Tuberculosis (TB) treatment outcomes are better among women as compared to those in men, said Dr KS Sachdeva, Chief Medical Officer (CMO), Revised National TB Control Programme (RNTCP) of the Government of India. According to the RNTCP data, among new sputum positive cases of TB registered in 2009, TB treatment success rates were higher in women (89 per cent) than those in men (87 per cent) and less women dropped out of TB treatment than men (4 per cent drop out or default rate for women, and 6 per cent default rate in men). He was speaking at a focussed meeting on TB and women organized in New Delhi by Global Health Advocates (GHA) on 8th March 2011.Although TB treatment outcomes are better in women, there are reported delays in getting women diagnosed and put on standard treatment. In a study in Nepal, women had a longer total delay before diagnosis of TB than men, said Dr KS Sachdeva.
Results from a study in Nepal comparing active and passive case finding methods showed higher detection of female TB cases by active case detection method in comparison to passive case detection method (46 per cent in women and 28 per cent in men who had TB). These facts pave the way to the assumption that female TB cases are under detected & under reported, said Dr Sachdeva.
TB is the third leading cause of death globally among women aged 15-44. In the year 2008, globally 3.6 million women got TB and 700,000 of them died due to TB. In some settings, women who become ill with TB may be stigmatized, discriminated against or ostracized by their families and communities.
In most countries men carry more of the TB burden, however more women are detected with TB in some settings such as Afghanistan, and parts of Pakistan and these conditions merit further investigation. Many community-based studies conducted by TB Research Centre (TRC), Chennai, have indicated that men are more infected with TB in India, said Dr KS Sachdeva, CMO at RNTCP in India. It is not clear to what extent these differences result from biological factors, socio-cultural contexts, and from under-recognition of TB among women due to poor access to care, said Dr Sachdeva.
According to the WHO Global TB Report 2010, men are twice as likely to get TB, said Dr KS Sachdeva as 35% of incident TB cases globally were reported in women. Dr Sachdeva said that data doesn't support the assumption of poor health seeking behaviour or under utilization of health services among females.
Most of the RNTCP strategies are gender neutral, said Dr Sachdeva. However there are dedicated efforts being made to reach out to women and men with TB who are currently not accessing available services. Involvement of female healthcare providers and ASHA workers in RNTCP, sputum transportation schemes, choice of DOTS providers, stigma reduction through mass media, community awareness, interpersonal communication with family members, among other strategies, linking poor and vulnerable populations with social welfare schemes are some of the measures currently undertaken by RNTCP to reach out to those women and men who are currently not accessing available TB care services, said Dr KS Sachdeva.
There are dedicated social assessment studies currently ongoing to identify TB risk factors of women and other marginalised populations, said Dr Sachdeva.
TB-HIV collaborative activities are also being implemented in India although they are gender neutral yet will benefit women living with HIV too, said Dr Sachdeva.
One of the most significant achievements of RNTCP is to bring down the mortality rate from 1000 every day to 750. Saving 250 lives daily from TB is a remarkable programme achievement, said Dr Sachdeva.
A hospital based multi-centric study conducted by TRC Chennai indicated that detection of smear-positive TB per 100,000 new adult out-patients was nearly three times higher among males than females (765 in males, 253 in females). At all study sites, women were more likely than men to utilize health services with higher female: male ratio among outpatients; but the prevalence of cough and smear positive TB was more among males, said Dr KS Sachdeva.
To reach out to the unreached people with TB, it appears new active TB case detection programmes need to become more gender sensitive (and not gender neutral) so that women who need TB services and are currently being not covered by the TB programme, get their long overdue right to health. This will also have pronounced favourable public health outcomes.
Bobby Ramakant – CNS
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