Gender and tuberculosis: cross-site analysis and implications of a multi-country study in Bangladesh India Malawi and Colombia.

Although more men than women are diagnosed with pulmonary tuberculosis (TB) more than half a million women die each year from this disease. The higher proportion of male cases consistently reported by TB programmes may accurately reflect a greater prevalence among men or it may be an artifact of persisting geographic socioeconomic cultural and health service-related barriers that disproportionately affect timely diagnosis and treatment in women. Despite notable achievements in expanding and implementing directly-observed treatment short course (DOTS) programmes over the past decade evidence indicates that gender-related barriers and questions about their magnitude and nature persist. Gender differentials can occur at different levels of TB control as they affect patients ability to access appropriate care undergo examination submit sputum for microscopic testing and to initiate and complete treatment. The possible influence of gender on TB and TB control needs to be considered. The WHO/TDR-sponsored research presented in this report addressed practical questions about the role of gender in TB and TB control in four low- to middle-income countries of Asia (Bangladesh and India) Africa (Malawi) and South America (Colombia). (authors)