Tuberculosis is the leading infectious cause of death in women worldwide. The disease poses a major threat to women's health security. Population growth, the HIV epidemic, increasing poverty and rising levels of drug resistance will inevitably increase the burden of this disease in women. Women are at increased risk of progression to disease during their reproductive years. However, in most low-income countries, twice as many men are notified with tuberculosis as women. Biological mechanisms may account for most of this difference but socioeconomic and cultural factors leading to barriers in accessing health care may cause under-notification in women. Tuberculosis control programmes should be sensitive to the constraints faced by women in accessing health care, in order to empower women to commence and complete treatment. The fear and stigma associated with tuberculosis have a greater impact on women than on men, often leaving them in a more precarious social and economic position. Tuberculosis in women creates orphans, impoverished families and reduces the economic development of society. Tuberculosis is a major cause of preventable suffering and death in women. WHO's recommended tuberculosis control strategy, DOTS, represents a cost-effective response to the problem of tuberculosis in women. Tuberculosis is a major women's health issue. It is a global health priority that tuberculosis treatment be made available to women, particularly to those in low-income countries who are bearing the brunt of this epidemic.
PIP: Tuberculosis (TB) kills more women each year than any other infection. Approximately one-third of the world's population is infected with TB, and the greatest burden of disease occurs in those 15-49 years old. TB is the third cause of morbidity and mortality combined in women of reproductive age in developing countries and leads to more deaths in women than maternal mortality. Prevalence of TB is similar in males and females until adolescence, when it increases in males. In high prevalence countries, however, women of reproductive age have higher rates of progression to disease than men in this age group. Gender differentials exist in reporting and diagnosing TB, and passive case finding likely leads to failure to diagnose TB in women. The socioeconomic consequences of TB in women are exacerbated by later presentation, which leads to a poor prognosis. The stigma associated with TB causes women to be divorced or to be unlikely to become married. A study in India found that male patients with TB expected their wives to care for them but infected wives rarely received care. Thus, married women may try to hide their symptoms instead of seeking help. TB in women has an adverse effect on child survival and family welfare. Socioeconomic factors also have an impact on TB control efforts, especially for women who suffer from disproportionate poverty, low social status, less education (which impedes seeking diagnosis), and barriers to health care. Women may find it more difficult to comply with treatment once symptoms subside. Thus, TB control programs should be gender sensitive. The HIV epidemic is also increasing the burden of TB for women, who seem to have a higher risk of developing TB during their reproductive years than that faced by men. TB is a neglected health problem that can be controlled through cost-effective interventions. A lack of political will and inadequate funding remain as obstacles to reducing the burden of TB in women.