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

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. Graphic abstract

Predictors Of Catastrophic Costs Of Tuberculosis (TB) Among Patients Co-Affected With TB-HIV And TB-Diabetes In Bhavnagar Region, Western India

“…Hospitalization was reported to be a significant predictor by investigators in other studies from Kenya, China, and Tanzania. 15,16,20,21 15,16,20,21 However, hospitalization was found not significantly associated with total costs as well as costs for drug-resistant TB in studies from Indonesia and China. 10,12 Patients lose wages and incur costs for transportation, food, and accommodation during the days of hospitalization.…”

“…Our study findings were supported by studies among patients with TB in Nigeria and Kenya -3 times (95% CI 1.5-5.9) and 1.25 times (95% CI 1.1-1.7) -higher odds of TB catastrophic costs respectively. 14,20 However, the type of facility was not a significant predictor in studies from Ghana and Indonesia. 12,18 Nearly half of the patients with TB seek a private care provider for their care in India.…”

“…Our study found female patients had 6 times (95% CI 1.2-33) higher odds of experiencing catastrophic costs due to TB among TB-HIV co-infected patients. However, a study in Nigeria found the male gender to be significantly associated 14 15,18,20,21 Ukwaja et al in their study in Nigeria found male patients being 3 times (95% CI 1.8-5.2) more likely to incur catastrophic costs due to TB. Being the primary earners in a family, we would expect the 'male gender' to be a significant predictor of catastrophic costs.…”

“…7 Globally, various studies have documented the predictors of catastrophic costs incurred due to TB. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Among some recent studies, some of the predictors reported were private provider consultation for the initial visit 6 , hospitalization 16,20 , loss of job 17 , human immunodeficiency virus (HIV) co-infection 7 , lower wealth quintiles 18,20,23 , and drug-resistance. 7,16,18,23 Evidence on predictors of catastrophic costs of TB among patients with TB-HIV co-infection or TBdiabetes comorbidity is lacking.…”

Challenges to paediatric tuberculosis care as perceived by health workers in Kano, North-western Nigeria

“…Adamu et al observed in their study in Kano that transportation and diagnostic out-of-pocket expenses may negatively affect the outcome of TB treatment. 4 This observation was not contrary to reports that medical expenses and other indirect costs in poverty situations are barriers to TB treatment and TB treatment initiation for individuals of all ages in Sub-Saharan Africa (SSA) by Sullivan et al , 16 Shimeles et al 15 Asres et al, 16 and Kirubi et al 17 Sullivan et al further reported, in their metaanalysis, that geography or distance to TB treatment centers (infrastructure barriers) contributed to delayed access and poor treatment outcomes. 6 The inability of children to cough up sputum was perceived as a challenge to paediatric TB care by 95.4% of health workers interviewed.…”