Gender and tuberculosis: a comparison of prevalence surveys with notification data to explore sex differences in case detection

OBJECTIVE: TO explore whether lower tuberculosis notification rates among w omen are due to a reduced access to health caret particularly diagnostic se rvices, for women. METHODS: Age- and sex-specific tuberculosis prevalence rates of smear-posit ive tuberculosis were obtained from tuberculosis prevalence surveys reporte d to the WHO or published in the literature. Age- and sex-specific notifica tion rates from the same countries in 1996 were used. RESULTS: Prevalence data and notifications from 29 surveys in 14 countries were used. Notification rates varied strongly among countries, but the fema le/male ratio was below 1 and decreased with increasing age in almost all. The female/male (F/M) prevalence ratios were less than 0.5 in surveys in th e South-East Asia and Western Pacific Region, and approximately 1 in the Af rican Region. CONCLUSION: In most countries the F/M sex ratio in prevalent cases was simi lar or lower than that in notified cases, suggesting that F/M differences i n notification rates may be largely due to epidemiological differences and not to differential access to health care. However, available data are limi ted as the prevalence surveys in Africa were carried out many years ago, an d in Asia notification rates may be distorted by a large private sector wit h deficiencies in notification.