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Abstract

Background: One primary objective of a tuberculosis (TB) eradication program is the recovery of patients. Consistent medication intake is vital for TB sufferers to achieve recovery, as discontinuation or dropout can impede progress. Gender bias stemming from differences in social roles between men and women may influence the utilization of TB treatment programs. This study seeks to provide an overview of gender bias in the utilization of TB treatment programs.

Methods: This qualitative research study employed an exploratory descriptive approach to examine the experiences of gender bias among six women who withdrew from TB treatment in Batanghari regency, Jambi Province, Indonesia. Data were collected in September 2023 through in-depth interviews and analyzed using content analysis techniques.

Results: The causes of dropping out of TB treatment in women included the patient’s negligence in taking medication, side effects, and financial and psychological obstacles. Conditions of gender bias were related to the dominant role of men in a household, which causes role stereotypes, double burdens, subordination, and marginalization. As a result, women’s health inherently was given less priority than men's. This is in contrast to the TB treatment services that were assessed as equal for men and women.

Conclusion: Our results reflect the role that gender values play in determining the quality of support for women in utilizing TB treatment programs. We recommend improving social structures related to gender role equality and increasing support for women undergoing TB treatment.

Keywords: Gender bias, tuberculosis, treatment, dropout

References

[1] Indonesia, Ministry of Health. National guidelines for tuberculosis control. Ministry of Health of the Republic of Indonesia; 2014.

[2] World Health Organization [WHO]. Global tuberculosis report 2019. Geneva: WHO; 2019.

[3] Indonesia, Ministry of Health. Indonesia health profile 2018. [cited 2019 Jan 31]. Available from: http://www.depkes.go.id/resources/download/pusdatin/profil-kesehatanindonesia/Profil-Kesehatan-Indonesia-tahun-2018.pdf.

[4] Johansson E, Long NH, Diwan VK, Winkvist A. Gender and tuberculosis control: perspectives on health seeking behaviour among men and women in Vietnam. Health Policy. 2000; 52(1): 33-51. doi: 10.1016/s0168-8510(00)00062-2.

[5] Diwan VK, Thorson A. Sex, gender, and tuberculosis. Lancet. 1999; 353(9157): 1000-1. doi: 10.1016/S0140-6736(99)01318-5.

[6] World Health Organization [WHO]. Tuberculosis and gender. Geneva: WHO; 2016.

[7] Gosoniu GD, Ganapathy S, Kemp J, Auer C, Somma D, Karim F, et al. Gender and socio-cultural determinants of delay to diagnosis of TB in Bangladesh, India and Malawi. Int J Tuberc Lung Dis. 2008; 12(7): 848-55.

[8] van den Hof S, Najlis CA, Bloss E, Straetemans M. A systematic review on the role of gender in tuberculosis control. The Hague: KNCV Tuberculosis Foundation; 2010.

[9] Rokhmah D. Gender and tuberculosis: the implication to low health care access for the poor. Jurnal Kesehatan Masyarakat Nasional. 2013; 7(10); 447-52.

[10] Thorson A, Hoa NP, Long NH, Allebeck P, Diwan VK. Do women with tuberculosis have a lower likelihood of getting diagnosed? Prevalence and case detection of sputum smear positive pulmonary TB, a population-based study from Vietnam. J Clin Epidemiol. 2004; 57(4): 398-402. doi: 10.1016/j.jclinepi.2002.11.001.

[11] Atre SR, Kudale AM, Morankar SN, Rangan SG, Weiss MG. Cultural concepts of tuberculosis and gender among the general population without tuberculosis in rural Maharashtra, India. Trop Med Int Health. 2004; 9(11): 1228-38. doi: 10.1111/j.1365-3156.2004.01321.x.

[12] Onifade DA, Bayer AM, Montoya R, Haro M, Alva J, Franco J, et al. Gender-related factors influencing tuberculosis control in shantytowns: a qualitative study. BMC Public Health. 2010; 10: 381. doi: 10.1186/1471-2458-10-381.

[13] Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012; 380(9859): 2224-60. doi: 10.1016/S0140-6736(12)61766-8.

[14] Smith GS, Van Den Eeden SK, Baxter R, Shan J, Van Rie A, Herring AH, et al. Cigarette smoking and pulmonary tuberculosis in northern California. J Epidemiol Community Health. 2015; 69(6): 568-73. doi: 10.1136/jech-2014-204292.

[15] Resta H, Sandra R, Irman V. Characteristics of age and gender to the incidence of pulmonary tuberculosis. In: Proceedings of the 2nd syedza saintika international conference on nursing, midwifery, Medical laboratory technology, public health, and health information management (SeSICNiMPH 2021). Atlantis Press; 2021. p. 230e3 . https://www.atlantis-press.com/proceedings/sesicnimph-21/ 125962081.

[16] Srivastava K, Kant S, Narain A, Bajpai J. Tuberculosis in women: A reflection of gender inequity. Eur Respir J. 2018; 52(suppl. 62): PA531. doi: 10.1183/13993003.congress-2018.PA531.

[17] Nugroho RA. Qualitative Study of Factors Behind Drop Out of Pulmonary Tuberculosis. Treatment. Journal of Public Health. 2011; 7(1): 83-90.

[18] Himawan AB, Hadisaputro S, Suprihati. Various risk factors for drop out pulmonary TB (Case Study in Jepara and Pati Regencies). Indonesian Journal of Public Health Publications. 2015; 2(1): 57-63.

[19] Abdool Karim SS, Naidoo K, Grobler A, Padayatchi N, Baxter C, Gray A, et al. Timing of initiation of antiretroviral drugs during tuberculosis therapy. N Engl J Med. 2010; 362(8): 697-706. doi: 10.1056/NEJMoa0905848.

[20] Erawatyningsih E, Purwanta, Subekti H. Factors affecting incompliance with medication among lung tuberculosis patients. Berita Kedokteran Masyarakat. 2009; 25(3): 117-24. doi: 10.22146/bkm.3558.

[21] Kuhnheim JS. Machos, Mistresses, Madonnas: Contesting the Power of Latin American Gender Imagery. Marit Melhuus, Kristi Anne Stolen Lesbian Voices from Latin America: Breaking Ground. Elena M. Martínez. Signs (Chic). 1999; 25(1): 260-3. doi: 10.1086/495428

[22] Becerra MC, Pachao-Torreblanca IF, Bayona J, Celi R, Shin SS, Kim JY, et al. Expanding tuberculosis case detection by screening household contacts. Public Health Rep. 2005; 120(3): 271-7. doi: 10.1177/003335490512000309.

[23] 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(1): 69-81. doi: 10.1016/s0168-8510(01)00143-9.

[24] Ford CM, Bayer AM, Gilman RH, Onifade D, Acosta C, Cabrera L, et al. Factors associated with delayed tuberculosis test-seeking behavior in the Peruvian Amazon. Am J Trop Med Hyg. 2009; 81(6): 1097-102. doi: 10.4269/ajtmh.2009.08-0627.

[25] Marchildon J. Gender inequality is seriously harming the global fight against tuberculosis. [updated 2019 Apr 19; cited 2023 Nov 28]. Available from: https://www.globalcitizen.org/en/content/gender-equality-and-tuberculosis/

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