title: Sex disparities in tuberculosis suspect evaluation: a cross-sectional analysis in rural Uganda.
abstract: METHODS
  Six primary health care centers in rural Uganda.
  
  
  OBJECTIVE
  To compare the quality of tuberculosis (TB) evaluation for men and women presenting to primary health care facilities in high-burden settings.
  
  
  METHODS
  Cross-sectional study using indicators derived from the International Standards of Tuberculosis Care (ISTC) to compare the quality of TB evaluation services provided to men and women.
  
  
  RESULTS
  Of 161 230 patient visits between January 2009 and December 2010, 112 329 (69.7%) were women. We considered 3308 (2.1%) patients with cough ≥2 weeks as TB suspects, of whom 1871 (56.6%) were women. Female TB suspects were less likely to be referred for sputum smear examination (45.9% vs. 61.6%, P < 0.001), to complete sputum smear examination if referred (73.7% vs. 78.3%, P = 0.024) and to receive comprehensive evaluation and care as defined by the ISTC (33.0% vs. 45.6%, P < 0.001). After adjusting for age, clinic site and visit date, women remained less likely to be referred for sputum smear examination (risk ratio [RR] 0.81, 95%CI 0.74-0.89, P < 0.001) and to receive ISTC-recommended care (RR 0.79, 95%CI 0.72-0.86, P < 0.001).
  
  
  CONCLUSIONS
  Strategies to ensure that women receive appropriate TB evaluation could provide a valuable opportunity for increasing case detection while also promoting equitable and universal access to care.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, San Francisco General Hospital, San Francisco, California 94110, USA.
authors.forename: C R
authors.initials: CR
authors.lastname: Miller
authors.forename: J L
authors.initials: JL
authors.lastname: Davis
authors.forename: A
authors.initials: A
authors.lastname: Katamba
authors.forename: A
authors.initials: A
authors.lastname: Sserwanga
authors.forename: S
authors.initials: S
authors.lastname: Kakeeto
authors.forename: F
authors.initials: F
authors.lastname: Kizito
authors.forename: A
authors.initials: A
authors.lastname: Cattamanchi
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D003371:Cough / Q000382:microbiology; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D016017:Odds Ratio; D011320:Primary Health Care; D011787:Quality of Health Care; D012017:Referral and Consultation; D012307:Risk Factors; D019035:Rural Health Services; D012737:Sex Factors; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents