Perceived Gender Equitable Norms and Previous Tuberculosis Testing in Malawi: A Secondary Analysis of a Cluster-based Prevalence Survey

Substantial evidence demonstrates that men have a higher prevalence of tuberculosis (TB) and decreased use of TB services compared to women. Gender roles and norms contribute to these disparities by influencing social and structural determinants, as well as individual behaviours. In this analysis, we investigated attitudes towards gender equitable norms and TB testing behaviours amongst Malawian men and women participating in a prevalence survey conducted before a community-based TB active case finding trial in Blantyre. Perceptions of gender norms were captured through a modified version of the Gender Equitable Men Scale (GEMS). Gender inequitable views were prevalent among both men (56.1%) and women (55.8%). The association between a composite GEMS score and TB testing history was modelled using logistic regression, accounting for various sociodemographic covariates (age, sex, wealth quantile, education, and HIV status) (OR = 1.12, 95% CI: 0.88-1.42, p=0.373). Bivariate analysis demonstrated no notable confounding by any covariates and no strong effect modification. While GEMS score had no association with TB testing history among women, men with higher GEMS scores (less gender-equitable views) were more likely to have been tested for TB across age groups. These findings provide a basis for future investigation into the patterns and motives TB behaviours, particularly in older men. Tailored public health strategies may then be implemented to address this important population.