Team:Paris Bettencourt/Human Practice/Gender Study/Gender Bias

  Reported cases of Tuberculosis in the world have an almost universal bias towards men, averaging 1.9 men for every woman infected in some regions and the cause of the bias in Tuberculosis is still debated. It is possible that increased incidence among men can be partially or completely attributed to bias in reporting and diagnosis of women. Particular weight is given to under reporting of females in comparison to males. A study in Pakistan found that women took longer to seek medical attention when symptoms first appeared and were much more likely to visit a traditional healer before going to the hospital when they did seek aid. Women who were surveyed about how they sought treatment for tuberculosis indicated that they were hesitant to seek medical aid due to the social stigma against the infection, especially when they were of child bearing age. This is sociological effect can be improved by reducing the burden of disease for those infected and attempting to combat the stigma associate with the disease through information campaigns. However even in cases which clinicians survey the population randomly for tuberculosis and do not rely on patients for reporting symptoms see a stark bias towards men.

  There may be other confounding factors regarding the observed sex bias in tuberculosis infections including that the reported standard sputum smear assay for detecting tuberculosis is less sensitive in women than it is in men. A study in Bangladesh found that women incorrectly completed the sputum smear assay at a higher rate than men. However, when they were given detailed instructions on how to complete the assay correctly detection rates matched those of men. Another possible explanation for the higher incidence rate in men is a clustering effect. The highest ratio of men to women was observed among individuals in clustered isolates associated with recent transmission. This indicates that transmission dynamics may have a role to play in the observed gender bias. The conflicting nature of gender studies in Tuberculosis highlights the need to obtain detailed epidemiology data and models regarding gender and disease progression, yet no models for gender effects on Tuberculosis yet exist. It will only be through careful examination of both the potential biological and sociological causes of gender bias in tuberculosis to truly understand the underlying mechanisms involved in the spread of tuberculosis within populations which may be critically important for countries which have a highly screwed sex ratio, including countries such as India and China, which also have very high burdens of Tuberculosis.