Households experiencing catastrophic costs due to tuberculosis in Uganda: magnitude and cost drivers
Households experiencing catastrophic costs due to tuberculosis in Uganda: magnitude and cost drivers
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DOI：
10.1186/s12889-020-09524-5
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发表时间：
2020-09-16
影响因子：
4.5
通讯作者：
Kirenga, Bruce
中科院分区：
文献类型：
--
作者：
Muttamba, Winters;Tumwebaze, Racheal;Kirenga, Bruce
背景乌干达的结核病患者在寻求和接受医疗保健的同时，承担了与疾病相关的大量费用。这些费用造成了获得和遵守的障碍，影响了健康结果，增加了疾病的传播。该研究确定了乌干达结核病影响的家庭承担灾难性成本和主要成本drivers.MethodsA横断面调查与回顾性数据收集和预测的比例在2017年进行。共有1178耐药（DR）结核病（44）和药物敏感（DS）结核病患者（1134），2周进入密集或连续治疗阶段的67个随机选择的结核病治疗facility.ResultsOf 1178受访者，62.7%是男性，44.7%的年龄在15- 34岁，55.5%是HIV阳性。对于每一次结核病发作，患者平均花费396美元用于DS-TB发作，3722美元用于耐多药结核病（MDR TB）发作。高达48.5%的家庭通过借贷、使用储蓄或出售资产来支付这些费用。超过一半（53.1%）的结核病影响的家庭经历了结核病相关的费用超过20%的家庭年度支出，与主要的成本驱动因素是非医疗支出，如旅行，营养补充剂和food.ConclusionDespite免费医疗保健在公共卫生设施，超过一半的乌干达结核病影响的家庭经历灾难性的成本。推出结核病援助方案、保险计划等社会保障干预措施，并通过国家结核病规划中心参与的多部门行动计划执行与社会保障有关的立法，将减轻这些成本。
BackgroundTuberculosis (TB) patients in Uganda incur large costs related to the illness, and while seeking and receiving health care. Such costs create access and adherence barriers which affect health outcomes and increase transmission of disease. The study ascertained the proportion of Ugandan TB affected households incurring catastrophic costs and the main cost drivers.MethodsA cross-sectional survey with retrospective data collection and projections was conducted in 2017. A total of 1178 drug resistant (DR) TB (44) and drug sensitive (DS) TB patients (1134), 2weeks into intensive or continuation phase of treatment were consecutively enrolled across 67 randomly selected TB treatment facilities.ResultsOf the 1178 respondents, 62.7% were male, 44.7% were aged 15-34years and 55.5% were HIV positive. For each TB episode, patients on average incurred costs of USD 396 for a DS-TB episode and USD 3722 for a Multi drug resistant tuberculosis (MDR TB) episode. Up to 48.5% of households borrowed, used savings or sold assets to defray these costs. More than half (53.1%) of TB affected households experienced TB-related costs above 20% of their annual household expenditure, with the main cost drivers being non-medical expenditure such as travel, nutritional supplements and food.ConclusionDespite free health care in public health facilities, over half of Ugandan TB affected households experience catastrophic costs. Roll out of social protection interventions like TB assistance programs, insurance schemes, and enforcement of legislation related to social protection through multi-sectoral action plans with central NTP involvement would palliate these costs.