Inequalities in Access to Tuberculosis Services in South Africa: Does Gender Matter?
Bibliographic record
Abstract
Abstract Background: Tuberculosis (TB) remains the leading cause of death in South Africa. As an infectious respiratory disease, control of TB includes antibiotic treatment over a number of months in order to cure the disease and reduce transmission to others. The need to adhere to treatment over an extended period highlights the importance of reducing access barriers to TB services. While gender related access barriers have been identified as critical in the treatment and control of other conditions such as Human Immunodeficiency Virus (HIV), no quantitative analyses currently exist that assess the gender-related dimensions of access to TB services in South Africa. Methods: This study aims to assess the gender-based differences in access to TB services in South Africa, from the perspective of TB patients. Using a comprehensive framework where access is defined as the opportunity to use services, we interviewed 1,229 TB patients using services in four provinces of South Africa. Comparisons of access barriers and adherence between men and women were examined using multivariate linear and logistic regressions.Results: There was no significant association between levels of adherence and gender (all p-values>0.05). Among availability-related variables, men spent significantly less time at the clinic to fetch TB medication compared with women (coefficient, -7.06; 95% CI, [-13.5, -0.7]). Regarding affordability, men were significantly less likely to receive a disability grant (AOR, 0.48; 95% CI, [0.36, 0.63]). Concerning the acceptability dimension, men were less likely to report that queues to visit a healthcare provider were too long or the cleanliness of the facility to be sub-standard (AOR, 0.69; 95% CI, [0.52, 0.91], and AOR, 0.67; 95% CI, [0.46, 0.97], respectively). Conclusions: Our findings indicate that there is no association between the level of adherence to TB treatment and gender. Moreover, there was no evidence of systematic gender-based inequalities in access to TB services. However, the findings reveal concerns about the condition and cleanliness of health facilities that may impact the patients' adherence and be a barrier, specifically, in women's use of TB services.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".