Background: As one of the World Health Organization (WHO) End Tuberculosis (TB) Strategy is to reduce the proportion of TB affected families that face catastrophic costs to 0% by 2020. This systematic review and meta-analysis aimed to estimate the pooled proportion of TB affected households who face catastrophic cost. Method: A search of the online database through September 2020 was performed. A total of 5114 articles were found, of which 29 articles got included in quantitative synthesis. Catastrophic cost is defined if total cost related to TB exceeded 20% of annual pre-TB household income. R software was used to estimate the pooled proportion at 95% confidence intervals (CIs) using the fixed/random-effect models. Result: The proportion of patients faced catastrophic cost was 43% (95% CI 34-52, I2= 99%. 32% (95% CI 29 - 35, I2= 70%) among drug sensitive, and 80% (95% CI 74-85, I2=54%) among drug resistant, and 81% (95% CI 78-84%, I2= 0%) among HIV patients. Regarding active versus passive case finding the pooled proportion of catastrophic cost was 12% (95% CI 9-16, I2= 95%) versus 42% (95% CI 35-50, I2= 94%). The pooled proportion of direct cost to the total cost was 45% (95% CI 39-51, I2= 91%). The pooled proportion of patients facing catastrophic health expenditure (CHE) at cut of point of 10% of their yearly income was 45% (95% CI 35-56, I2= 93%) while at 40% of their capacity to pay was 63% (95% CI 40-80, I2= 96%). Conclusion: Despite the ongoing efforts, there is a significant proportion of patients facing catastrophic cost, which represent a main obstacle against TB control.
This study aimed to identify geo-spatial pattern of under-five mortality (U5M) in Alexandria and its key determinants. We analyzed the geospatial distribution of 3064 deaths registered at 24 health offices reported from January 2018 to June 2019. The localities of Alexandria city were clustered into high and low incidence areas. Neonates represented 58.7% of U5M, while post-neonates and children were 31.1%, 10.2% respectively. Male deaths were significantly higher (P=0.036). The main leading causes of U5M were prematurity (28.32%), pneumonia (11.01%), cardiac arrest (10.57%), congenital malformation (9.95%), and childhood cardiovascular diseases (9.20%). Spatial distribution of U5M (including the most common three causes) tend to be clustered in western parts of Alexandria (El Hawaria, Bahig, Hamlis and Ketaa Maryiut). Another 9 clusters are at risk of being hotspots. Illiteracy, divorce, and poor locality characteristics (household size, population density, and access to water supply and sanitation), were statistically significant predictors of U5M.
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