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It has been recognised that TB is now the single biggest infectious killer of women in the world.

Data from the World Health Organisation (WHO) confirms that tuberculosis is the leading cause of death among women of reproductive age:

Over 900 million are infected with TB world-wide. TB accounts for 9% of deaths world-wide among women aged between 15 and 44.

In 1996, a study by the World Bank, WHO and Harvard University reports tuberculosis as a leading cause of 'healthy years lost' among women of reproductive age:

8.7 million 'disability adjusted life years' were lost as a result of tuberculosis compared with 8.5 million due to sexually transmitted diseases, 3.6 million due to HIV, 2.3 million due to diarrhoea diseases and 2 million due to malaria.

Women of reproductive age once infected with tuberculosis are more susceptible to sickness than men of the same age. Women in this age group are also at greater risk of becoming infected with HIV. As a result, in certain regions of Africa, young women with tuberculosis out-number young men with the disease. Yet, tuberculosis is curable and preventable!

Several studies have indicated that as a result of a combination of various cultural, social and economic factors, especially in low income countries, women often have difficulties in accessing health care. Therefore by the time they attend clinics, their disease is already at a very advanced stage.

Following an international research meeting on tuberculosis and gender in Sweden last year, specific research studies have been recommended in order to study the impact of tuberculosis on women.

There is also a need to recognise and study the vital contribution of women to the treatment and control of this disease. Women have long been key elements in the care and management of tuberculosis, not only in their own families but also in the wider community. For example, in low income townships in Zambia a large number of women volunteers are involved in running innovative 'home based community care' programmes. This service integrates tuberculosis and HIV/AIDS care, control and prevention. In addition to their demanding role as home care volunteers, most of these women are already directly affected by the dual epidemic of TB and HIV/AIDS. For example they care for chronically ill family members or relatives, or take orphans into their own family1. Again, in an industrial town in South Africa, local women joined forces - using all races, churches, social classes, businesses, the local health department and voluntary organisations - and developed a programme which has become a showcase, demonstrating to the rest of the country how effectively to control TB2.

Therefore, on a global level, programmes for tuberculosis control must understand and respond especially to the needs of women - in order to promote health and to reduce possible unequal access to health care..

(1) Under the Mupundu Tree, Strategies for Hope Series, ACTIONAID, TALC. (2) TB: A Crossroads, WHO Report on the Global Tuberculosis Epidemic 1998, WHO. Photos courtesy of the WHO Report on the Global TB Epidemic 1998.