Assessing access barriers to tuberculosis care with the Tool to Estimate Patients' Costs: pilot results from two districts in Kenya

BMC Public Health

Research Article

Joseph Sitienei¹  Hillary Kipruto²  Beatrice Kirubi³  Verena Mauch⁴  Eveline Klinkenberg⁵  Naomi Woods⁶ 

[1] Division of Leprosy, Tuberculosis and Lung Disease, Ministry of Public Health and Sanitation Kenya, Nairobi, Kenya;Division of Leprosy, Tuberculosis and Lung Disease, Ministry of Public Health and Sanitation Kenya, Nairobi, Kenya;World Health Organization Kenya, Nairobi, Kenya;Gertrude's Children's Hospital, Nairobi, Kenya;KNCV Tuberculosis Foundation, Den Haag, The Netherlands;KNCV Tuberculosis Foundation, Den Haag, The Netherlands;Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands;Merlin, Goma, Congo;

关键词: Health Facility;    Public Health Facility;    Asset Index;    Sputum Smear Microscopy;    Health Facility Visit;   

DOI  :  10.1186/1471-2458-11-43

 received in 2010-05-14, accepted in 2011-01-18,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundThe poor face geographical, socio-cultural and health system barriers in accessing tuberculosis care. These may cause delays to timely diagnosis and treatment resulting in more advanced disease and continued transmission of TB. By addressing barriers and reasons for delay, costs incurred by TB patients can be effectively reduced. A Tool to Estimate Patients' Costs has been developed. It can assist TB control programs in assessing such barriers. This study presents the Tool and results of its pilot in Kenya.MethodsThe Tool was adapted to the local setting, translated into Kiswahili and pretested. Nine public health facilities in two districts in Eastern Province were purposively sampled. Responses gathered from TB patients above 15 years of age with at least one month of treatment completed and signed informed consent were double entered and analyzed. Follow-up interviews with key informants on district and national level were conducted to assess the impact of the pilot and to explore potential interventions.ResultsA total of 208 patients were interviewed in September 2008. TB patients in both districts have a substantial burden of direct (out of pocket; USD 55.8) and indirect (opportunity; USD 294.2) costs due to TB. Inability to work is a major cause of increased poverty. Results confirm a 'medical poverty trap' situation in the two districts: expenditures increased while incomes decreased. Subsequently, TB treatment services were decentralized to fifteen more facilities and other health programs were approached for nutritional support of TB patients and sputum sample transport. On the national level, a TB and poverty sub-committee was convened to develop a comprehensive pro-poor approach.ConclusionsThe Tool to Estimate Patients' Costs proved to be a valuable instrument to assess the costs incurred by TB patients, socioeconomic situations, health-seeking behavior patterns, concurrent illnesses such as HIV, and social and gender-related impacts. The Tool helps to identify and tackle bottlenecks in access to TB care, especially for the poor. Reducing delays in diagnosis, decentralization of services, fully integrated TB/HIV care and expansion of health insurance coverage would alleviate patients' economic constraints due to TB.

【 授权许可】

CC BY   
© Mauch et al; licensee BioMed Central Ltd. 2011