Killer TB Taking Toll on Afghan Women

When 23-year-old Aziza got married four years ago, she moved into a small Kabul mud house with ten members of her husband’s family. She has rarely seen the sun since.

After spending most of her time in cramped, dark, damp conditions while caring for the menfolk and cleaning the house, the mother of two’s health has deteriorated. Aziza is currently receiving treatment in the capital’s National Tuberculosis Institute, where she is only one of a growing number of Afghan women struck down with this potentially fatal disease.

The brutalities of the Taleban may be a thing of the past, but pulmonary tuberculosis, TB, and the restrictions of Afghanistan’s conservative society are now combining to deadly effect.

The latest statistics from the World Health Organisation, WHO, show women accounted for two thirds of all TB cases in the country between 1997 and 2000. Afghanistan’s health centre and hospital statistics consistently show that female TB patients outnumber males across the country, and their number is steadily increasing.

That women are disproportionately the victims is unusual. In other countries in the region such as India, Pakistan and Bangladesh, only 40 per cent of TB cases are women, and the worldwide figure is as low as 37 per cent.

The Afghan figures have puzzled health experts, but a number of theories have emerged to explain the unusual statistics.

TB is a bacterial infection that attacks the lungs and then spreads to other organs of the body. Although it is fairly easy to cure – requiring multi-drug treatment over a period of six to eight months – it can be deadly if untreated.

The most dangerous form of the disease is the airborne pulmonary TB, which is highly contagious and often attacks people with weakened immune systems. In Afghanistan various social and cultural factors can combine to make women much more susceptible to infection.

Dr Abdul Wodood Hydari, deputy director of Afghanistan’s National Tuberculosis Institute, told IWPR that multiple pregnancies take a heavy toll on women’s stamina, and this can leave them very vulnerable.

Afghani is a 36-year-old TB patient from the Shomali Plains, about an hour north of Kabul. A mother of six, she has also suffered three miscarriages, and she says that this relentless depletion of her body’s resources is the main reason for her illness. “From being a very healthy and strong woman, I am now a skinny person who easily gets sick,” she said.

Childbirth is only one of the burdens on women’s health. Afghanistan also has a long-standing tradition that males must be served first, leaving the female family members to eat what is left over. Women such as Aziza often become exhausted and malnourished, as the demands of home and family often leave them without a proper meal.

“We never have enough food to eat, especially for myself, because I have to serve my husband and his family first,” Aziza told IWPR.

Aziza also shares another complaint with many Afghan women. Her husband and his family are very conservative and rarely let her out of the house. This means that she is at the mercy of others when it comes to seeking health care.

Dr Hydari says that this often delays diagnosis and treatment, increasing the chances that women will spread the disease.

Aside from clinical reasons, the high rate of TB in Afghan women may have something to do with the fact that the country’s population comprises more females than males after more than two decades of fighting, or it could simply be related to how statistics are reported.

In Afghanistan, the public health sector provides the bulk of statistics to the authorities, although the private sector is also a major provider of healthcare. However, women are rarely able to see private practitioners due to poverty and sexual taboos, so they usually report to public clinics.

Dr Nadir Aksir, an Afghan doctor with his own private practice, told IWPR that that he sees more male TB patients than female ones. This is because there is a great stigma attached to having the disease in Afghan society, and most patients are desperate to keep their diagnosis secret.

Given a choice, patients will always choose private treatment over public clinics to ensure their anonymity, and this may have obscured the real statistics even further.

There will be no definitive answers until further studies are undertaken. At the moment, the only indisputable fact is that pulmonary tuberculosis continues to be a major problem in Afghanistan, and once it strikes, it can be a merciless killer of both women and men.

Abdul Mobeen is a freelance journalist based in Kabul