Dataset Information

Pre- and post-diagnosis costs of tuberculosis to patients on Directly Observed Treatment Short course in districts of southwestern Ethiopia: a longitudinal study.

ABSTRACT:

Background

Financial burden on tuberculosis (TB) patients results in delayed treatment and poor compliance. We assessed pre- and post-diagnosis costs to TB patients.

Methods

A longitudinal study among 735 new TB cases was conducted from January 2015 through June 2016 in 10 woredas (districts) of southwestern Ethiopia. Direct out-of-pocket, payments, and lost income (indirect cost) were solicited from patients during the first 2 months and at the end of treatment. Thus, we ascertained direct medical, nonmedical, and indirect costs incurred by patients during pre- and post-diagnosis periods. We categorized costs incurred from onset of illness until TB diagnosis as pre-diagnosis and that incurred after diagnosis through treatment completion as post-diagnosis. Pre- and post-diagnosis costs constitute total cost incurred by the patients. We fitted linear regression model to identify predictors of cost.

Results

Between onset of illness and anti-TB treatment course, patients incurred a median (inter-quartile range (IQR)) of US$201.48 (136.7-318.94). Of the total cost, the indirect and direct costs respectively constituted 70.6 and 29.4%. TB patients incurred a median (IQR) of US$97.62 (6.43-184.22) and US$93.75 (56.91-141.54) during the pre- and post-diagnosis periods, respectively. Thus, patients incurred 53.6% of the total cost during the pre-diagnosis period. Direct out-of-pocket expenses during the pre- and post-diagnosis periods respectively amount to median (IQR) of US$21.64 (10.23-48.31) and US$35.02 (0-70.04). Patient delay days (p?ConclusionTB patients incur substantial cost for care seeking and treatment despite "free service" for TB. Therefore, promoting early care seeking, decentralizing efficient diagnosis, and treatment services within reach of peoples, and introducing reimbursement system for direct costs can help minimize financial burden to the patient.

SUBMITTER: Asres A

PROVIDER: S-EPMC5963051 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

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Pre- and post-diagnosis costs of tuberculosis to patients on Directly Observed Treatment Short course in districts of southwestern Ethiopia: a longitudinal study.

Asres Abyot A Jerene Degu D Deressa Wakgari W

Journal of health, population, and nutrition 20180521 1

<h4>Background</h4>Financial burden on tuberculosis (TB) patients results in delayed treatment and poor compliance. We assessed pre- and post-diagnosis costs to TB patients.<h4>Methods</h4>A longitudinal study among 735 new TB cases was conducted from January 2015 through June 2016 in 10 woredas (districts) of southwestern Ethiopia. Direct out-of-pocket, payments, and lost income (indirect cost) were solicited from patients during the first 2 months and at the end of treatment. Thus, we ascertai ...[more]

PMID: 29784037

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Project description:BackgroundDelayed tuberculosis (TB) diagnosis and treatment increase morbidity, mortality, expenditure, and transmission in the community. This study assessed patient and provider related delays to diagnosis and treatment of TB.MethodsA cross-sectional study was conducted among 735 new adult TB cases registered between January to December 2015 in 10 woredas equivalent to districts of southwestern Ethiopia. Data were collected through face-to-face interview of patients within the first 2 months of treatment initiation. Delay in days was tracked at three intervals: between onset of symptoms and self-presentation (Patient delay), Self-presentation to treatment initiation (Provider delay) and total delay. Days elapsed beyond median were used to define the delays. Bivariate and multiple logistic regression models were fit to identify predictors of delays and statistical significance was judged at p < 0.05.ResultThe median (inter-quartile range) of patient, provider and total delays were 25 (IQR;15-36), 22 (IQR:9-48) and 55 (IQR:32-100) days, respectively. More than half (54.6%) of the total delay was attributed to health system. Prior self-treatment [adjusted Odds Ratio (aOR)]: 1.72, 95% confidence interval [CI]:1.07-2.75), HIV co-infection (aOR:1.8, 95% CI: 1.05-3.10) and extra-pulmonary TB (aOR: 1.54,95% CI:1.03-2.29) were independently associated with increased odds of patient delay. On the other hand initial presentation to health posts or private clinics (aOR: 1.42, 95% CI: 1.01, 2.0) and patient delay (aOR: 1.81, 95% CI: 1.33-2.50) significantly predicted longer provider delay. Finally, having extra pulmonary TB (aOR: 1.6, 95% CI: 1.07-2.38), prior consultation of traditional healer (aOR: 3.72, 95% CI: 1.01-13.77) and use of holy water (aOR: 2.73, 95% CI: 1.11, 6.70) independently predicted longer total delay.ConclusionTuberculosis patients waited too long time to initiate anti-TB treatment reflecting longer periods of morbidity and disease transmission. The delays are attributed to the patient, disease and health system related factors. Hence, improving community awareness, involving informal providers, health extension workers and TB treatment supporters can reduce the patient delay. Similarly, cough screening and improving diagnostic efficiencies of healthcare facilities should be in place to reduce the provider delays.

