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Patients direct costs to undergo TB diagnosis

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Anderson de Cuevas, Rachel, Lawson, Lovett, Al-Sonboli, Najla, Al-Aghbari, Nasher, Arbide, Isabel, Sherchand, Jeevan B., Nnamdi, Emenyonu E., Aseffa, Abraham, Yassin, Mohammed A., Abdurrahman, Saddiq T., Obasanya, Joshua, Olanrewaju, Oladimeji, Datiko, Daniel, Theobald, Sally ORCID: https://orcid.org/0000-0002-9053-211X, Ramsay, Andrew, Squire, Bertie ORCID: https://orcid.org/0000-0001-7173-9038 and Cuevas, Luis ORCID: https://orcid.org/0000-0002-6581-0587 (2016) 'Patients direct costs to undergo TB diagnosis'. Infectious Diseases of Poverty, Vol 5, Issue 24.

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Abstract

Background
A major impediment to the treatment of TB is a diagnostic process that requires multiple visits. Descriptions of patient costs associated with diagnosis use different protocols and are not comparable.

Methods
We aimed to describe the direct costs incurred by adults attending TB diagnostic centres in four countries and factors associated with expenditure for diagnosis. Surveys of 2225 adults attending smear-microscopy centres in Nigeria, Nepal, Ethiopia and Yemen. Adults >18 years with cough >2 weeks were enrolled prospectively. Direct costs were quantified using structured questionnaires. Patients with costs >75th quartile were considered to have high expenditure (cases) and compared with patients with costs <75th quartile to identify factors associated with high expenditure.

Results
The most significant expenses were due to clinic fees and transport. Most participants attended the centres with companions. High expenditure was associated with attending with company, residing in rural areas/other towns and illiteracy.

Conclusions
The costs incurred by patients are substantial and share common patterns across countries. Removing user fees, transparent charging policies and reimbursing clinic expenses would reduce the poverty-inducing effects of direct diagnostic costs. In locations with limited resources, support could be prioritised for those most at risk of high expenditure; those who are illiterate, attend the service with company and rural residents.

Item Type: Article
Subjects: WA Public Health > WA 30 Socioeconomic factors in public health (General)
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WF Respiratory System > Tuberculosis > WF 200 Tuberculosis (General)
WF Respiratory System > Tuberculosis > WF 220 Diagnosis. Prognosis
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1186/s40249-016-0117-x
Depositing User: Jessica Jones
Date Deposited: 29 Mar 2016 14:28
Last Modified: 25 Aug 2017 13:11
URI: http://archive.lstmed.ac.uk/id/eprint/5815

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