SETTING: Chest Clinic, University Teaching Hospital, Zambia. OBJECTIVE: To study the pre-diagnosis economic impact, burden, and barriers to care-seeking for tuberculosis patients in urban Zambia. DESIGN: In-depth interviews conducted over a 9-week period with adult in-patients and out-patients registering with new pulmonary tuberculosis; data analysis using Epi Info. RESULTS: Interviews were completed by 202 patients: 64% normally worked, but 31% stopped due to their tuberculosis, with an average of 48 days off. The mean duration of illness prior to their tuberculosis registration was 63 days, with 64% of patients delaying in presenting to the Chest Clinic. Of these, 38% blamed money shortages for their delay. In seeking diagnosis, patients incurred a mean total cost equivalent to 127% of their mean monthly income (pounds sterling UK 40 [$US 59]); direct expenditures represented 60% of this cost. In addition, patients lost, on average, 18 work days prior to diagnosis. Care-givers incurred costs equivalent to 31% of the mean monthly income (pounds sterling UK 10 [$US 15]). CONCLUSION: The economic burden of tuberculosis on patients creates barriers to prompt diagnosis which may lead to continuing transmission of the infection. Important economic barriers include transportation expenditure, cost of 'special food', and lost income. These barriers may be reduced through interventions that reduce the number of health encounters, travel distances and duration of illness before diagnosis.
SETTING: Chest Clinic, University Teaching Hospital, Zambia. OBJECTIVE: To study the pre-diagnosis economic impact, burden, and barriers to care-seeking for tuberculosispatients in urban Zambia. DESIGN: In-depth interviews conducted over a 9-week period with adult in-patients and out-patients registering with new pulmonary tuberculosis; data analysis using Epi Info. RESULTS: Interviews were completed by 202 patients: 64% normally worked, but 31% stopped due to their tuberculosis, with an average of 48 days off. The mean duration of illness prior to their tuberculosis registration was 63 days, with 64% of patients delaying in presenting to the Chest Clinic. Of these, 38% blamed money shortages for their delay. In seeking diagnosis, patients incurred a mean total cost equivalent to 127% of their mean monthly income (pounds sterling UK 40 [$US 59]); direct expenditures represented 60% of this cost. In addition, patients lost, on average, 18 work days prior to diagnosis. Care-givers incurred costs equivalent to 31% of the mean monthly income (pounds sterling UK 10 [$US 15]). CONCLUSION: The economic burden of tuberculosis on patients creates barriers to prompt diagnosis which may lead to continuing transmission of the infection. Important economic barriers include transportation expenditure, cost of 'special food', and lost income. These barriers may be reduced through interventions that reduce the number of health encounters, travel distances and duration of illness before diagnosis.
Authors: Rebecca L Walcott; Justin B Ingels; Phaedra S Corso; Sarah Zalwango; Christopher C Whalen; Juliet N Sekandi Journal: Glob Public Health Date: 2020-02-06
Authors: M R Baldwin; P P Yori; C Ford; D A J Moore; R H Gilman; C Vidal; E Ticona; C A Evans Journal: Int J Tuberc Lung Dis Date: 2004-12 Impact factor: 2.373
Authors: Julia R Kemp; Gillian Mann; Bertha Nhlema Simwaka; Felix Ml Salaniponi; Stephen Bertel Squire Journal: Bull World Health Organ Date: 2007-08 Impact factor: 9.408
Authors: Merrin E Rutherford; Rovina Ruslami; Melissa Anselmo; Bachti Alisjahbana; Neti Yulianti; Hedy Sampurno; Reinout van Crevel; Philip C Hill Journal: Bull World Health Organ Date: 2013-09-10 Impact factor: 9.408