Project description:Data regarding tuberculosis (TB) treatment outcomes, proportion of TB/HIV co-infection and associated factors have been released at different TB treatment facilities in Ethiopia and elsewhere in the world as part of the auditing and surveillance service. However, these data are missing for the TB clinic offering directly observed treatment short-course (DOTs) at Debre Tabor General Hospital (DTGH).The authors analysed the records of 985 TB patients registered at the DTGH from September 2008 to December 2016. Data on patients' sex, age, type of TB, and treatment outcomes were extracted from the TB treatment registration logbook. The treatment outcome of patients was categorized according to the National TB and Leprosy Control Program guidelines: cured, treatment completed, treatment failed, died, and not evaluated (transferred out and unknown cases).Around half of the registered patients were males (516, 52.4%). In terms of TB types, 381 (38.7%), 241 (24.5%), and 363 (36.9%) patients had smear-negative pulmonary TB, smear-positive pulmonary TB, and extra pulmonary TB, respectively. Six hundred and seventy-two patients (90.1%) had successful treatment outcomes (cured and treatment completed), while 74 patients (9.9%) had unsuccessful treatment outcomes (death and treatment failure).TB treatment outcome was not associated with age, sex, type and history of TB, or co-infection with HIV (P > 0.05). The proportion of TB/HIV co-infection was at 24.2%, and these were found to be significantly associated with the age groups of 25-34, 35-44 and ≥65 years:(aOR: 0.44; 95% CI: 0.25-0.8), (aOR: 0.39; 95% CI: 0.20-0.70), (aOR: 4.2; 95% CI: 1.30-12.9), respectively.The proportion of patients with successful treatment outcomes was above the World Health Organization target set for Millennium Development Goal of 85% and in line with that of the global milestone target set at > 90% for 2025. Relatively higher proportions of transfer-out cases were recorded in the present study. Similarly, the proportion of TB/HIV co-infection cases was much higher than the national average of 8%.Thus, the health facility under study should develop strategies to record the final treatment outcome of transfer-out cases. In addition, strategies to reduce the burden of TB/HIV co-infection should be strengthened.

Project description:BACKGROUND:Tuberculosis (TB) is a leading cause of death among infectious agents, ranking above HIV/AIDS. Though much effort has been done, Ethiopia remained one of those countries which share the greatest burden of TB. Evaluating the TB treatment outcome is one method of TB control measures. Therefore, the aim of the current study was to assess TB treatment outcome and its determinants under directly observed treatment short courses in Adama City, Central Ethiopia. METHOD:An institutional based cross sectional study was conducted in all public and private health facilities of Adama city from March 1st 2016 to December 31st, 2016. The data were entered and analyzed by using SPSS version 21.0 statistical software. The results were presented using descriptive statistics. Univariate and multivariate logistic regression model was used to evaluate the potential determinants of unsuccessful treatment outcome. RESULTS:Among 281 patients evaluated, 90(32%) were cured, 137(48.8%) have completed the treatment, 4(1.4%) were treatment failure, 36(12.8%) were lost to follow up, and 14 (5%) died. The overall treatment success rate was 80.8%. Age 15-24 (Adjusted odds ratio (AOR): 4.97; 95% Confidence interval (CI): 1.13-21.90), distance less than 5 kilometers from treatment center (AOR: 3.1; 95% CI: 1.42-6.77), being seronegative for human immunodeficiency virus (HIV) (AOR: 20.38; 95% CI: 7.80-53.24) were associated with successful TB treatment outcome. CONCLUSION:The treatment outcome of all forms tuberculosis patients in Adama city was unsatisfactory when referred with the national pooled estimate of 86% and WHO 2030 international target of ?90%. Thus, enhancing client supervision, treatment monitoring; and working on provision TB treatment services at nearby health facilities should be a priority concern to improve the success rate of treatment outcome. Further studies are also recommended to explore important factors which were not examined by current study.

