Gender difference in delays to diagnosis and health care seeking behaviour in a rural area of Nepal.
METHODS
Directly observed treatment for tuberculosis using a short-course regimen (DOTS) was introduced in a rural area of Nepal. All new patients assigned to DOTS from mid-December 1997 to mid-June 1999 were eligible for the study.


OBJECTIVE
To examine delays in tuberculosis (TB) diagnosis and compare health care seeking behaviour between men and women.


METHODS
A cross-sectional analysis of patient interviews.


RESULTS
Women were found to have a significantly longer total delay before diagnosis of tuberculosis (median 2.3 months for men, 3.3 months for women). When they visited traditional healers first, women had a significantly longer delay than men from the first visit to health care providers to diagnosis (median 1.5 months for men, 3.0 months for women). More women (35%) visited traditional healers before diagnosis than men (18%), and were more likely to receive more complicated charms from traditional healers. Men tended to visit the government medical establishment first if they knew that free TB treatment was available, but women did not.


CONCLUSIONS
Women were more likely to visit and to believe in traditional healers; this might lead to the longer delays experienced before TB diagnosis.
Department of Preventive Medicine, Kyoto Prefectural University of Medicine, Japan. YQW06170@nifty.com
M
M
Yamasaki-Nakagawa
K
K
Ozasa
N
N
Yamada
K
K
Osuga
A
A
Shimouchi
N
N
Ishikawa
D S
DS
Bam
T
T
Mori
D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000008:administration & dosage; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D004334:Drug Administration Schedule; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D008519:Medicine, Traditional; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D010342:Patient Acceptance of Health Care; D012424:Rural Population; D012737:Sex Factors; D018709:Statistics, Nonparametric; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*
D000995:Antitubercular Agents