Gender Dynamics and Adherence to Tuberculosis Treatment in the Greater Accra Region

Abstract

Tuberculosis (TB) infection is a global disease, however, its menace is felt more in the developing countries, with the marginalized, the poor and other hard-to-reach people facing the greatest barriers to diagnosis, treatment and cure. In relation to gender, TB is the third leading cause of death for women worldwide. Studies on TB and gender have indicated that women experience different risk factors, social and economic consequences and barriers to treatment as compared to men. Gender, as a variable has been found from both medical and social research to influence the epidemiology of TB in various ways. The main aim of the study was to assess the gender dynamics and adherence to TB treatment. The study was descriptive design and used both qualitative and quantitative methodology. The study involved 310 patients (112 female and 198 males) who were receiving treatment at the time of the study and in-depth interviews with 24 TB respondents made up of 12 males (6 TB/HIV co-infected and 6 HIV negative) and 12 females (6 TB/HIV co-infected and 6 HIV negative) and key informants made up of 6 TB coordinators selected from the six facilities where the study took place. Of the 42.3% respondents who did not adhere to the TB treatment regimen, 33% were female and 39.5% males. TB and HIV co-infected among the respondents involved in the survey was 11.9%. Findings from the study indicated that among the factors used to assess adherence, females were more adherent than their male counterparts (demographic/socioeconomic factors (OR 2.83 CI 95%, 1.44 - 5.58, p>0.003), service/provider-related factors (OR 1.85 CI 95%, 1.05 - 3.23), p>0.032), gender-based factors (OR 1.71 (1.04 - 2.83), p>0.035), community-related factors OR 1.55 CI 95%, 0.94 - 2.55, p>0.087), patient-related factors (OR 2.36 (CI 95%, 1.38 - 4.03, p>0.002). Individual variables that produced significant results were age (40 - 49 p<0.012, 50 – 59 p<0.000 and 60+ p<0.05) marital status (married p<0.014,

widowed p<0.000, divorced/separated p<0.015), income, earning between Gh ₵ 200 and 399 p<0.000 and Gh ₵ 400, p<0.002. Those who reported getting money for treatment was not difficult were less likely to be non-adherent (p<0.002). Findings from the in-depth interviews corroborated the quantitative findings. Males were more likely to ever-miss medication and key among the factors were inadequate education on the disease, distance to the health facilities, lack of social support, difficulty in getting money for treatment which translated in missing appointments schedules and number of years patients had lived in their community. On the other hand, factors promoting adherence were education by Health Care Workers (HCWs) about disease condition, age and income. The in-depth interview revealed that, stigma associated with the disease was the main reason why females especially adhered to the treatment regimen in order to be rid of the infection. This study has implication for disease control in terms of better understanding the gender dynamics of the different barriers to TB health care and improving adherence and treatment outcome. The study has provided data on the magnitude of risk factors for non-adherence based on gender, which will be useful in estimating the impact of Directly Observed Treatment Short Course (DOTS) strategy over time, as well as for developing appropriate strategies to inform the National Tuberculosis Control Programme (NTP) in Ghana.