As Covid-19 cases keep rising in the country, a pattern is emerging: a disproportionately high number of men are being infected.

At the beginning of April, truck drivers and their associates (turn boys, off-loaders, and delivery men) were a risk factor in the spread of the disease. Now, however, with the number of community transmissions rising, the same pattern is persisting.

On August 31, statistics on the Uganda Covid-19 Response Info Hub showed that the country has 3037 cumulative coronavirus cases. Of those who were still hospitalised, 85.2 per cent (950) were men, while 14.8 per cent (165) were female.

Last month, Mr George Bagala, an accountant working in Kampala, tested positive for the coronavirus. Like many who have recently tested positive, Bagala was surprised at the results.

I rarely go downtown, and I always wear a mask in public. But I remember, at the beginning of the month I visited a friend. When I entered his office, I removed my mask. My friend had flu and he was drinking lemon tea. It was a hot afternoon and the air conditioner was on, he says.

Downtown Kampala, with its open air markets, shopping arcades, and business hubs, is a hotspot for the virus because of overcrowding and lax adherence to the wearing masks and social distancing.Two days later, an ambulance ferried Bagalas friend to Mulago National Referral Hospital after he tested positive for Covid-19.

By then, I was not well. I had a feeling of blood rushing to my head all the time. I was fatigued all the time, had muscle aches and pain in my eyes. But I put this down to stress, until my wife advised me to take a test, he says.After a mass test at his workplace, Bagala and 10 of his male workmates tested positive for the virus. Role of gender in mortality and morbidity according to a paper, Gender Differences in patients with Covid-19: Focus on Severity and Mortality, published in April 2020 on Frontiers in Public Health, of the 2,442 people who died on the Chinese mainland from the coronavirus, two-thirds were men.

The World Health Organisation Covid-19 weekly surveillance report indicates that 63 per cent of the Covid-19 related deaths in Europe have been among men. The study also adds that according to clinical classification of severity, men tended to develop more serious cases than women.Dr Monica Musenero, the senior presidential advisor on epidemics, says these statistics are being replicated all over the world.

It is a global fact that Covid-19 is infecting and killing more men than women. We dont know why, but in Uganda we are looking at different reasons. It could be that men have more core morbidities (other chronic diseases), or it could be age or genetics. By mid September, we will have a desegregation of the data from the community transmission cases, she says.

Men more exposedStatistics from the Response Info Hub show that the most affected age group were those between 30 and 39, closely followed by those in the 20 and 29 age group.For instance, by August 31, 350 men aged between 30 and 39 had been infected with the virus, yet only 35 women in the same age group had been affected.

In the 20 to 29 age group, 268 were men while 71 were female. By the same date, 17 men had died from Covid-19 compared to nine women.Dr Alex Ndyabakira, an epidemiologist with Uganda Public Health Fellowship Programme, says more men are infected by virtue of being breadwinners.

The 20 to 39 age group is a mobile population. Men are the majority in the open struggle for survival because they work away from home. You will find that most people in Kikuubo (business hub) and taxi parks are young men. The women in this age group are in their child-bearing years and they tend to be stay-at-home mothers or work in less risky places, he says.Dr Ndyabakira adds that the risk of exposure through travel cannot be under looked.

Public transport is a risk factor. How many taxi drivers and conductors are women? Even the length of exposure matters. A passenger is less likely to be infected than the conductor who spends the entire day in the taxi. Besides, we are in a political season, and most people gathering in rallies and political meetings are men, he added.

It is also true that the majority of rapid response health workers and burial teams are men. Both occupations are high risk factors for contracting the virus.

However, Ivan Bamweyana, a member of the Kampala Capital City Authoritys Covid-19 taskforce, says in the medical profession more women have been impacted.

Many female nurses are on the frontlines, treating people who have tested positive. We cannot conclusively say men are more exposed because we do not yet have the statistics on which people are being tested. If you are testing more men because they are the ones in the trading centre, it is obvious more men will turn up positive, he says.

A man without a mask buys bananas from a street vendor without a mask near Jinja Road traffic lights on August. PHOTO | KELVIN ATUHAIRE

Poor medical seeking behaviourGenerally, as a nation, voluntary health seeking behaviour is still a challenge. For many men, going to hospital is a sign of weakness.

