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. 2022 Mar 29;22(1):600.
doi: 10.1186/s12889-022-12987-3.

Economic burden of tuberculosis in Tanzania: a national survey of costs faced by tuberculosis-affected households

Andrew Martin Kilale  1 , Andrea Pantoja  2 , Bhavin Jani  3 , Nyagosya Range  4 , Bernard James Ngowi  4   5 , Charles Makasi  4 , Melkisedeck Majaha  4 , Chacha Dionis Manga  4 , Sylvia Haule  4 , Amani Wilfred  4 , Pudensiana Hilary  4 , Vishnu Mahamba  6 , Emmanuel Nkiligi  7 , Wilbard Muhandiki  7 , Emmanuel Matechi  7 , Beatrice Mutayoba  7 , Nobuyuki Nishkiori  2 , Julia Ershova  8
Affiliations

Economic burden of tuberculosis in Tanzania: a national survey of costs faced by tuberculosis-affected households

Andrew Martin Kilale et al. BMC Public Health. .

Abstract

Background: Although tuberculosis (TB) care is free in Tanzania, TB-associated costs may compromise access to services and treatment adherence resulting in poor outcomes and increased risk of transmission in the community. TB can impact economically patients and their households. We assessed the economic burden of TB on patients and their households in Tanzania and identified cost drivers to inform policies and programs for potential interventions to mitigate costs.

Methods: We conducted a nationally representative cross-sectional survey using a standard methodology recommended by World Health Organization. TB patients of all ages and with all types of TB from 30 clusters across Tanzania were interviewed during July - September 2019. We used the human capital approach to assess the indirect costs and a threshold of 20% of the household annual expenditure to determine the proportion of TB-affected households experiencing catastrophic cost. We descriptively analyzed the cost data and fitted multivariable logistic regression models to identify potential predictors of catastrophic costs.

Results: Of the 777 TB-affected households, 44.9% faced catastrophic costs due to TB. This proportion was higher (80.0%) among households of patients with multi-drug resistant TB (MDR-TB). Overall, cost was driven by income loss while accessing TB services (33.7%), nutritional supplements (32.6%), and medical costs (15.1%). Most income loss was associated with hospitalization and time for picking up TB drugs. Most TB patients (85.9%) reported worsening financial situations due to TB, and over fifty percent (53.0%) borrowed money or sold assets to finance TB treatment. In multivariable analysis, the factors associated with catastrophic costs included hospitalization (adjusted odds ratio [aOR] = 34.9; 95% confidence interval (CI):12.5-146.17), living in semi-urban (aOR = 1.6; 95% CI:1.0-2.5) or rural areas (aOR = 2.6; 95% CI:1.8-3.7), having MDR-TB (aOR = 3.4; 95% CI:1.2-10.9), and facility-based directly-observed treatment (DOT) (aOR = 7.2; 95% CI:2.4-26.6).

Conclusion: We found that the cost of TB care is catastrophic for almost half of the TB-affected households in Tanzania; our findings support the results from other surveys recently conducted in sub-Saharan Africa. Collaborative efforts across health, employment and social welfare sectors are imperative to minimize household costs due to TB disease and improve access to care, patient adherence and outcomes.

Keywords: Catastrophic Cost; Cost drivers; National Survey; Out-of-pocket Expenditures; Tanzania; Tuberculosis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Social consequences of having TB as perceived by patients in the poorest/wealthiest expenditure quintile
Fig. 2
Fig. 2
Proportion of households with TB patients facing catastrophic costs, by different thresholds, 777 TB-affected households
See this image and copyright information in PMC

References

    1. World Health Organization. Global tuberculosis report 2021. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IG. Available from: https://www.who.int/teams/global-tuberculosis-programme/tb-reports/globa...
    1. Janssens J-P, Rieder HL. An ecological analysis of incidence of tuberculosis and per capita gross domestic product. Eur Respir J. 2008;32(5):1415–1416. doi: 10.1183/09031936.00078708. - DOI - PubMed
    1. Farmer PE. The consumption of the poor: Tuberculosis in the 21st century. Ethnography. 2000;1(2):183–216. doi: 10.1177/14661380022230732. - DOI
    1. Oxlade O, Murray M. Tuberculosis and poverty: why are the poor at greater risk in India? PLOS ONE. 2012;7(11):e47533. doi: 10.1371/journal.pone.0047533. - DOI - PMC - PubMed
    1. Laokri S, Weil O, Drabo KM, Dembelé SM, Kafando B, Dujardin B. Removal of user fees no guarantee of universal health coverage: observations from Burkina Faso. Bull World Health Organ [Internet]. 2013 [cited 2020 Nov 5]; Available from: https://www.who.int/bulletin/volumes/91/4/12-110015/en/ - PMC - PubMed

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