Can Malawi's poor afford free tuberculosis services? Patient and household costs associated with a tuberculosis diagnosis in Lilongwe
Can Malawi's poor afford free tuberculosis services? Patient and household costs associated with a tuberculosis diagnosis in Lilongwe
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DOI：
10.2471/blt.06.033167
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发表时间：
2007-08-01
期刊：
影响因子：
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通讯作者：
Squire, Stephen Bertel
中科院分区：
文献类型：
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作者：
Kemp, Julia R;Mann, Gillian;Squire, Stephen Bertel
目的评估马拉维利隆圭市区穷人和妇女获得结核病诊断的相对成本，在该地区，公共卫生服务可在6公里范围内免费提供。方法从利隆圭市所有公立和教会卫生机构系统抽样调查179名结核病患者，对患者和家庭的直接成本和机会成本进行评估。贫困状况是根据1998年马拉维综合家庭调查（MIHS）确定的。患者在获得结核病诊断时平均花费13美元（996马克或18天的收入），并损失22天的工作时间。对于非贫困患者，总费用占月总收入的129%，即扣除食品支出后的184%。对于穷人来说，这一费用上升到月收入的248%，除去食物后上升到574%。当妇女或穷人生病时，其家庭面临的机会成本更大。结论即使在提供免费服务的情况下，患者和家庭的结核病诊断费用也高得令人望而却步。在扩大结核病服务以实现千年发展目标的过程中，迫切需要确定对穷人及其家庭具有成本效益的结核病诊断战略。
Objective To assess the relative costs of accessing a TB diagnosis for the poor and for women in urban Lilongwe, Malawi, a setting where public health services are accessible within 6 kilometres and provided free of charge.Methods Patient and household direct and opportunity costs were assessed from a survey of 179 TB patients, systematically sampled from all public and mission health facilities in Lilongwe. Poverty status was determined from the 1998 Malawi Integrated Household Survey (MIHS).Findings On average, patients spent US$ 13 (MK 996 or 18 days' income) and lost 22 days from work while accessing a TB diagnosis. For non-poor patients, the total costs amounted to 129% of total monthly income, or 184% after food expenditures. For the poor, this cost rose to 248% of monthly income or 574% after food. When a woman or when the poor are sick, the opportunity costs faced by their households are greater.Conclusion Patient and household costs of TB diagnosis are prohibitively high even where services are provided free of charge. In scaling up TB services to reach the Millennium Development Goals, there is an urgent need to identify strategies for diagnosing TB that are cost-effective for the poor and their households.