Gender Disparities in Tuberculosis Outcomes in the West and North Regions of Cameroon: A Retrospective Cohort Study 2010-2015
Disparités de Genre dans l'Évolution de la Tuberculose dans les Régions de l'Ouest et du Nord du Cameroun : Une Étude de Cohorte Rétrospective 2010-2015
DOI:
https://doi.org/10.5281/zenodo.19074950Keywords:
Tuberculosis, Gender Specific Outcomes, Predictors, Cameroon, HIV Co infectionAbstract
ABSTRACT
Introduction. Gender disparities persist in tuberculosis (TB), with a male predominance often reported. Few studies have analyzed sex-specific prognostic factors in sub-Saharan Africa. This study aimed to determine the male-to-female ratio, incidence, and predictors of poor TB outcomes by gender in two regions of Cameroon. Methods. A retrospective cohort included all patients aged 15 years and over registered in TB diagnosis and treatment centers in the West and North regions from 2010 to 2015. After sex stratification, multinomial logistic regression identified independent factors associated with loss to follow-up and death. Results. Of 19,681 included patients, 63.7% were male (sex ratio 1.7:1). Median age was 34 years in men versus 32 years in women (p < 0.001). Loss to follow-up incidence was significantly higher in men [3.4% vs. 1.8%, p < 0.001], while mortality was similar [7.7% vs. 8.5%, p = 0.097]. In multivariate analysis, independent factors associated with loss to follow-up in men were: age <34 years [OR 1.70], underweight [1.70], smear-positive pulmonary TB [3.62], retreatment [3.60], referred patients [2.44], and starting treatment before 2012 [1.52]. In women, only starting treatment before 2012 was predictive, and obesity was protective [0.25]. Factors associated with mortality in men were: age >34 years [2.07], underweight [2.07], extra-pulmonary TB [2.21], HIV infection [4.58], West region [2.59], and treatment before 2012 [1.24]. In women, the same factors predicted mortality, except age and extra-pulmonary TB, with overweight/obesity being protective [0.60]. Conclusion. The male-to-female TB ratio is 1.7:1 in the West and North regions of Cameroon. Men have a higher risk of loss to follow-up, while mortality is comparable between sexes. Reinforced counseling and tailored follow-up for men could reduce loss to follow-up. TB control programs should integrate these gender differences to optimize management.
RÉSUMÉ
Introduction. Les disparités de genre dans la tuberculose (TB) persistent, mais peu d'études ont analysé les facteurs pronostiques spécifiques au sexe en Afrique subsaharienne. Cette étude a déterminé le ratio homme/femme, l'incidence et les prédicteurs de l'évolution défavorable selon le genre dans deux régions du Cameroun. Méthodes. Cohorte rétrospective incluant tous les patients ≥15 ans enregistrés dans les centres de diagnostic et de traitement de la TB des régions de l'Ouest et du Nord (2010-2015). Après stratification par sexe, une régression logistique multinomiale a identifié les facteurs associés à la perdue de vue et au décès. Résultats. Sur 19 681 patients, 63,7 % étaient des hommes (sex-ratio 1,7). Âge médian : 34 ans (hommes) vs 32 ans (femmes), p < 0,001. La perdue de vue était plus élevée chez les hommes (3,4 % vs 1,8 %, p < 0,001), la mortalité similaire (7,7 % vs 8,5 %). Chez les hommes, les facteurs de perdue de vue étaient : âge <34 ans, dénutrition, tuberculose bacillifère, retraitement, patient référé et traitement avant 2012. Chez les femmes, seul le traitement avant 2012 était prédictif, et l'obésité était protectrice. Les facteurs de mortalité chez les hommes étaient : âge >34 ans, dénutrition, tuberculose extra-pulmonaire, VIH, région Ouest et traitement avant 2012. Chez les femmes, les mêmes facteurs prédisaient la mortalité (sauf âge et forme extra-pulmonaire), avec un effet protecteur du surpoids/obésité. Conclusion. Le ratio homme/femme de la TB est de 1,7 dans les régions étudiées. Les hommes ont un risque plus élevé de perdue de vue, justifiant un conseil renforcé et un suivi adapté. Les programmes doivent intégrer ces différences de genre.
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Copyright (c) 2026 Balkissou Adamou Dodo, Endale-Mangamba Laurent Mireille, Kuaban Alain, Poka-Mayap Virginie, Nsounfon Abdou Wouoliyou, Pefura-Yone Eric Walter
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