Tuberculosis and Gender in Nigeria, Sex Differences in Diagnosis and Treatment Outcome of TB and TB HIV Infected Patients

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DOI: 10.21522/TIJPH.2013.04.04.Art035

Authors : Ejike Kenneth Nwene

Abstract:

Background: Worldwide, gender differences are reported in diagnosis and treatment outcome of TB and TB HIV patients. Religious and socio-cultural factors are responsible but largely controversial. This study assessed gender issues in diagnosis and treatment outcome of TB and TB HIV patients.

Objective: To assess gender differences in diagnosis and treatment outcome of TB and TB HIV infected patients.

Methodology: We did a cross sectional retrospective analysis of 980 TB patients treated in 6 out of 21 randomly selected local government areas of Anambra state Nigeria between 2008 and 2012. Information on age, sex, HIV status, case notification, treatment outcome was evaluated from TB treatment cards and TB registers. Treatment outcome was recorded as cured, completed treatment, failed, defaulted, died.

Results: The male female ratio among the 980 TB patients was 57.4% vs 42.6%.. The study HIV prevalence is 27.7%; women contributed 52.6% of this population. Women had better treatment success rate than men (85.7% vs. 80.5%). TB treatment outcome in women compared to men were Cured (50.4% vs 40.7%, p = 0.063), treatment completed (35.3% vs 39.8%, p= 0.330), died (5.5% vs5.5%, p=0.8812), defaulter (6.55 vs10.5%, p = 0.042), failure (1.6% vs 1.5%, p=0.749).

Conclusion: We conclude more TB cases in males but females are more prone to TB HIV confection, have better treatment outcome and lower default rate.

Gender-specific strategies, including active case finding among women, increased tracking and adherence for male, are warranted to optimize TB management.

Keywords: Gender, Nigeria, Tuberculosis, HIV, Co infection, NTBLCP.

References:

[1] Akinola A F, Abimbola S O, Afolabi E B. Treatment outcomes among pulmonary tuberculosis patients at treatment centers in Ibadan, Nigeria. Annals of African medicine, 2009; 8 (2): 100-104.

[2] Aggleton P, Rivers K. Gender Inequalities in Health and Diseases. Int Gender Iss 2007:28 – 32.

[3] Bello S I. Challenges of DOTS implementation strategy in the treatment of tuberculosis in a tertiary health institution, Ilorin, Nigeria. African journal of pharmacy and pharmacology, 2010 ; 4(4): 158- 164.

[4] Borgdorff MW, Nagelkerke NJ, Dye C, Nunn P. Gender and tuberculosis: A comparison of prevalence surveys with notification data to explore sex differences in case detection. Int J Tuberc Lung Dis. 2000;4:123–32. [PubMed]

[5] Belay T, Abebe M, Assengedegh B, Dieter R, Frank E, Ulrich S. Treatment outcome of TB patients at Gondar university teaching hospital, North West Ethiopia. BMC Public Health 2009; 9:37.

[6] Central TB Division, Directorate General of Health Services, Ministry of Health and Family Welfare, Nirman Bhawan, New Delhi. TB India 2012. RNTCP Status Report. 2012:7–17.]

[7] D. Chan-Yeung M, Noertjojo K, Chan SL, Tam CM. Sex differences in tuberculosis in Hong Kong. Int J Tuberc Lung Dis 2002;6:11-8.

[8] Diwan VK, Thorson A. Sex, gender, and tuberculosis. Lancet. 1999;353:1000–1. [PubMed]

[9] Frank-Peterside N, Onwuka A P, Okonko I O. Epidemiology of Pulmonary Tuberculosis in University of PortHarcourt Teaching Hospital: age related disparities. Science pub.net/report; 2012, 4(5).

[10] Glynn J, Sonnenberg P, Nelson G, Bester A, Shearer S, Murray J. Increasing risk of TB with increasing duration of HIV infection: results from 2000 men followed for 12 years. International journal for TB and lung disease, 2007; 11 (11):112.

[11] Gidado M, Ejembi C L. Tuberculosis case management and treatment outcome: Assessment of the effectiveness of public private mix of tuberculosis programme in Kaduna state, Nigeria. Annals of African medicine.2009; 8 (1): 25-31.

[12] G = Karim F, Islam MA, Chowdhury AM, Johansson E, Diwan VK. Gender differences in delays in diagnosis and treatment of tuberculosis. Health Policy Plan. 2007;22:329–34. [PubMed]

[13] H= Holmes CB, Hausler H, Nunn P. A review of sex differences in the epidemiology of tuberculosis. Int J Tuberc Lung Dis. 1998;2:96–104. [PubMed]

[14] Hawkes S, Buse K. Gender and global health: evidence, policy, and inconvenient truths. Lancet. 2013; 381:1783–1787. doi: 10.1016/S0140-6736(13)60253-6 PMID: 23683645

[15] Holmes CB, Hausler H, Nunn P. A review of sex differences in the epidemiology of tuberculosis. Int J Tuberc Lung Dis. 1998;2:96–104.]

