Eastwood S V, Hill P C
Department of Medicine, University of Birmingham, Birmingham, United Kingdom.
Int J Tuberc Lung Dis. 2004 Jan;8(1):70-5.
The Medical Research Council unit in Fajara, The Gambia.
To explore gender differences in care seeking behaviour, access to treatment, and knowledge and perceptions about tuberculosis.
Fifteen government health workers were interviewed to define the scope of the issues involved, then 15 male and 15 female tuberculosis patients were interviewed. Qualitative semi-structured questionnaires were used in health worker and patient interviews. Data were analysed using the thematic framework method. The main themes were compared between male and female patients.
Patients often initially consulted traditional healers and pharmacies. Women used traditional healers more, probably because of stronger traditional beliefs, time constraints and increased confidentiality. Regardless of sex, most patients acknowledged problems affording the transport costs to access treatment. Health workers and patients highlighted negative perceptions of tuberculosis. Lack of knowledge about tuberculosis and stigma were widely reported, and were worst in female patients.
Tuberculosis is a stigmatised disease in The Gambia, particularly in women, and its management is associated with access problems. Health education is required to provide basic knowledge about the disease and to reduce stigma, and further decentralisation of tuberculosis services is needed to improve access.
冈比亚法贾拉的医学研究理事会单位。
探讨在寻求治疗行为、获得治疗的机会以及关于结核病的知识和认知方面的性别差异。
对15名政府卫生工作者进行访谈以界定所涉问题的范围，然后对15名男性和15名女性结核病患者进行访谈。在对卫生工作者和患者的访谈中使用了定性半结构化问卷。采用主题框架法对数据进行分析。对男性和女性患者的主要主题进行了比较。
患者最初常常咨询传统治疗师和药店。女性更多地使用传统治疗师，可能是因为传统观念更强、时间限制以及保密性更高。无论性别如何，大多数患者都承认支付前往接受治疗的交通费用存在问题。卫生工作者和患者都强调了对结核病的负面看法。关于结核病的知识缺乏和污名化现象被广泛提及，在女性患者中情况最为严重。
在冈比亚，结核病是一种受污名化的疾病，尤其是在女性中，并且其管理存在获得治疗方面的问题。需要开展健康教育以提供关于该疾病的基本知识并减少污名化，还需要进一步将结核病服务去中心化以改善获得治疗的机会。
