Social determinants put women at risk of tuberculosis (TB)

It is no coincidence but rather an ill-synergy of a range of factors that increase the risk for a woman to get tuberculosis (TB). In India, sixty per cent women are poor which often means poor living conditions, poor food, long working hours and ignoring health overtime. Fifty five per cent women are anaemic. Anaemia is a cause of TB (as it accelerates progression from latent TB infection to active TB disease) and effect of TB too (once a person develops TB anaemia can set in). Forty eight per cent women are malnourished. Fifty six per cent of India’s total population lives in urban slums (overcrowded, poorly ventilated) out of which women constitute forty seven per cent.

At a meeting on importance of addressing TB in context of women's health organized by Global Health Advocates (GHA) to mark the International Women’s Day (8th March), the writing was on the wall: TB is the third leading cause of death globally among women aged 15-44. In some settings, women who become ill with TB may be stigmatized, discriminated against or ostracized by their families and communities.

In most countries men carry more of the TB burden, however more women are detected with TB in some settings such as Afghanistan, and parts of Pakistan and these conditions merit further investigation.

"Universal access won't be achieved if women don't have access to services" said Mamta Jacob from Global Health Advocates (GHA). "Due to social determinants and existing disparities, a woman is at a higher risk of getting infected with TB, developing active TB disease from a latent TB infection, and delaying TB diagnosis and initiation of standard treatment for TB" said Mamta Jacob.

Another social reality stares at our face: the caretaker role of a woman which is a blessing but puts her at risk of infections. "The length of exposure to TB bacilli heightens the risk to infection. No matter what socio-economic class a woman comes from, she is the one who is most likely to take care of the sick family member, in her role as a mother, daughter, sister, wife or others" said Mamta Jacob.

"Most slum houses are very poorly ventilated and at times there is hardly any ventilation. Men relatively stay for a shorter time in slum houses and women spend much more time because of her role in house" said Mamta Jacob.

TB progresses faster in women than men from latent TB infection to active TB disease.

Another major modifiable risk factor for TB is use of solid fuel for cooking – and – it is the women who are most exposed to solid fuel emissions. Ninety per cent rural population and thirty one per cent urban population use solid fuels in India. Reducing smoking and solid-fuel use can substantially lower not only TB risk but also the risk of developing chronic obstructive pulmonary disease (COPD) and lung cancer.

Bobby Ramakant - CNS 


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