In addition to marginalization by poverty and ethnicity, gender is likely to contribute to vulnerability to TB-related stigma affecting women. Stigma often contributes to psychosocial problems and emotional suffering, and it may hinder help seeking and treatment adherence. TB-related stigma and its gender-specific features have not been carefully studied in Bangladesh, and such research is needed to reduce adverse effects of stigma. This study assessed and compared stigma in women and men, and identified crosscutting and gender-specific features of TB-related stigma. To assess stigma and the context of TB-related illness experience, meaning and help seeking behavior from patients' perspectives, a cultural epidemiological study administered a locally adapted semi-structured EMIC interview to 50 women and 52 men with pulmonary TB in rural Bangladesh. Indicators of TB-related stigma were assessed individually and collectively in a validated index. They were compared by sex, and illness narratives elaborated features of stigma with reference to features of TB. The study showed that six indicators of TB-related stigma were more prominent in accounts of women and two were more prominent in men's interviews. Gender differences appeared somewhat less after adjusting for other sociodemographic variables, and age was most significantly inversely related to stigma. Features of stigma more prominent in the accounts of women included feeling shamed or embarrassed, thinking less of themselves and feeling that others refused to visit or avoided them. Men were less likely to disclose their condition to a confidant, stay away from work or report that their spouse refused sex because of TB. Effective public health information and counselling sensitive to gender-specific features of stigma are needed to protect TB patients from the adverse impact of avoidable stigma. Further research is needed to clarify effects of gender-specific features of felt and enacted stigma on help seeking and treatment adherence.

The purpose of this study was to assess the effect of street life on the growth and health status of poor children who live and work full-time on the streets of Dhaka, Bangladesh (street children), independent of the effects of poverty. This was accomplished by comparing 142 street children with 150 poor children who live and work on the streets of Dhaka but who return to their families at night (slum children). Children between 7-14 years old were recruited at locales where street and slum children are typically found. Weight and upper arm circumference did not differ significantly between street and slum children (P > 0.05), but energy reserves, as assessed by skinfolds, were significantly larger in street than in slum children (P < 0.05). There was no wasting in either street or slum children. Although the majority of children in both groups were stunted and underweight, there were no significant differences between groups (P > 0.05). The prevalence of disease symptoms tended to be slightly higher in street children than in slum children, but few of the differences were statistically significant (P < 0.05). These data do not support the contention that street children are a particularly high-risk group. The greater-than-expected growth and health status of street children, compared to other poor children, may be due to biologically fitter children being more likely to permanently move to the streets and/or to remain on the streets once the move has been made.

The negative impact of poverty on the biological well-being of children is well established. The purpose of the present study was to evaluate the impact of the stress of full-time street life on the dietary patterns and dietary adequacy of street children living in Dhaka, Bangladesh. This was accomplished by comparing the nutritional patterns of full-time street children with those of other poor children in Dhaka who also spend their days on the streets but who return to their families at night. There were few differences between groups, possibly due to street children being a select group. However, there were significant sex differences in both groups of children, with boys tending to have more diverse and more adequate diets than girls. The cause of this latter pattern could not be determined with the available data but may involve cultural values favoring males over females.