultural features of tuberculosis (TB) and the distribution of TB-related experiences, meanings and behaviours with reference to gender across cultures in three high-endemic low-income countries.

DESIGN: Approximately 100 patients at three sites were interviewed with in-depth semi-structured Explanatory Model Interview Catalogue (EMIC) interviews inquiring about patterns of distress, perceived causes and help-seeking behaviours in the context of illness narratives.

RESULTS: Female patients reported more diverse symptoms and men more frequently focused on financial concerns. Most patients reported psychological and emotional distress. Men emphasised smoking and drinking alcohol as causes of TB, and women in Malawi reported sexual causes associated with HIV/AIDS. In Bangladesh, exaggerated concerns about the risk of spread despite treatment contributed to social isolation of women. Public health services were preferred in Malawi, and private doctors in India and Bangladesh.

CONCLUSION: Cross-site analysis of these studies has identified features of TB that influence the burden of disease and are likely to affect timely help seeking and adherence to treatment. Health systems benefit from sex-disaggregated epidemiological data complemented by cultural epidemiological study, which together clarify the role of gender and contribute to the knowledge base for TB control at various levels.
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Keywords: DOTS treatment; TB control; cultural epidemiology; gender; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Department of Public Health and Epidemiology, Swiss Tropical Institute, Basel, Switzerland 2: Bangladesh Rural Advancement Committee (BRAC) Research and Evaluation Division, Dhaka, Bangladesh 3: Equi-TB Knowledge Programme, Liverpool School of Tropical Medicine, Liverpool, UK 4: Tuberculosis Research Centre, Chennai, India

Publication date: July 1, 2008

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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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