• S V Eastwood and P C Hill.
• Department of Medicine, University of Birmingham, Birmingham, United Kingdom.
• Int. J. Tuberc. Lung Dis. 2004 Jan 1; 8 (1): 70-5.

SettingThe Medical Research Council unit in Fajara, The Gambia.ObjectiveTo explore gender differences in care seeking behaviour, access to treatment, and knowledge and perceptions about tuberculosis.DesignFifteen 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.ResultsPatients 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.ConclusionsTuberculosis 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.

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