The Role of Gender in Seeking Care for Neglected Tropical Diseases

Gender plays a pivotal role in the prevalence, transmission, and exposure to diseases, especially for neglected tropic diseases. As a result, public health and health care efforts must account for the role of gender when working to prevent and intervene in the chain of transmission. Unfortunately, there has been little focus on how these gender-related factors impact health-seeking behaviors.

However, a recent study highlighted the role of gender and related challenges for those seeking treatment for neglected tropical diseases. Interviewing 20 people in Ethiopia, the research team focused on 5 neglected tropical diseases (NTDs): lymphatic filariasis, podoconiosis, schistosomiasis, soil-transmitted helminth infection, and trachoma. When compared to men, we know that women are disproportionately impacted by NTDs as well as poverty, illiteracy, lower education, and social status.

The research team highlighted these factors and the interaction between gender and NTDs, but point to a gap in how we understand the role of gender and its impact on seeking medical care for such diseases. Pointing to studies that highlighted how women’s “experiences of physical impairments from NTDs exacerbate existing socio-cultural and economic inequalities”, it is critical to understand the barriers for early diagnosis and care.

From 2017 to 2018, the research team worked with the Ethiopian Federal Ministry of Health and the Regional Health Bureau to understand this problem within the aforementioned 5 NTDs. Conducted in a rural administrative office, inclusion criteria for a designated health center included access to electricity and clean water, availability of rooms, reported cases of the specific NTDs, etc.

Of the six health centers in the study area, only 1 met criteria for inclusion in the study and interviews thus began with health workers and laboratory staff. Interviewees included health workers (pediatrics, outpatient), nurses, health officers, laboratory technicians, health management information systems focal person, physicians, among others.

What the team found was fascinating. The health workers noted that women face additional challenges when seeking care and often only seek care in the later stages of the disease. Researchers noted some of the statements that were telling of the reality:

• “If the disease is around the genital area, they are afraid of talking with men. And sometimes diseases around women’s womb are not easily identified because women hide the disease fearing their secret may be revealed.” P01, female HEW, interview
• “You know, there are people who are affected by urinary diseases. A lot of people are affected by those diseases and some even had surgery. Even I am affected by this disease. You see, the disease very much exists in the community, but no one dares to speak frankly about it. People do not talk about it with others, especially when the disease is related to the genital area. They hide the disease from the people around them.” G12, male community member, FGD
• “For people with swollen testicles, it would be better to train males to educate those men. I’m afraid that will not be practical for us. It would be better to educate some men together with us. It is important to identify people with this problem through them. Because they may hide their problems from us women—they may hide the swelling.” E18, female HDA leader, FGD
• “I think people are afraid and they can only talk about the disease when they are at the hospital. So I’m worried that if the person affected by those diseases is a man, they will not tell the [female] Health Development Army member and she won’t be able to identify those cases easily.” G12, male community member, FG
• “The patient was female and the doctor was male. She was ashamed, tried to cover herself with a cloth, and she was talking more with me than with the doctor.” B06, female nurse, hospital, interview

The research team also noted the power dynamics and the unequal gender role relations when it comes to seeking care. They report that women are less likely to seek care or seek it later than men. The gender power dynamics of needing to ask their husbands for permission to disclose their disease or seek care, economic dependency, threat of violence if they disclose their symptoms, and social stigma.

Overall, they found that health care workers continued to state how women face additional challenges in seeking medical care, from both power dynamics and access to services. The full research study can be found in PLOS Neglected Tropical Diseases, but should be another reminder of how gender can greatly impact not only access to care, but willingness to seek it out. More health initiatives, especially for NTDs, should take this into consideration and be proactive in their approaches.