Gender and literacy: factors related to diagnostic delay and unsuccessful treatment of tuberculosis in the mountainous area of Yemen.
METHODS
People in the mountainous area of Yemen, having maintained their traditional lifestyle, generally believe that uneducated women are unsuccessful in using modern medical care. Whether this belief applies to tuberculosis (TB) diagnosis and treatment has not been researched in Yemen.


OBJECTIVE
To examine how gender and literacy influence TB diagnosis and treatment.


METHODS
Individual interviews and data collection were conducted for 74 smear-positive pulmonary TB patients visiting the National Tuberculosis Institute in Sana'a from December 2001 to March 2002. The treatment outcome for each patient was checked from September 2002 to March 2003.


RESULTS
Illiterate patients had a longer diagnostic delay than literate patients (P = 0.006, univariate logistic regression analysis). They also maintained their traditional view of illness, not the illness 'TB'. More females than males completed treatment (P = 0.046, univariate logistic regression analysis). Supervision by male relatives contributed to completion of treatment among female patients.


CONCLUSIONS
Lack of education does not hinder women from receiving TB diagnosis and treatment. The concept of traditional illness, however, causes a longer diagnostic delay among illiterate patients, and the role of male relatives positively influences treatment outcomes for female patients.
Date
J
J
Department of Medical Humanities, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan. jane@olive.freemail.ne.jp
Okita
K
K
D003469:Culture; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care; D019035:Rural Health Services; D012737:Sex Factors; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control*; D015006:Yemen