Project description:BackgroundDespite reported long delays to initiate anti-TB treatment and poor outcomes in different parts of Ethiopia and elsewhere, evidences on association between the delay and treatment outcomes are scanty.MethodsA follow up study among 735 new TB cases registered at health facilities in districts of southwest Ethiopia was conducted from January 2015 to June 2016. Patients reported days elapsed between onset of illness and treatment commencement of 30 days cutoff was considered to ascertain exposure. Thus, those elapsed beyond 30 days to initiate anti-TB treatment since onset of illness were exposed and otherwise non-exposed. The cases were followed until earliest outcome was observed. Treatment outcomes was ascertained as per the World Health Organization standard definitions and dichotomized into 'successful' when cured or treatment completed and 'unsuccessful' when lost to follow-up or died or treatment failure. Bivariate and multiple log-binomial models were fitted to identify predictors of unsuccessful outcomes.ResultsThe overall treatment success among the treatment cohort was 89.7% (88.4% vs. 94.2%, p = 0.01 respectively among those initiated treatment beyond and within of 30 days of onset of illness. Higher risk of unsuccessful outcome was predicted by treatment initiation beyond 30 days of onset [Adjusted Relative Risk (ARR) = 1.92, 95%CI:1.30, 2.81], HIV co-infection (ARR = 2.18, 95%CI:1.47, 3.25) and received treatment at hospital (ARR = 3.73, 95%CI:2.23, 6.25). On the other hand, lower risk of unsuccessful outcome was predicted by weight gain (ARR = 0.40, 95%CI:0.19, 0.83) and sputum smear negative conversion (ARR = 0.17,95% CI:0.09, 0.33) at the end of second month treatment.ConclusionHigher risk of unsuccessful outcome is associated with prolonged days elapsed between onset of illness and treatment commencement. Hence, promotion of early care seeking, improving diagnostic and case holding efficiencies of health facilities and TB/HIV collaborative interventions can reduce risk of unsuccessful outcome.

Project description:IntroductionTuberculosis is a public health problem in Nigeria. One of the most effective ways of controlling tuberculosis is the directly observed treatment short-course. However, some factors influence tuberculosis patients' treatment nonadherence via directly observed treatment short-course. The study objective was to assess medication nonadherence and associated factors among tuberculosis patients in north-west Nigeria.MethodsA cross-sectional study enrolled tuberculosis patients using directly observed treatment short-course in public health facilities in Kano and Kaduna States from January 2015 to June 2016. The sample selection was conducted via a multistage sampling procedure. Data were collected using tuberculosis patients' demographic and clinical characteristics forms, well-validated structured instruments, and medical records. SPSS version 20 was used for data analysis. Logistic and multivariable logistic regression analyses to determine factors of medication nonadherence (P < 0.05).ResultsComplete responses from 390 patients out of the 460 patients recruited for the study were used for data analyses. The mean age was 51.5 (standard deviation = ±13.8) years. The mean tuberculosis medication adherence questionnaire score was 4.35 ± 1.12. The prevalence of nonadherence to tuberculosis medication was 30.5%. Multivariable logistic regression analysis showed that having a monthly income between #100,000 and #199, 000 (adjusted odds ratio = 0.01; 95% confidence interval: 0.00-0.13), being widowed (adjusted odds ratio = 26.74, 95% confidence interval: 2.92-232.9), being married (adjusted odds ratio = 120.49, 95% confidence interval: 5.38-271.1), having a distance <5 km to directly observed treatment short-course center from home (adjusted odds ratio = 0.06, 95% confidence interval: 0.00-0.01), having a tuberculosis/HIV co-infection (adjusted odds ratio = 0.01, 95% confidence interval: 0.12-0.35), use of antiretroviral treatment and cotrimoxazole prophylaxis therapy medications (adjusted odds ratio = 24.9, 95% confidence interval: 19.6-304.3) were associated with tuberculosis medication nonadherence.ConclusionTuberculosis medication nonadherence was high among the patients. Thus, patient-specific adherence education, attenuation of potential factors for tuberculosis medication nonadherence, and continual resource support for tuberculosis patients are needed to improve treatment outcomes.

