title: Unusual sex differences in tuberculosis notifications across Pakistan and the role of environmental factors.
abstract: In developing countries, only one-third of new tuberculosis cases notified are from women. It is not clear whether tuberculosis incidence is lower in women than men, or whether notification figures reflect under-detection of tuberculosis in women. Pakistan, however, presents an unusual pattern of sex differences in tuberculosis notifications. While 2 of the 4 provinces (Sindh and Punjab) report more notifications from men (female to male ratios 0.81 and 0.89 respectively in 2009), the other 2 provinces (Khyber-Pakhtunkhwa and Balochistan) consistently report higher numbers of smear-positive tuberculosis notifications from women than men (1.37 and 1.40). No other country is known to have such a large variation in the sex ratios of notifications across regions. Large variations in female to male smear-positive notification ratios in different settings across a single country may indicate that environmental factors, rather than endogenous biological factors, are important in influencing the observed sex differences in tuberculosis notifications.
authors: London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom. Mishalk@cantab.net
authors: M S
authors: MS
authors: Khan
authors: M S
authors: MS
authors: Khan
authors: R
authors: R
authors: Hasan
authors: P
authors: P
authors: Godfrey-Faussett
mesh_terms: D003906:Developing Countries; D018563:Disease Notification / Q000706:statistics & numerical data*; D004777:Environment; D005260:Female; D006801:Humans; D008297:Male; D010154:Pakistan / Q000453:epidemiology; D012737:Sex Factors; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology*