Gendered risk factors for TB in a pastoralist setting in northern Kenya

There is currently a paucity of research delineating gender-related risk factors for TB in pastoralist societies. Exploring differences in risk factors by gender is important since variation in roles and behavior can differentially effect the development of TB disease in men and women. In order to address this gap and to better inform prevention efforts targeting high-risk groups within these hard-to-reach populations, a case-control study was conducted in two district hospitals in northern Kenya to identify differential risk factors for active TB disease among adult men and women in pastoralist settings. Recruitment for cases and controls was stratified by gender and took place in batches, frequency matching on age. Approximately two controls were recruited for each new adult TB case from within each hospital and structured interviews were conducted among the participants. Results from multivariate logistic regressions indicated there were important similarities and differences in factors associated with TB across gender. For both men and women, lack of livestock, religion, distance to the hospital, TB knowledge, exposure to an indoor fire, nutritional status, and HIV status were associated with TB. Among men, TB was related to history of TB contact and being a current cigarette smoker and miraa chewer. Among women, TB was related to living in a boma (traditional pastoralist housing structure) and brewing alcohol. The role of these results in designing gender-based TB prevention policies and interventions among at-risk men and women in pastoralist populations will be discussed.