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. 2021 Oct;26(10):1248-1255.
doi: 10.1111/tmi.13647. Epub 2021 Aug 3.

Catastrophic costs among tuberculosis-affected households in Zimbabwe: A national health facility-based survey

Collins Timire  1   2   3 , Mkhokheli Ngwenya  4 , Joconiah Chirenda  5 , John Z Metcalfe  6 , Katharina Kranzer  3 , Debora Pedrazzoli  7   8 , Kudakwashe C Takarinda  1   2 , Peter Nguhiu  9 , Geshem Madzingaidzo  1 , Kwenzikweyinkosi Ndlovu  1 , Tawanda Mapuranga  1 , Morna Cornell  10 , Charles Sandy  1
Affiliations

Catastrophic costs among tuberculosis-affected households in Zimbabwe: A national health facility-based survey

Collins Timire et al. Trop Med Int Health. 2021 Oct.

Abstract

Objectives: To determine the incidence and major drivers of catastrophic costs among TB-affected households in Zimbabwe.

Methods: We conducted a nationally representative health facility-based survey with random cluster sampling among consecutively enrolled drug-susceptible (DS-TB) and drug-resistant TB (DR-TB) patients. Costs incurred and income lost due to TB illness were captured using an interviewer-administered standardised questionnaire. We used multivariable logistic regression to determine the risk factors for experiencing catastrophic costs.

Results: A total of 841 patients were enrolled and were weighted to 900 during data analysis. There were 500 (56%) males and 46 (6%) DR-TB patients. Thirty-five (72%) DR-TB patients were HIV co-infected. Overall, 80% (95% CI: 77-82) of TB patients and their households experienced catastrophic costs. The major cost driver pre-TB diagnosis was direct medical costs. Nutritional supplements were the major cost driver post-TB diagnosis, with a median cost of US$360 (IQR: 240-600). Post-TB median diagnosis costs were three times higher among DR-TB (US$1,659 [653-2,787]) than drug DS-TB-affected households (US$537 [204-1,134]). Income loss was five times higher among DR-TB than DS-TB patients. In multivariable analysis, household wealth was the only covariate that remained significantly associated with catastrophic costs: The poorest households had 16 times the odds of incurring catastrophic costs versus the wealthiest households (adjusted odds ratio [aOR: 15.7 95% CI: 7.5-33.1]).

Conclusion: The majority of TB-affected households, especially those affected by DR-TB, experienced catastrophic costs. Since the major cost drivers fall outside the healthcare system, multi-sectoral approaches to TB control and linking TB patients to social protection may reduce catastrophic costs.

Keywords: Zimbabwe; financial protection; patient cost; social protection; tuberculosis; universal health coverage.

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Conflict of interest statement

Competing interests

The authors declare they have no competing interests

Figures

Figure 1:
Figure 1:
Flow of patients who were enrolled in the Zimbabwe patient cost survey, 2018
Figure 2:
Figure 2:
Proportion of tuberculosis-affected households who experienced TB-related catastrophic costs during the Zimbabwe tuberculosis patient cost survey 2018
See this image and copyright information in PMC

References

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