Determinants of household catastrophic costs for drug sensitive tuberculosis patients in Kenya.

IF 4.8 1区 医学 Q1 INFECTIOUS DISEASES Infectious Diseases of Poverty Pub Date : 2021-07-05 DOI:10.1186/s40249-021-00879-4
Beatrice Kirubi, Jane Ong'ang'o, Peter Nguhiu, Knut Lönnroth, Aiban Rono, Kristi Sidney-Annerstedt
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引用次数: 10

Abstract

Background: Despite free diagnosis and treatment for tuberculosis (TB), the costs during treatment impose a significant financial burden on patients and their households. The study sought to identify the determinants for catastrophic costs among patients with drug-sensitive TB (DSTB) and their households in Kenya.

Methods: The data was collected during the 2017 Kenya national patient cost survey from a nationally representative sample (n = 1071). Treatment related costs and productivity losses were estimated. Total costs exceeding 20% of household income were defined as catastrophic and used as the outcome. Multivariable Poisson regression analysis was performed to measure the association between selected individual, household and disease characteristics and occurrence of catastrophic costs. A deterministic sensitivity analysis was carried using different thresholds and the significant predictors were explored.

Results: The proportion of catastrophic costs among DSTB patients was 27% (n = 294). Patients with catastrophic costs had higher median productivity losses, 39 h [interquartile range (IQR): 20-104], and total median costs of USD 567 (IQR: 299-1144). The incidence of catastrophic costs had a dose response with household expenditure. The poorest quintile was 6.2 times [95% confidence intervals (CI): 4.0-9.7] more likely to incur catastrophic costs compared to the richest. The prevalence of catastrophic costs decreased with increasing household expenditure quintiles (proportion of catastrophic costs: 59.7%, 32.9%, 23.6%, 15.9%, and 9.5%) from the lowest quintile (Q1) to the highest quintile (Q5). Other determinants included hospitalization: prevalence ratio (PR) = 2.8 (95% CI: 1.8-4.5) and delayed treatment: PR = 1.5 (95% CI: 1.3-1.7). Protective factors included receiving care at a public health facility: PR = 0.8 (95% CI: 0.6-1.0), and a higher body mass index (BMI): PR = 0.97 (95% CI: 0.96-0.98). Pre TB expenditure, hospitalization and BMI were significant predictors in all sensitivity analysis scenarios.

Conclusions: There are significant inequities in the occurrence of catastrophic costs. Social protection interventions in addition to existing medical and public health interventions are important to implement for patients most at risk of incurring catastrophic costs.

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肯尼亚药物敏感结核病患者家庭灾难性费用的决定因素。
背景:尽管结核病的诊断和治疗是免费的,但治疗期间的费用给患者及其家庭带来了沉重的经济负担。该研究试图确定肯尼亚药物敏感性结核病(DSTB)患者及其家庭灾难性成本的决定因素。方法:数据是在2017年肯尼亚全国患者成本调查期间从全国代表性样本(n = 1071)中收集的。估计了与处理相关的成本和生产力损失。超过家庭收入20%的总成本被定义为灾难性的,并被用作结果。采用多变量泊松回归分析来衡量所选个人、家庭和疾病特征与灾难性成本发生之间的关系。采用不同阈值进行确定性敏感性分析,探索显著预测因子。结果:DSTB患者发生灾难性费用的比例为27% (n = 294)。灾难性成本患者的生产力损失中位数较高,为39小时[四分位数范围(IQR): 20-104],总中位数成本为567美元(IQR: 299-1144)。灾难性费用的发生率与家庭支出呈剂量反应。最贫穷的五分之一比最富有的人遭受灾难性损失的可能性高6.2倍[95%可信区间(CI): 4.0-9.7]。从最低五分位数(第一季度)到最高五分位数(第五季度),灾难性成本的流行率随着家庭支出五分位数的增加而下降(灾难性成本占比:59.7%、32.9%、23.6%、15.9%和9.5%)。其他决定因素包括住院:患病率(PR) = 2.8 (95% CI: 1.8-4.5)和延迟治疗:PR = 1.5 (95% CI: 1.3-1.7)。保护因素包括在公共卫生机构接受治疗:PR = 0.8 (95% CI: 0.6-1.0)和较高的身体质量指数(BMI): PR = 0.97 (95% CI: 0.96-0.98)。结核病前支出、住院和BMI是所有敏感性分析情景的重要预测因子。结论:灾难性成本的发生存在显著的不平等。除了现有的医疗和公共卫生干预措施之外,社会保护干预措施对于最有可能承担灾难性费用的患者来说非常重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Infectious Diseases of Poverty
Infectious Diseases of Poverty Medicine-Public Health, Environmental and Occupational Health
CiteScore
16.70
自引率
1.20%
发文量
368
审稿时长
13 weeks
期刊介绍: Infectious Diseases of Poverty is a peer-reviewed, open access journal that focuses on essential public health questions related to infectious diseases of poverty. It covers a wide range of topics and methods, including the biology of pathogens and vectors, diagnosis and detection, treatment and case management, epidemiology and modeling, zoonotic hosts and animal reservoirs, control strategies and implementation, new technologies, and their application. The journal also explores the impact of transdisciplinary or multisectoral approaches on health systems, ecohealth, environmental management, and innovative technologies. It aims to provide a platform for the exchange of research and ideas that can contribute to the improvement of public health in resource-limited settings. In summary, Infectious Diseases of Poverty aims to address the urgent challenges posed by infectious diseases in impoverished populations. By publishing high-quality research in various areas, the journal seeks to advance our understanding of these diseases and contribute to the development of effective strategies for prevention, diagnosis, and treatment.
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