Household catastrophic payments for tuberculosis care in Nigeria: incidence, determinants, and policy implications for universal health coverage

作     者：Kingsley Nnanna Ukwaja Isaac Alobu Seye Abimbola Philip Christy Hopewell 

作者机构：Department of Internal MedicineFederal Teaching HospitalAbakalikiEbonyi StateNigeria National Tuberculosis and Leprosy Control ProgrammeMinistry of HealthAbakalikiEbonyi StateNigeria National Primary Health Care Development AgencyAbujaNigeria Francis J Curry International Tuberculosis CenterDivision of Pulmonary and Critical Care MedicineSan Francisco General HospitalUniversity of CaliforniaSan FranciscoCAUSA 

出 版 物：《Infectious Diseases of Poverty》 (贫困所致传染病（英文）)

年 卷 期：2013年第2卷第1期

页      面：166-174页

核心收录：

学科分类：1004[医学-公共卫生与预防医学(可授医学、理学学位)] 100401[医学-流行病与卫生统计学] 10[医学] 

基　　金：This work was supported by a 2010 PATS-MECOR small grant award received by KNU 

主　　题：Cost analysis Health policy Tuberculosis Regression analysis Nigeria 

摘      要：Background:Studies on costs incurred by patients for tuberculosis(TB)care are limited as these costs are reported as averages,and the economic impact of the costs is estimated based on average patient/household *** expenditures do not represent the poor because they spend less on treatment compared to other economic ***,the extent to which TB expenditures risk sending households into,or further into,poverty and its determinants,is *** assessed the incidence and determinants of household catastrophic payments for TB care in rural ***:Data used were obtained from a survey of 452 pulmonary TB patients sampled from three rural health facilities in Ebonyi State,*** household direct costs and income data,we analyzed the incidence of household catastrophic payments using,as thresholds,the traditional10%of household income and the≥40%of non-food income,as recommended by the World Health *** used logistic regression analysis to identify the determinants of catastrophic ***:Average direct household costs for TB were US$157 or 14%of average annual *** incidence catastrophic payment was 44%;with 69%and 15%of the poorest and richest household income-quartiles experiencing catastrophic activity,*** determinants of catastrophic payments were:age40 years(adjusted odds ratio[aOR]3.9;95%confidence interval[CI],2.0,7.8),male gender(aOR 3.0;CI 1.8,5.2),urban residence(aOR 3.8;CI 1.9,7.7),formal education(aOR 4.7;CI 2.5,8.9),care at a private facility(aOR 2.9;1.5,5.9),poor household(aOR 6.7;CI 3.7,12),household where the patient is the primary earner(aOR 3.8;CI 2.2,6.6]),and HIV co-infection(aOR 3.1;CI 1.7,5.6).Conclusions:Current cost-lowering strategies are not enough to prevent households from incurring catastrophic out-of-pocket payments for TB *** and social protection interventions are needed for identified at-risk groups,and community-level interventions may reduce