Gender and tuberculosis control in armed conflict areas in Nepal

Setting: TB is the greatest single infectious cause of death among women in the developing world. Armed conflict could affect the TB treatment service delivery system, more specifically, a higher proportion of women could face more problems in accessing and completing the TB treatment. Objectives: To explore the gender differences in TB treatment services in armed conflict areas by: a) socio-demographic factors, b) level of civil conflict, and c) physical availability of the services. Design: A cross sectional design with a structured questionnaire was used in the study. Study population was the Tuberculosis patients who were being treated under the WHO recommended strategy Directly Observed Treatment Short Course. The study was conducted in Dang district of Nepal. A total of 180 TB patients participated in the face to face interview. Results: A significant difference in education was observed between male and female TB patients. Females were more likely to visit Traditional Healers for the first consultation. More than two thirds of the patients could not visit the DOTS centers when mass campaigns were organized, closures were declared, casualties and killings happened. A significant difference between male and female was observed in the service use during the rainy season. Conclusion: Women were more likely to make their first consultative visit to a traditional healer; this can cause a delay in diagnosis and or might not be able to attain the DOTS center. Since women were less likely to comply with treatment during the rainy season, an alternative approach is recommended. A study in the health care delivery systems in armed conflict areas, using a mixed method approach with a team of researchers from multidisciplinary fields is also recommended.