Gender difference in delays to diagnosis and health care seeking behaviourin a rural area of Nepal

SETTING: Directly observed treatment for tuberculosis using a shea-course r egimen (DOTS) was introduced in a rural area of Nepal. All new patients ass igned to DOTS from mid-December 1997 to mid-June 1999 were eligible for the study. OBJECTIVE: TO examine delays in tuberculosis (TB) diagnosis and compare hea lth care seeking behaviour between men and women. DESIGN: A cross-sectional analysis of patient interviews. RESULTS: Women were found to have a significantly longer total delay before diagnosis of tuberculosis (median 2.3 months for men, 3.3 months for women ). When they visited traditional healers first, women had a significantly l onger delay than men from the first visit to health care providers to diagn osis (median 1.5 months for men, 3.0 months for women). More women (35%) vi sited traditional healers before diagnosis than men (18%), and were more li kely to receive more complicated charms from traditional healers. Men tende d to visit the government medical establishment first if they knew that fre e TB treatment was available, but women did not. CONCLUSION: Women were more likely to visit and to believe in traditional h ealers; this might lead to the longer delays experienced before TB diagnosi s.