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Free Content Tuberculosis may be underestimated in Rwandan women

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BACKGROUND AND HYPOTHESIS: The majority of adult tuberculosis (TB) cases reported to the surveillance system in Rwanda are male. If this results from detection mechanisms that are less sensitive to TB in women, notified cases should be more severe in women than in men.

METHODS: We analysed the 2006 series of TB cases among persons aged ≥15 years in Huye District and Kigali. Severe TB was defined as disease leading to death, or extra-pulmonary or disseminated TB.

RESULTS: Of 1673 cases identified, 40% involved women, who were younger than men (65% vs. 54% aged <35 years). Overall severity was similar in both sexes. Considering age <35 years, women were at higher risk of severe TB than men, although the difference was not statistically significant. Smear-negative pulmonary TB (SNPTB), and human immunodeficiency virus (HIV) infection were more frequent in women than in men (59% vs. 42%, P < 0.001). For women with smear-positive pulmonary TB (SPPTB), the risk of death was twice that among men (adjusted hazard ratio 1.8; 95%CI 1.0–3.2).

CONCLUSIONS: Among female TB patients, the higher risk of death with SPPTB, the higher frequency of SNPTB and the higher prevalence of HIV infection suggest that the passive system of case detection may underestimate the burden of TB in Rwandan women.
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Keywords: Rwanda; severity; sex; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Tuberculosis Unit, Centre for Treatment and Research on AIDS, Malaria, Tuberculosis and Other Epidemics (TRAC Plus), Kigali, Rwanda 2: Laval University, Faculty of Medicine, Department of Social and Preventive Medicine, Québec, Québec, Canada; and Institut National de Santé Publique du Québec, Québec, Québec, Canada 3: McGill University, Faculty of Medicine, Respiratory Division and Respiratory Epidemiology and Clinical Research Unit, Montreal, Québec, Canada

Publication date: June 1, 2011

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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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