title: Male Gender is independently associated with pulmonary tuberculosis among sputum and non-sputum producers people with presumptive tuberculosis in Southwestern Uganda.
abstract: BACKGROUND
  Little is known about the association between gender and risk of TB infection. We sought to assess the impact of gender on TB prevalence among people with presumptive tuberculosis at a regional referral hospital in a high TB and HIV prevalence setting.
  
  
  METHODS
  We analyzed data from two diagnostic TB studies conducted in rural, southwestern Uganda. People with presumptive tuberculosis were evaluated by chest X-ray, fluorescence microscopy, TB culture, and HIV testing. Our primary outcome of interest was TB infection, as defined by a positive TB culture. Our primary explanatory variable of interest was gender. We fit univariable and multivariable logistic regression models to investigate associations between TB infection and gender, before and after adjusting or possible confounding factors, including ability to produce sputum, age and residence.
  
  
  RESULTS
  Between April 2010 and September 2012, 863 people with presumptive tuberculosis (PWPTB) were enrolled in the two studies at Mbarara Regional Referral Hospital (MRRH) in Uganda. Among them 664 (76.9%) were able to produce sputum. X-ray was suggestive of TB for 258 (66.5%) of males and 175 (44.8%) of female (p < 0.001). using microscopy 84 (20%) of males and 48 (10.9%) of females were diagnosed with TB (p < 0.001) while 122 (30.3%) of males and 76 (18.4%) of females were diagnosed with TB (p < 0.001) using TB culture. In multivariable logistic regression models, the odds of having TB was higher in males than females (AOR 2.2 (1.56-3.18 95% CI°, P < 0.001), after adjustment for age, HIV status, ability to produce sputum, and residence.
  
  
  CONCLUSIONS
  In Southwestern Uganda, TB prevalence is higher among male than female people with presumptive TB. The increased risk of TB among males is independent of other TB risk factors. These findings emphasize the need for gender-focused interventions aimed at reducing TB transmission.
authors.affiliation: Epicentre Mbarara, Mbarara, Uganda. yap.boum@epicentre.msf.org.|Mbarara University of Science and Technology, Mbarara, Uganda. yap.boum@epicentre.msf.org.
authors.forename: Yap
authors.initials: Y
authors.lastname: Boum
authors.affiliation: Epicentre Mbarara, Mbarara, Uganda. daniel.atwine@epicentre.msf.org.
authors.forename: Daniel
authors.initials: D
authors.lastname: Atwine
authors.affiliation: Epicentre Mbarara, Mbarara, Uganda. patrick.orikiriza@epicentre.msf.org.
authors.forename: Patrick
authors.initials: P
authors.lastname: Orikiriza
authors.affiliation: Uganda National Tuberculosis and Leprosy program, Mbarara, Uganda. asiimwejpk@yahoo.co.uk.
authors.forename: Justus
authors.initials: J
authors.lastname: Assimwe
authors.affiliation: Epicentre, Paris, France. anne-laure.page@epicentre.msf.org.
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Page
authors.affiliation: Epicentre Mbarara, Mbarara, Uganda. juliet.mwanga@epicentre.msf.org.|Mbarara University of Science and Technology, Mbarara, Uganda. juliet.mwanga@epicentre.msf.org.
authors.forename: Juliet
authors.initials: J
authors.lastname: Mwanga-Amumpaire
authors.affiliation: Epicentre, Paris, France. maryline.bonnet@epicentre.msf.org.
authors.forename: Maryline
authors.initials: M
authors.lastname: Bonnet
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D015995:Prevalence; D012307:Risk Factors; D012423:Rural Health; D012737:Sex Factors; D013048:Specimen Handling; D013183:Sputum / Q000737:chemistry / Q000378:metabolism* / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult