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Health Policy and Planning 2007 22(5):329-334; doi:10.1093/heapol/czm026
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Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2007; all rights reserved.

Gender differences in delays in diagnosis and treatment of tuberculosis

Fazlul Karim1,3,*, Md. Akramul Islam2, AMR Chowdhury1, Eva Johansson3 and Vinod K Diwan3

1Research and Evaluation Division, BRAC, Dhaka, Bangladesh.
2BRAC Health Programme, BRAC, Dhaka, Bangladesh.
3Dept of Public Health Sciences, Division of International Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.

*Corresponding author. Division of International Health (IHCAR), Dept of Public Health Sciences, Nobels väg 9, SE-171 77 Stockholm, Sweden. Fax: +46 831 1590. E-mail: f_karim124{at}yahoo.com; karim.f{at}Brac.net

Objective To assess the gender variations in delay from symptom onset to help seeking, diagnosis and treatment of tuberculosis (TB) using DOTS at community level, in 10 subdistricts of Bangladesh with 2.5 million people under a non-governmental organization's (Building Resources Across Communities, or BRAC) DOTS programme for TB control.

Design A cross-sectional survey of 1000 newly diagnosed pulmonary TB patients (500 women and 500 men).

Findings Women, in comparison with men, had significantly longer mean and median delays in total delay (63.2 and 61.0 days vs. 60.3 and 53 days, respectively), total diagnostic delay (61.2, 60.0 vs. 58.5, 52.0 days), patient's delay (51.9, 50.0 vs. 48.7, 42.0 days) and treatment delay (2.0, 1.0 vs. 1.9, 1.0 day). Patient's mean and median delays were longer than the health system delay. However, patient gender showed strong association with total delay, total diagnostic delay and patient's delay. Older age of women was significantly associated with longer patient and treatment delay categories, respectively.

Conclusion Compared with men, women experienced longer delays at various stages of the clinical process of help seeking for TB. This warrants appropriate measures to improve the situation.

Key Words: Delay, gender, DOTS, tuberculosis, service provider, Bangladesh

Accepted for publication 1 May 2007.


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