Tuberculosis and gender: exploring the patterns in a case control study in Malawi.
BACKGROUND
In many populations there is an excess of tuberculosis in young women and older men. We explored possible explanations for these patterns, concentrating on human immunodeficiency virus (HIV) status, pregnancy, smoking, cooking smoke exposure, contact with tuberculosis cases within the household or outside, and gender differences in health service usage and diagnostic delay.


METHODS
Case control study in Karonga District, Malawi.


METHODS
Cases were new tuberculosis patients with bacteriological or histological evidence of tuberculosis. Controls were selected in the community using field-based random sampling.


RESULTS
The study included 598 tuberculosis cases and 992 controls, with an excess of tuberculosis in young females and older males. This was more marked in HIV-positive individuals. HIV infection was a similarly strong risk factor for tuberculosis in both men and women. Tuberculosis was associated with having a family or household contact with tuberculosis for both men and women. For women, but not men, contacts outside the close family and household were also a risk factor for tuberculosis. Tuberculosis was not associated with current or recent pregnancy, or with smoking or smoke exposure. There were no differences between men and women in health service usage or delay.


CONCLUSIONS
In this population, HIV infection and contacts with known tuberculosis patients are important determinants of the gender distribution of cases.
Crampin
A C
AC
Karonga Prevention Study, Chilumba, Malawi.
Glynn
J R
JR
Floyd
S
S
Malema
S S
SS
Mwinuka
V K
VK
Ngwira
B M M
BM
Mwaungulu
F D
FD
Warndorff
D K
DK
Fine
P E M
PE
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D016022:Case-Control Studies; D003296:Cooking; D005260:Female; D015658:HIV Infections / Q000150:complications; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D012307:Risk Factors; D012737:Sex Factors; D012906:Smoke / Q000009:adverse effects; D012907:Smoking / Q000009:adverse effects; D012959:Socioeconomic Factors; D013997:Time Factors; D014376:Tuberculosis / Q000453:epidemiology* / Q000635:transmission
D012906:Smoke