Gender differences in delays in diagnosis and treatment of tuberculosis

OBJECTIVE: To assess the gender variations in delay from symptom onset to help seeking, diagnosis and treatment of tuberculosis (TB) using DOTS at community level, in 10 subdistricts of Bangladesh with 2.5 million people under a non-governmental organization's (Building Resources Across Communities, or BRAC) DOTS programme for TB control. DESIGN: A cross-sectional survey of 1000 newly diagnosed pulmonary TB patients (500 women and 500 men). FINDINGS: Women, in comparison with men, had significantly longer mean and median delays in total delay (63.2 and 61.0 days vs. 60.3 and 53 days, respectively), total diagnostic delay (61.2, 60.0 vs. 58.5, 52.0 days), patient's delay (51.9, 50.0 vs. 48.7, 42.0 days) and treatment delay (2.0, 1.0 vs. 1.9, 1.0 day). Patient's mean and median delays were longer than the health system delay. However, patient gender showed strong association with total delay, total diagnostic delay and patient's delay. Older age of women was significantly associated with longer patient and treatment delay categories, respectively. CONCLUSION: Compared with men, women experienced longer delays at various stages of the clinical process of help seeking for TB. This warrants appropriate measures to improve the situation.