1. Gender differences in access to treatment and caring for TB in poor households Luhanga T 1, Chilimampunga C 2, Salaniponi FML 3, Squire SB 1,4, Kemp J 1,4 KEY FINDINGS Access to and Control over Resources  Most respondents said women do most domestic activities which take up most of their ‘free’ time  Most men spend more time on income activities; have more cash and have more influence over decision-making on household resources  Married female patients rely on husbands for cash for care seeking Costs for Accessing Care (for patients)  Financial costs (transport, consultation, food) were higher for male patients  Some care providers delayed referral, increasing patients’ financial costs  Time spent for care seeking was higher for most female patients Costs of Providing Care (for guardians)  Women are care providers at household level  Female children replace women’s activities as carers at household level  For women caring activities get added on household and other activities  Most female guardians reported taking up income generating activities to support patients Impact of TB illness  Most patients said TB has a negative impact on them and their and families.  Incomes decrease, activities increase, marriage prospects decrease  The strong link between HIV/AIDS and TB results in patients (especially female) being shunned  TB illness has great impact on guardians in terms of activities, income and children’s school attendance “Some people say that people should not chat with me because I have AIDS and when they breathe they may inhale the disease. So when I go in a group, for example to chat, instead of people greeting me, they just stare at me. So to avoid that I don’t go anywhere”(002MFP). “Men have authority over the income in the house even where women are doing small income generating activities and bring income…you should not forget that the house in which this woman stays is not hers...and the owner of the house will control all the resources in the house” (9FGDMW) CONCLUSION Women carry greatest burden of care for TB within household Women have fewer resources to access care Men have more decision-making power over resources High costs may pose greater barriers for women to access TB care The differences in time, costs and impact of TB care on men and women in Malawi, may contribute to the observed differences in case notifications for TB “For three months I was getting a packet of Bactrim which I would take for 3 days. He [‘the doctor’] would come again and ask how I felt. I said there was no change and started giving me Chloramphenical. He would inject me Chloramphenical and give me Bactrim for another 3 days. He would also give me some tablets for malungo (malaria). Each time he came he was charging K200 for injection and K100 tablets…. I did that for 3 months” (002MFP) AIM To assess if there are gender differences in costs incurred in the process of care seeking and care provision at household level OBJECTIVES  To explore men’s and women’s access to and control over resources for care-seeking;  To assess costs incurred by patients and guardians during care-seeking;  To assess the social and economic impact of TB illness Address: 1 EQUI-TB Knowledge Programme, Lilongwe, Malawi 2 University of Malawi, Chancellor College, Zomba, Malawi. 3 National TB Control Programme, Lilongwe, Malawi. 4 Liverpool School of Tropical Medicine, Liverpool, UK. METHODOLOGY STUDY SITE: Ntandire – poor urban community Lilongwe, Malawi METHODS: Qualitative Methods 18 Focus Group Discussions 30 Individual Interviews 3 Case Studies Total Respondents = 236 Each FGD = 8-10 participants Patients 4 unmarried men 4 married men 4 married women 4 unmarried women 3 Male guardians 4 Female guardians 7 Key informants (grocers, private practitioners, traditional healers) “I was staying with my in-laws after my husband had just died. Usually when I go to the hospital, they would eat, when I come back there would be no food. I would just stay hungry that day. I couldn’t do anything to raise money because I was very sick… Later my mother in-law told me to go back to my house. After I asked her what I would be eating, she said that I would still be eating at her house but when I was coming she packed all my things and put in some maize flour. I just knew that was a way of telling me that I should be on my own and cooking on my own” (025UFP). The Malawi Equi-TB Knwloedge Programme is a collaboration between: Liverpool School of Tropical Medicine, National TB Programme, Malawi and Department of Sociology, University of Malawi Funded by the Department for International Development (DFID), UK Community Members 4 groups of married men 4 groups of unmarried men 6 groups of married women 4 groups of unmarried women Patients 2 Female patients & spouse 1 Male patient & and spouse Example of a Focus Group Discussion session with community members Facilitator (TL) Observer BACKGROUND  Gender differences are observed in notified TB cases (Hudelson, 1996)  Observed differences may be due to differential access to care and support (Kutzin, 1996)  Many costs are incurred in the process of accessing and providing care for TB (Gibson et al 1998)  In Malawi there are more notified TB cases for male patients (52% male and 48% female – 1999)  The difference might be attributed to the differential access to resources for care seeking