Determinants of help seeking and treatment seeking behavior of Tuberculosis patients - Gender perspective: A systematic review

Abstract

BACKGROUND Help and treatment seeking behavior of men and women suffering from tuberculosis is largely determined by how he/she and those around them perceive the causes, regard the diagnosis, accept the treatment, and adhere to the treatment. OBJECTIVES To critically appraise and synthesize the best available evidence on gender-based determinants of help and treatment seeking behavior of tuberculosis patients. INCLUSION CRITERIA Male and female tuberculosis patients (>=15 years) living in developed and developing countries were included. Quantitative studies examining gender differences in help and treatment seeking among tuberculosis patients with cross-sectional, retrospective and prospective cohort were included. TYPES OF PRIMARY OUTCOMES Outcomes related to determinants of help seeking: pattern of distress, perceived cause of tuberculosis and stigma related to tuberculosis patients and determinants of treatment seeking: delay in diagnosis, health service utilization, and consequence of treatment seeking; treatment outcomes. SEARCH STRATEGY The review considered both published and unpublished studies in the English language published between January 1990 and December 2010. Databases of the Joanna Briggs Institute, PubMed, Popline, Cochrane Library, CINAHL and MedNar were searched. The search focused on key elements of objectives (participants, comparator, and outcome) and a thorough search was undertaken utilizing a standardized three step approach. METHODOLOGICAL QUALITY Considered papers were critically appraised by two independent reviewers using standardized Joanna Briggs Institute tools. Data was extracted using the Joanna Briggs Institute Meta Analysis of Statistical Assessment and Review Instrument data extraction tool. Data was analyzed using Revman 5.1 software from the Cochrane collaboration. RESULTS Nine cross-sectional, two retrospective and one prospective cohort studies were included in the review. Males were 49% less likely to have psychological distress than females (OR=0.51, 95% CI=0.32-0.83). Males were 46% less likely to perceive health, illness and injuries as a cause of tuberculosis infection than females (OR=0.54, 95% CI=0.31-0.96). Males were 78% less likely to use a traditional healer as health service utilization than females (OR=0.22, 95% CI=0.07-0.66). Males were almost twice more likely to be diagnosed within 30 days in a health institution than females (OR=1.76, 95% CI=1.09-2.84) however, they were 23% less likely to successfully complete tuberculosis treatment (OR=0.77, 95% CI=0.68-0.87). CONCLUSIONS Gender differences were observed on determinants of help seeking such as distress, perceived causes of tuberculosis infection and stigma components. Determinants of treatment seeking that showed significant gender differences were utilization of health services for diagnosis and treatment, patient delay in seeking health service and treatment outcome of tuberculosis.