Project description:BACKGROUND:The directly observed treatment short-course (DOTS) is one of the most effective tuberculosis (TB) control measures worldwide. However, despite its aim of providing comprehensive and humanistic care, few studies have examined its psychological effects from the patient's perspective. Thus, this study aimed to evaluate the psychological changes and identify associated factors among patients with TB undergoing the DOTS program in Japan. METHODS:This cross-sectional study recruited patients with TB receiving the DOTS program via 32 public health centers in four metropolitan cities in Japan. Surveys were administered to the patients and their attending public health or clinical nurses, who were responsible for their care and the DOTS program. Data were collected regarding the patients' demographic and clinical characteristics, post-traumatic growth (using the Post-Traumatic Growth Inventory-Short Form [PTGI-SF]), and medication adherence, alongside open-ended questions, from 2014 to 2015. Additionally, the patients' appraisal of the DOTS program's efficacy and nurses' assessment of the program's practices were measured using two original questionnaires. Factors associated with post-traumatic growth were analyzed using variable estimation, correlation analysis, and logistic regression. Thematic analysis was conducted on the open-ended responses. RESULTS:Questionnaires were returned by 127 patients (125 valid answers); 98 (78.4%) of the respondents were men. Their mean age was 63.3 (standard deviation: 15.8) years. The mean PTGI-SF score was 21.7 (standard deviation: 11.1). The logistic regression analysis found that post-traumatic growth was significantly associated with the patients' appraisal of the program's efficacy (odds ratio [OR]?=?1.157, 95% confidence interval [CI]?=?1.026-1.304) and nurses' assessment of the practices (OR?=?1.307, 95% CI?=?1.065-1.603). In the qualitative analysis, "Non-acceptance," "Frustration," and "Anxiety" were extracted as barriers to treatment; "Fear," "Acquiring a partner," "Relief," and "Belief" were extracted as treatment drivers; and "Life changes" and "Rebuilding oneself" were extracted as treatment outcomes. CONCLUSIONS:The DOTS program in Japan improves patients' treatment adherence and leads to recovery and psychological growth. Even in other regions, it may be effective to incorporate this program's practices that place importance on partnerships with patients. It is also necessary to continue refined quantitative and qualitative evaluations.

Project description:BACKGROUND:Tuberculosis (TB) remains a major global public health problem in many developing countries including Kingdom of Saudi Arabia (KSA). Patient compliance with anti-tuberculosis treatment is a determining factor in controlling the spread of TB. This study compares the default rate and the perception of their treatment among TB patients being treated by means of a community mobile outreach approach, with those of patients being treated by means of a facility-based Directly Observed Treatment Short course (DOTS) in the Jeddah region of Saudi Arabia. METHODS:A comparative cross-sectional study of 200?TB patients who presented at the Madain Alfahd Primary Health Care Center (PHCC) Jeddah, between January 2018 and November 2018 was undertaken. In one group, randomly assigned patients were served by mobile outreach teams who administered oral anti-TB treatment under the DOTS regime. In the other group, the patients were treated by means of the traditional facility-based DOTS treatment. A questionnaire measuring patient attitudes and understanding of the disease and their treatment modes was completed by patients at the beginning of their treatment, and again after 3?months. The results were analysed by means of independent and Paired T Tests, along with chi square analysis. RESULTS:We found that the overall default rate among those patients served by our mobile outreach team was only 3%, compared with a 22% default rate among non-mobile team treated patients (p?=?<?0.001). A major change in the attitude and understanding scores of patients was noted in both groups after 3?months. A significant difference was also noted in the mean compliance scores (mobile team served =58.43 and facility-based =55.55, p?<?0.001) after 3?months of treatment. CONCLUSION:Our study indicated that treatment by means of our mobile outreach DOTS can offer an effective strategy for the treatment of TB patients. A reduced patient default rate and a better understanding of the disease and its treatment confirmed a positive impact of mobile outreach teams on these patients. Treating TB patients by means of mobile outreach teams can thus be recommended as a means for the cure and prevention of the further spread of the disease.

Dataset Information

Pre- and post-diagnosis costs of tuberculosis to patients on Directly Observed Treatment Short course in districts of southwestern Ethiopia: a longitudinal study.

Background

Methods

Results

Publications

Pre- and post-diagnosis costs of tuberculosis to patients on Directly Observed Treatment Short course in districts of southwestern Ethiopia: a longitudinal study.

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