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Health care workers' gender bias in testing could contribute to missed tuberculosis among women in South Africa

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SETTING: Eight communities with high tuberculosis (TB) prevalence, Western Cape, South Africa.

OBJECTIVE: To identify sex differences in TB health-seeking behaviour and diagnosis in primary health care facilities and how this influences TB diagnosis.

DESIGN: We used data from a prevalence survey among 30,017 adults conducted in 2010 as part of the Zambia, South Africa Tuberculosis and AIDS Reduction (ZAMSTAR) trial.

RESULTS: A total of 1670 (5.4%) adults indicated they had a cough of 2 weeks, 950 (56.9%) of whom were women. Women were less likely to report a cough of 2 weeks (5.1% vs. 6.4%, P < 0.001), but were more likely to seek care for their cough (32.6% vs. 26.9%, P = 0.012). Of all adults who sought care, 403 (80.0%) sought care for their cough at a primary health care (PHC) facility (79.0% women vs. 81.4% men, P = 0.511). Women were less likely to be asked for a sputum sample at the PHC facility (63.3% vs. 77.2%, P = 0.003) and less likely to have a positive sputum result (12.6% vs. 20.7%, P = 0.023).

CONCLUSION: The attainment of sex equity in the provision of TB health services requires adherence to testing protocols. Everyone, irrespective of sex, who seeks care for a cough of 2 weeks should be tested.

Keywords: gender; health seeking; screening; tuberculosis

Document Type: Research Article

Affiliations: 1: Department of Economics, Stellenbosch University, Private Bag X1, Matieland 7602, Stellenbosch, South Africa. [email protected] 2: Department of Economics, Stellenbosch University, Stellenbosch, South Africa 3: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa 4: Zambia AIDS Related Tuberculosis Project, Lusaka, Zambia; Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK 5: Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK

Publication date: March 1, 2016

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