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Gender-based differences in community-wide screening for pulmonary tuberculosis in Karachi, Pakistan: an observational study of 311 732 individuals undergoing screening
  1. Shifa Salman Habib1,
  2. Syed Mohammad Asad Zaidi1,
  3. Wafa Zehra Jamal1,2,
  4. Kiran Sohail Azeemi1,
  5. Salman Khan3,
  6. Saira Khowaja3,
  7. Abdul Khalique Domki4,
  8. Aamir Khan5,
  9. Faiz Ahmad Khan6,7
  1. 1 Community Health Solutions, Karachi, Pakistan
  2. 2 Aga Khan University Hospital, Karachi, Pakistan
  3. 3 Global Health Directorate, Karachi, Pakistan
  4. 4 Provincial TB Program - Sindh, Karachi, Pakistan
  5. 5 Interactive Research and Development, Karachi, Pakistan
  6. 6 Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, Quebec, Canada
  7. 7 McGill International TB Centre, McGill University, Montreal, Quebec, Canada
  1. Correspondence to Dr Faiz Ahmad Khan, Respiratory Epidemiology & Clinical Research Unit, McGill University Health Centre, Montreal, Canada; faiz.ahmadkhan{at}


We describe gender-based differences in a community-wide TB screening programme in Karachi, Pakistan, in which 311 732 individuals were screened in mobile camps using symptom questionnaires and van-mounted digital chest X-ray, between 1 January 2018 and 31 December 2019. Only 22.4% (69 869) of camp attendees were women. Female attendees were less likely to have sputum collected and tested (31.5% (95% CI 30.4% to 32.7%) vs 38.5% (95% CI 37.6% to 39.1%)) or to initiate TB treatment (75.9% (95% CI 68.1% to 82.6%) vs 82.8% (95% CI 78.9% to 86.2%)), when indicated. Among the participants, the age-standardised prevalence of active TB was higher among women (prevalence ratio 1.4, 95% CI 1.1 to 1.7). These findings underscore the importance of integrating gender into the design and monitoring of TB screening programmes to ensure that women and men benefit equally from this important intervention.

  • tuberculosis
  • clinical epidemiology

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  • Contributors Study design: SSH, SMAZ, FAK. Data acquisition: SSH, SMAZ, WZJ, KSA, SKha, AKD, AK. Data analysis: SSH, SMAZ, WZJ, FAK. Wrote the first draft: FAK, SSH, WZJ. Revision of the paper and approval of the final version: all authors.

  • Funding The screening campaign was funded by the Global Fund Against AIDS, Tuberculosis and Malaria via the Indus Health Network. The retrospective study presented in the research letter had no funding.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.