Cultural epidemiology of TB with reference to gender in Bangladesh, India and Malawi.
METHODS
TB control programmes in Bangladesh, India and Malawi.


OBJECTIVE
To identify and compare socio-cultural features of tuberculosis (TB) and the distribution of TB-related experiences, meanings and behaviours with reference to gender across cultures in three high-endemic low-income countries.


METHODS
Approximately 100 patients at three sites were interviewed with in-depth semi-structured Explanatory Model Interview Catalogue (EMIC) interviews inquiring about patterns of distress, perceived causes and help-seeking behaviours in the context of illness narratives.


RESULTS
Female patients reported more diverse symptoms and men more frequently focused on financial concerns. Most patients reported psychological and emotional distress. Men emphasised smoking and drinking alcohol as causes of TB, and women in Malawi reported sexual causes associated with HIV/AIDS. In Bangladesh, exaggerated concerns about the risk of spread despite treatment contributed to social isolation of women. Public health services were preferred in Malawi, and private doctors in India and Bangladesh.


CONCLUSIONS
Cross-site analysis of these studies has identified features of TB that influence the burden of disease and are likely to affect timely help seeking and adherence to treatment. Health systems benefit from sex-disaggregated epidemiological data complemented by cultural epidemiological study, which together clarify the role of gender and contribute to the knowledge base for TB control at various levels.
Department of Public Health and Epidemiology, Swiss Tropical Institute, Basel, Switzerland. mitchell-g.weiss@unibas.ch
M G
MG
Weiss
D
D
Somma
F
F
Karim
A
A
Abouihia
C
C
Auer
J
J
Kemp
M S
MS
Jawahar
D001459:Bangladesh / Q000453:epidemiology; D003140:Communicable Disease Control; D003469:Culture; D019353:Endemic Diseases / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008295:Malawi / Q000453:epidemiology; D008297:Male; D010342:Patient Acceptance of Health Care; D011203:Poverty; D012737:Sex Factors; D012934:Social Isolation; D012940:Social Problems; D014376:Tuberculosis / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology* / Q000523:psychology