A Study to Explore the Causes of Higher Notification of Tuberculosis in Adult Females in the Province of Khyber Pakhtunkhwa, Pakistan

Abstract

Background: Tuberculosis (TB) continues to be major cause of death for adult females in Pakistan, which ranks as the fifth highest country in the world with a TB burden. Globally, TB occurrence, morbidity and mortality is higher in males. However, the notification of TB in Khyber Pakhtunkhwa (KPK) and Balochistan is higher in females as compared to males. This study aims to explore the risk factors associated with the higher notification of TB in women in KPK province of Pakistan. Aim : To explore the reasons behind the variation of Tuberculosis Notification between males and females in the province of Khyber Pakhtunkhwa (KPK), Pakistan. Objectives: 1. To describe the epidemiological characteristics of confirmed TB cases in KPK by age, gender and geographical location between 2002 and 2010. 2. To determine the risk factors associated with TB in the province of KPK. 3. To assess the knowledge of new diagnosed TB patients. 4. To evaluate the level of knowledge, attitude and practice of physicians working in TB diagnostic centres (TDCs) in KPK. Methods: 1. We retrospectively collected data for all registered TB patients between 2002 and 2010 using data from the National TB Control Programme (NTCP) in KPK, Pakistan. We analysed the data to show the distribution of TB by age, gender, type of disease, geographical location and treatment outcome. 2. We carried out a cross-sectional study from 1st July 2012 to 30th September 2012, identifying newly diagnosed TB patients from ten districts (five high notification and five low notification districts) in PKP to determine the risk factors associated with the diagnosis of TB and knowledge assessment of TB patients in higher versus lower notification districts. 3. We carried out a cross sectional study of a sample of general practitioners in these districts to assess their knowledge and management of TB cases. Results: Through a descriptive analysis of nationally collected data, we confirmed that female patients in KPK were at a higher risk of contracting TB compared to males. We determined that the majority of female patients in higher notification districts were illiterate, unemployed, poor and living in households of low socioeconomic status when compared to women from low notification districts. A strong association was noted for the interaction between education and gender (OR = 0.16), suggesting that more educated women were around 6 times less likely to be in a higher notification area (1/0.16) compared to a low notification area. It was also observed from the logistic regression model that income level (OR = 0.42), anaemia (OR = 0.45) and unemployment (Or = 0.23) were also associated with being in a high notification district in the province of KPK. Lower notification districts with female gender were used as reference category for the model. Finally, knowledge of general practitioners about the treatment, follow up and complications of TB was poor. Discussion: Our results suggest that differences in socio-economic factors are implicated in the differential notification of TB between men and women and between high and low notification districts. Poor knowledge of physicians in the treatment and management of TB may also be a contributory factor. This has implications for the future management of TB control programs in these areas and in Pakistan more generally.

Date of Award	1 Aug 2017
Original language	English
Awarding Institution	The University of Manchester
Supervisor	David Baxter (Supervisor), Aneez Esmail (Supervisor) & Mark Woodhead (Supervisor)