When a woman has a persistent headache, she will go to a clinic for treatment. On the other hand, a man will take a panadol and dismiss the disease. But even if he goes to hospital, when he is referred to another hospital, he is less likely to comply with the referral, Dr Musenero says.It could also be that because of poor health seeking behaviour, most men are not aware of underlying medical conditions they might have that could predispose them to the virus.

Women, on the other hand, during their childbearing years always get maternity reviews that bring these conditions to light.Bamweyana says women have a more responsible attitude towards the coronavirus.

Women having a better health seeking behaviour compared to men. As a result, they tend to take Covid-19 related messaging very seriously. Men, though, will tend to think that Covid-19 is nothing to them. I have heard people say that they have survived being shot at or have lived through hellish situations and survived, so how can Covid-19 affect them. They think it is a simple flu, he says.

Risky lifestylesPoverty and neglect for a healthy lifestyle have seen many Ugandans unable to eat a balanced diet. One of the keys to fighting the virus is to boost immunity levels by eating fruits and vegetables.

In an effort to maintain a minimum weight or to lose weight, a number of women in the most affected age group (20-39) will try to maintain healthy lifestyles, which includes eating lots of fruits and vegetables.Covid-19 affects the respiratory system and lifestyle behaviour such as smoking that impact lung health are more predominant in men.

In Uganda, smoking is largely a male habit. The Global Adult Tobacco Survey: Country Report 2013 showed that 7.9 per cent of adults in Uganda aged 15 and above (1.3 million) use tobacco products. The rates are higher among males than women, with 11.6 per cent of men and 4.6 per cent of women using tobacco products.

According to a WHO publication, although there are currently no peer-reviewed studies that directly estimate the risk of hospitalisation with Covid-19 among smokers, 27 observational studies found that smokers constituted 1.4 per cent to 18.5 per cent of hospitalised adults.

The studies done in Europe have not been conclusive. However, smoking is a sever risk factor for any respiratory disease, but even with that, if you have a male smoker and a female smoker, the man is likely to die from Covid-19 than the woman, Dr Musenero says.

Another reason could be that women are more likely than men to adhere to wearing masks. Because of high testosterone levels, men are alpha risk takers and tend to believe they cannot be infected with the virus.

The psychological effectAlthough a conclusive study is yet to be done, the effects of the lockdown and the subsequent downward economic effect seem to be affecting more men than women. Since July, seven men between the ages of 29 and 40 have been known to have committed suicide.

Dr Musenero says this is because women cope better than men when it comes to stress.Men tend to want to work through their problems and show that they are in charge. A woman, on the other hand, will call up a friend, narrate her problems, cry about it and will feel better. Ordinarily, a man would go to a bar to socialise with friends but now, those places are closed, she says.

The way forwardSince the data is still being analysed, there is no guarantee that broadcast messages targeted at men will change the trend.A proper data analysis must be done before a message targeting men can go out. Otherwise, you might cause relaxation of the standard operating procedures among women, Bamweyana says.

Another disturbing detail that is being analysed, according to Dr Musenero, is that most of those who have died never reaced the stage of needing a ventilator, as has been the case in Europe and the USA. Here, the progression from flu and cough to respiratory distress has been alarmingly quick less than five days.

It is a global fact that Covid-19 is infecting and killing more men than women. We dont know why, but in Uganda we are looking at different reasons. It could be that men have more core morbidities (other chronic diseases), or it could be age or genetics. By mid September, we will have a desegregation of the data from the community transmission cases, Dr Monica Musenero, the senior presidential advisor on epidemics.

Many female nurses are on the frontlines, treating people who have tested positive. We cannot conclusively say men are more exposed because we do not yet have the statistics on which people are being tested. If you are testing more men because they are the ones in the trading centre, it is obvious more men will turn up positive, Mr Ivan Bamweyana, member of KCCA Covid-19 Taskforce,

gnantume@ug.nationmedia.com

See more here:
Covid-19 taking a greater toll on men than women - reports - Daily Monitor

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