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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
The High Cost of Free Tuberculosis Services: Patient and Household Costs Associated with Tuberculosis Care in Ebonyi State, Nigeria
PLoS ONE, Volume 8, No. 8, Article e73134, Year 2013
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Description
Objective:Poverty is both a cause and consequence of tuberculosis. The objective of this study is to quantify patient/household costs for an episode of tuberculosis (TB), its relationships with household impoverishment, and the strategies used to cope with the costs by TB patients in a resource-limited high TB/HIV setting.Methods:A cross-sectional study was conducted in three rural hospitals in southeast Nigeria. Consecutive adults with newly diagnosed pulmonary TB were interviewed to determine the costs each incurred in their care-seeking pathway using a standardised questionnaire. We defined direct costs as out-of-pocket payments, and indirect costs as lost income.Results:Of 452 patients enrolled, majority were male 55% (249), and rural residents 79% (356), with a mean age of 34 (±11.6) years. Median direct pre-diagnosis/diagnosis cost was $49 per patient. Median direct treatment cost was $36 per patient. Indirect pre-diagnostic and treatment costs were $416, or 79% of total patient costs, $528. The median total cost of TB care per household was $592; corresponding to 37% of median annual household income pre-TB. Most patients reported having to borrow money 212(47%), sell assets 42(9%), or both 144(32%) to cope with the cost of care. Following an episode of TB, household income reduced increasing the proportion of households classified as poor from 54% to 79%. Before TB illness, independent predictors of household poverty were; rural residence (adjusted odds ratio [aOR] 2.8), HIV-positive status (aOR 4.8), and care-seeking at a private facility (aOR 5.1). After TB care, independent determinants of household poverty were; younger age (≤35 years; aOR 2.4), male gender (aOR 2.1), and HIV-positive status (aOR 2.5).Conclusion:Patient and household costs for TB care are potentially catastrophic even where services are provided free-of-charge. There is an urgent need to implement strategies for TB care that are affordable for the poor. © 2013 Ukwaja et al.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC3754914/bin/pone.0073134.s001.doc
Authors & Co-Authors
Ukwaja, Kingsley Nnanna
Nigeria, Abakaliki
Federal Teaching Hospital
Alobu, Isaac A.
Nigeria, Abakaliki
Ministry of Health
lgwenyi, Chika
Nigeria, Abakaliki
Federal Teaching Hospital
Hopewell, Philip C.
United States, San Francisco
University of California, San Francisco
Statistics
Citations: 84
Authors: 4
Affiliations: 3
Identifiers
Doi:
10.1371/journal.pone.0073134
e-ISSN:
19326203
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study
Case-Control Study
Study Approach
Quantitative
Study Locations
Nigeria
Participants Gender
Male