Elsevier

Health Policy

Volume 58, Issue 1, October 2001, Pages 69-81
Health Policy

Fear and social isolation as consequences of tuberculosis in VietNam: a gender analysis

https://doi.org/10.1016/S0168-8510(01)00143-9Get rights and content

Abstract

Setting: the study was conducted in four districts in different regions of Vietnam. Objective: to describe the socio-economic consequences of tuberculosis (TB) in Vietnam with special reference to gender differentials concerning social stigma and isolation. Design: sixteen focus group discussions were carried out with men and women, TB patients and non-TB participants. Data was analysed using modified grounded theory technique. Results: generally, the participants had good knowledge about TB. However, knowledge and practice were not closely related in the sense that most non-TB participants perceived that TB can be successfully cured, while patients were seriously shocked when they were told that they had TB. Male patients often worried about economic-related problems, while female patients worried about social consequences of the disease. Both in the family and the community, isolation could be subtle, but it could also be obvious and had a tendency to continue much longer than medically justified. Conclusion: information on stigma and isolation due to TB and gender differences is important for understanding patient dynamics and its effects on the disease. Tuberculosis control programmes need better understanding of the gender differences in attitudes and beliefs to improve case-detection and treatment outcome.

Introduction

Approximately one-third of the world's population is infected with Mycobacterium tuberculosis and three million people die every year due to tuberculosis (TB) [1]. In Vietnam, TB is one of the leading causes of death among adults and adolescents [2]. In 1999 alone, 88 946 TB cases were detected (115/100 000) of whom two-thirds were men and only one-third are women [2]. Similarly, among TB cases notified to the WHO every year, the ratio of female to male is 1/1.5–2.1, and it is unclear why more males than females are diagnosed with TB [3]. However, although the number of cases of TB is higher among men, the TB case fatality rate seems to be higher among women [4].

It is noted that in industrialised societies men die earlier than women, but women report poorer health than men do [5]. It has increasingly been recognised that women often receive inadequate health care. Women use qualified health services less than men, probably because women do not recognise their needs or find it difficult to overcome social and cultural barriers in relation to seeking health care [6]. In addition, women in developing countries often have lower socio-economic status and reduced access to economic resources, lower education and less information than men. Unfortunately, gender differences in health and health care seeking behaviour, including for TB, in developing countries have, until recently, received little attention from researchers, health programmes and international development efforts [7], [8], [9].

Due to its effect on physical appearance and the social stigma attached to it, TB is likely to have adverse consequences particularly for women [10]. The fear and stigma associated with TB seems to have a greater impact on women than on men, often placing them in an economically or socially precarious position [11]. Factors such as socio-economic and nutritional status, health seeking behaviour and access to health care, which differ considerably between women and men, may influence the prevalence and prognosis of TB and its social consequences. In many cultures, the largely unmarked social stigma of TB contributes to lengthy delays in seeking professional care and abandonment of treatment [12]. However, it is not clear how the stigma of TB influences the health seeking process, household health behaviour and social support [13].

This article describes beliefs, attitudes and perception of people regarding socio-economic consequences of having TB in Vietnam with special reference to gender differentials concerning social stigma and isolation. The following questions are addressed: How do patients feel when the TB diagnosis is disclosed to them? What are the main concerns of men and women suffering from TB? What changes take place in the relationship between the patient and the spouse, family members, relatives, friends and society? How can social stigma and isolation be described? Finally, how can socio-economic consequences of TB affect control of the disease?

Section snippets

Study populations and methods

The study was carried out in four districts of four provinces in Vietnam (Hanoi, Quang Ninh, Ho Chi Minh City and Quang Nam-Da Nang). These districts were purposively selected from different regions of the country, e.g. urban and rural areas, southern and the northern part of the country. Each urban district has a population of around 200 000 inhabitants. Small trading and selling manual labour are the major occupations in the urban districts. Each rural district has a population of about 150

Results

Participants’ understanding of TB was generally in agreement with biomedical knowledge. Most of them described TB as a contagious and dangerous disease that could be transmitted through patient contact. They perceived that TB could affect all people, especially the poor who worked hard and had low living standards. Three major themes regarding social consequences of having TB were identified and will be presented in this article, (i) initial reaction to a TB diagnosis; (ii) economic burden of

Discussion

This qualitative study has provided specific information on beliefs and perceptions of men and women with and without TB, on the socio-economic consequences of TB in Vietnam. The difference in perception and beliefs between men and women is considerably influenced by the roles of women in the family and the social contexts [16]. In Vietnam, the female subordination in the family is mainly rooted in their subordinate economic roles [17]. In rural areas, men most often are active in farming, and

References (29)

  • P.J. Dolin et al.

    Global tuberculosis incidence and mortality during 1990–2000.

    Bulletin of World Health Organisation

    (1994)
  • MOH, Health statistic yearbook 1999. Hanoi: Ministry of Health;...
  • J.A. Kumaresan et al.

    Tuberculosis

  • P. Key

    Women, health and development, with special reference to Indian women

    Health Policy and Planning

    (1987)
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