[16] K.= Yamasaki-Nakagawa M, Ozasa K, Yamada N, Osuga K, Shimouchi A, Ishikawa N, et al. Gender difference in delays to diagnosis and health care seeking behaviour in a rural area of Nepal. Int J Tuberc Lung Dis. 2001;5:24–31. [PubMed]

[17] Karim F, Islam MA, Chowdhury AM, Johansson E, Diwan VK. Gender differences in delays in diagnosis and treatment of tuberculosis. Health Policy Plan. 2007;22:329–34. [PubMed]

[18] Khatri GR, Frieden TR. The status and prospectus of tuberculosis control in India. Int J Tuberc Lung Dis 2000;4:193-200. ]

[19] L=. Begum V, de Colombani P, Das Gupta S, Salim AH, Hussain H, Pietroni M, et al. Tuberculosis and patient gender in Bangladesh: Sex differences in diagnosis and treatment outcome. Int J Tubercu Lung Dis. 2001;5:604–10. [PubMed]

[20] Long NH, Johansson E, Diwan VK, Winkvist A. Fear and social isolation as consequences of tuberculosis in Vietnam: A gender analysis. Health Policy. 2001;58:69–81. [PubMed]

[21] Long NH, Johansson E, Diwan VK, Winkvist A. Fear and social isolation as consequences of tuberculosis in Vietnam: A gender analysis. Health Policy. 2001;58:69–81. [PubMed]

[22] Lawson L, Lawson JO, Olajide I, Ememyonu N, Bello CS, Olatunji OO, Davies PD, Thacher TC. Sex differences in the clinical presentation of urban Nigerian patients with pulmonary tuberculosis. West Afr J Med. 2008 Apr;27(2):82–6. [PubMed]]

[23] Lagrada L P, Uehara N, Kawahara K. Analysis of factors of treatment completion in DOTS health facilities in Metro Manilla Phillipines, a case control study. PMID,2008 ; 83(12):765 -772.

[24] Long, N.H., E. Johansson, V.K. Diwan and A. Winkvist, Fear and social isolation as consequences of tuberculosis in Vietnam: a gender analysis, Health Policy 2001, 58(1):69–81.

[25] M= Raja A. Immunology of tuberculosis. Indian J Med Res. 2004;120:213–32. [PubMed]

[26] Mark J R. Chronic cough due to tuberculosis and other infections. ACCP evidence based clinical practice, 2006; 129; 1975 -2015.

[27] Mukherjee A, Saha I, Sarkar A, Chowdhury R. Gender differences in notification rates, clinical forms and treatment outcomes of tuberculosis patients placed under RNTCP. Lung India. 2012;29:120–2. [PMC free article] [PubMed]

[28] Mukherjee A, Saha I, Sarkar A, Chowdhury R. Gender differences in notification rates, clinical forms and treatment outcomes of tuberculosis patients placed under RNTCP. Lung India. 2012;29:120–2. [PMC free article] [PubMed]

[29] Martinez HZ, Suazo FM, Gil JQC, Bello CG, Escalera AMA, Marquez HG, Casanova LG. Spatial epidemiology of bovine tuberculosis in Mexico. Veterinaria Italiana. 2007;43(3):629–63. [PubMed]

[30] N= Ahmed J, Chadha VK, Singh S, Venkatachalappa B, Kumar P. Utilization of RNTCP services in rural areas of Bellary District, Karnataka, by gender, age and distance from health centre. Indian J Tuberc. 2009;56:62–8. [PubMed]

[31] Nigerian Stop TB Partnership Strategic Plan 2011

[32] Nigeria National Census :2006

[33] O=. Yang ZH, Kong Y, Wilson F, Foxman B, Fowler AH, Marrs CF, et al. Identification of risk factors for extra pulmonary tuberculosis. Clin Infect Dis. 2004;38:199–205. [PubMed]

[34] Odaibo GN, Gboun MF, Ekanem EE, Gwarzo SN, Saliu I, Egbewunmi SA, Abebe EA, Olaleye DO. HIV infection among patients with PTB in Nigeria. African Journal of Medicine and Medical Sciences. 2006;35:93–98. [PubMed]]

[35] Onifade, D.A. et al., Gender-related factors influencing tuberculosis control in shantytowns: a qualitative study, BMC Public Health 2010, 10:381, http://www.biomedcentral.com/1471-2458/10/381.

[36] P=. Martinez AN, Rhee JT, Small PM, Behr MA. Sex differences in the epidemiology of tuberculosis in San Francisco. Int J Tuberc Lung Dis. 2000;4:26–31. [PubMed

[37] Sweet H, Denison S. Gender inequalities in health and diseases. Int Gender Iss 2008: 5-32.

[38] World Health Organization, Global TB Report, Geneva;2015.

[39] WHO - Africa Region. Strategic plan for tuberculosis control for the African region: 2006 - 2010. WHO report - AFRO report 2006. Harare, Zimbabwe: World Health Organisation - Regional Office for Africa, 2006).

[40] World Health Organisation, Global TB Report, Geneva;2014.

[41] Waisbord, S., Behavioral Barriers in Tuberculosis Control: A Literature Review, The CHANGE Project/Academy for Educational Development, Washington, DC, 2005, http://pdf.usaid.gov/pdf_docs/Pnadf406.pdf.

[42] United Nations General Assembly. United Nations millennium declaration. A/RES/55/2. 2000 Sep 8 [cited 2 Aug 2016]. Available: http://www.un.org/millennium/declaration/ares552e.htm.

[43] Yamasaki-Nakagawa M, Ozasa K, Yamada N, Osuga K, Shimouchi A, Ishikawa N, et al. Gender difference in delays to diagnosis and health care seeking behaviour in a rural area of Nepal. Int J Tuberc Lung Dis. 2001;5:24–31. [PubMed]

[44] Zachariah R, Fitzgerald M, Massaquoi M, Acabu A, Chiloma D, Salaniponi F M L, Harries A D. Does antiretroviral treatment reduce case fatality among HIV positive patients with Tuberculosis in Malawi. International journal for TB and lung disease, 2007; 11 (8):848 -853.