Abstract
BackgroundAlthough globally, the number of notified TB cases is higher for males, a few countries in the Eastern Mediterranean Region (Afghanistan; Lebanon; Iran and Pakistan) of the World Health Organization have a relatively higher number of female cases. Pakistan ranks fifth amongst the highest TB burden countries and poses a rich ground for exploratory research to address the gender differences in TB cases. It is uniquely neighboured by India on the East, having higher number of cases in males than in females, and by Afghanistan and Iran on the West, having higher number of cases in females than in males. The objective is to see whether these gender differences are evenly distributed across the country or vary by geographies, to enable effective targeting of TB control strategies.MethodsCross-sectional analysis was carried out on secondary data, obtained from National Tuberculosis Program. Disaggregated at the provincial level, the sex-specific case notification rates (CNR) were calculated and trends over a 10-year span (2001–2010) were examined. Sex-specific differences for the four Pakistani provinces were analyzed using chi-square test and odds ratios with corresponding confidence intervals. Cumulative countrywide sex-specific notification rates were used as the reference group.ResultsThe trends for 2001–2010 in the western provinces of Pakistan show higher female CNR as compared to those seen in the eastern provinces having slightly higher male CNR. The proportions of female notified TB cases are approximately twice as high in the western provinces when compared to the eastern provinces and Pakistan over all.ConclusionsThese findings suggest that females are particularly affected by TB disease burden in the west parts of Pakistan. This gender disparity requires a coordinated regional and international effort to further explore triggers and moderators of increased acquisition and progression of TB disease among females in the region to guarantee effective TB control.
Highlights
Globally, the number of notified TB cases is higher for males, a few countries in the Eastern Mediterranean Region (Afghanistan; Lebanon; Iran and Pakistan) of the World Health Organization have a relatively higher number of female cases
Trends in TB case notification rates (2001–2010) of the four provinces and Pakistan overall The study population consisted of 571958 new sputum smear positive (NSS +ve) cases, from 2001 to 2010, reported from the whole of Pakistan to the National TB Program
In the eastern provinces the gender pattern in notification rates persisted over time with a slight predominance of male notified cases resembling the trends for the whole of Pakistan
Summary
The number of notified TB cases is higher for males, a few countries in the Eastern Mediterranean Region (Afghanistan; Lebanon; Iran and Pakistan) of the World Health Organization have a relatively higher number of female cases. Pakistan ranks fifth amongst the highest TB burden countries and poses a rich ground for exploratory research to address the gender differences in TB cases It is uniquely neighboured by India on the East, having higher number of cases in males than in females, and by Afghanistan and Iran on the West, having higher number of cases in females than in males. TB is responsible for 5.1% of total national disease burden in Pakistan with approximately 47% of the pulmonary TB cases and 38% of all TB cases comprising of smear positive pulmonary TB [3] It contributes about 63% of the TB burden in the EMR with a aCase Notification Rate (CNR) [4] of 60 per 100 000 population for NSS +ve TB cases [1,5,6]. A similar sex disparity in TB CNR is seen in Iran, adjacent to Pakistan and Afghanistan, with MFR of 1Á00: 1Á50 for the notified TB cases [2]
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