Gender-Related Factors Influencing Women's Health Seeking for Tuberculosis Care in Ebonyi State, Nigeria

Abstract

This is a qualitative, descriptive study to explore gender-related factors that influence health seeking for tuberculosis (TB) care by women in Ebonyi State, Nigeria. In-depth interviews based on interview guides were conducted with participants selected through purposive sampling in communities in the state. The results show that gender relations prohibit women from seeking care for symptoms of TB and other diseases outside their community without their husbands' approval. Gender norms on intra-household resource ownership and control divest women of the power to allocate money for health care seeking. Yet, the same norms place the burden of spending on health care for minor illnesses on women, and such repeated, out-of-pocket expenditures on health care at the village level make it difficult for women to save money for use for health care seeking for major illnesses such as TB, which, even if subsidized, still involves hidden costs such as transport fare. The opening hours of TB clinics do not favour their use by most women as they are open when women are usually engaged in income-generating activities. Attending the clinics may therefore entail opportunity costs for many women. People with chronic, infectious diseases such as TB and HIV are generally stigmatized and avoided. Women suffer more stigma and discrimination than men. Stigma and discrimination make women reluctant to seek care for TB until the disease is advanced. Policies and programmes aimed at increasing women's access to TB services should not only take these gender norms that disempower women into explicit consideration but also include interventions to address them. The programmes should integrate flexible opening hours for TB treatment units, including introduction of evening consultation for women. Interventions should also integrate anti-stigma strategies led by the community members themselves.

Tuberculosis and gender in the Asia‐Pacific region

“…Some TB policies and programs do attempt to address the known obstacles created by gender norms. 22 Evidence across countries and cultures shows that the organisation of TB treatment services is a major factor in the decisions people make about seeking and following treatment regimes, and that services have rarely been designed with users' needs in focus. 23 The social relationships between healthcare staff and people with TB have been described as authoritarian, with a lack of respect and empathy impeding engagement with care.…”

Determinants of delayed diagnosis and treatment of tuberculosis in high-burden countries: a mixed-methods systematic review and meta-analysis

“…4). Qualitative studies highlighted limitations for women to seek healthcare [113,115,123,124,128]. Women reported economic constraints and power imbalances in the decision-making process as barriers to care-seeking [113,115,123,124].…”

“…Bangladesh [113,114], Brazil [127,128], Cambodia [115], China [133,134], Ethiopia [108], India [113,119], Nigeria [123], Philippines [124], Russia[135], South Africa [137][138][139][140][141][142], Tanzania [112], Zambia [125], Zimbabwe [126] Perceived stigma and discrimination at workplace, within family and the community against women, and associating TB with HIV deterred presumptive TB cases from seeking TB diagnosis and care "When someone says, 'I have TB' others will say that the person has three words [HIV].'' [141] "The person would be scared that she would lose her job and that people and friends would avoid her."…”

Social, Historical and Cultural Dimensions of Tuberculosis

“…To broaden current models, anthropological fieldwork may interpret critically the qualitative experience of gender and how socially constructed and socially vulnerable gender roles influence agency, health seeking and treatment compliance. In the absence of conclusive data about the biological predisposition to TB disease due to sex, TB policies and programmes should try to address the known obstacles created by gender norms, such as integrating flexible clinic hours to increase women's access to TB treatment services (Oshi et al, 2014). Capturing epidemiological data about sex and ethnographic data about how gender is constructed, performed and challenged in the social spaces where TB diagnoses are revealed and concealed will lead to transformative health care practices that promote the social inclusion of all TB patients.…”

“…The objective, one shared by others in the field (e.g. Oshi et al, 2014), is to encourage a systematic exploration of the social, historical and cultural factors that influence health seeking, treatment adherence and successful public health policies. The aim is to stimulate more social studies of TB and to open the space for more collaboration among quantitative and qualitative researchers.…”