title: Health care workers' gender bias in testing could contribute to missed tuberculosis among women in South Africa.
abstract: METHODS
  Eight communities with high tuberculosis (TB) prevalence, Western Cape, South Africa.
  
  
  OBJECTIVE
  To identify sex differences in TB health-seeking behaviour and diagnosis in primary health care facilities and how this influences TB diagnosis.
  
  
  METHODS
  We used data from a prevalence survey among 30,017 adults conducted in 2010 as part of the Zambia, South Africa Tuberculosis and AIDS Reduction (ZAMSTAR) trial.
  
  
  RESULTS
  A total of 1670 (5.4%) adults indicated they had a cough of ⩾2 weeks, 950 (56.9%) of whom were women. Women were less likely to report a cough of ⩾2 weeks (5.1% vs. 6.4%, P < 0.001), but were more likely to seek care for their cough (32.6% vs. 26.9%, P = 0.012). Of all adults who sought care, 403 (80.0%) sought care for their cough at a primary health care (PHC) facility (79.0% women vs. 81.4% men, P = 0.511). Women were less likely to be asked for a sputum sample at the PHC facility (63.3% vs. 77.2%, P = 0.003) and less likely to have a positive sputum result (12.6% vs. 20.7%, P = 0.023).
  
  
  CONCLUSIONS
  The attainment of sex equity in the provision of TB health services requires adherence to testing protocols. Everyone, irrespective of sex, who seeks care for a cough of ⩾2 weeks should be tested.
authors.affiliation: Department of Economics, Stellenbosch University, Private Bag X1, Matieland 7602, Stellenbosch, South Africa. anjasmith@sun.ac.za.
authors.forename: A
authors.initials: A
authors.lastname: Smith
authors.affiliation: Department of Economics, Stellenbosch University, Stellenbosch, South Africa.
authors.forename: R
authors.initials: R
authors.lastname: Burger
authors.affiliation: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.
authors.forename: M
authors.initials: M
authors.lastname: Claassens
authors.affiliation: Zambia AIDS Related Tuberculosis Project, Lusaka, Zambia; Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: H
authors.initials: H
authors.lastname: Ayles
authors.affiliation: Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Godfrey-Faussett
authors.affiliation: Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.
authors.forename: N
authors.initials: N
authors.lastname: Beyers
mesh_terms: D000293:Adolescent; D000328:Adult; D003371:Cough / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D006282:Health Personnel; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011287:Prejudice; D015995:Prevalence; D012737:Sex Factors; D012959:Socioeconomic Factors; D013183:Sputum / Q000382:microbiology; D013997:Time Factors; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology*; D055815:Young Adult; D015024:Zambia / Q000453:epidemiology