Tuberculosis and Gender:

Treatment Seeking Behaviors and Social Beliefs of Women with Tuberculosis in Rural Bangladesh

Elizabeth Fair, Dr. Sadia Chowdhury, Md. Akramul Islam
Bangladesh Rural Advancement Committee (BRAC)

Abstract --

In Bangladesh, a country of 122 million people, there are an estimated 150,000 new cases and 80,000 deaths from TB every year with a 2% annual risk of infection. The national TB records of BRAC and the government program suggest that only approximately 30% of TB patients being reported and receiving treatment are women. Prevalence and detection rates are lower for women, although among children below fifteen years of age the case detection and incidence rates are similar between the sexes. To explore reasons for why less women are being treated for tuberculosis, a study area was chosen where the BRAC TB Control Program has been in place since 1992, and data from 1995 and 1996 was analyzed with a focus on the age and gender distribution of TB patients. Next, six single-sexed focus group discussions were conducted with female TB patients, community members, and local health providers to get a sense of their perceptions of TB and treatment seeking behavior of women. Findings from the data analysis demonstrated that the chosen area was representative of the national TB statistics and the findings from focus group discussions showed that strong stigmas persist in the community including an openly stated fear and avoidance of TB patients. The implications of these stigmas and social beliefs are more severe for women and have a powerful impact on female treatment seeking behavior. Women tend to hide or ignore symptoms for fear the community or their family might find out - in general, married women fear they would be rejected by their husband and sent back to their father's home, while unmarried women fear that contracting TB would ruin their chance of marriage and bring shame to their family. The majority of participants believe that TB is hereditary and an infected woman will pass it on to her children. Participants agreed that women feel most comfortable going to locally based village doctors or traditional healers for health problems because they are familiar, accessible, and less costly. These findings highlight the crucial need to begin breaking down the persisting stigmas and myths of TB. There is a pressing need to initiate a collaboration with the village doctors and traditional healers in TB control efforts. Health providers should be made aware of these gender issues and receive training in assisting the patients with the social consequences of the illness in addition to the medical treatment for the disease.