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Free Content The economic burden of tuberculosis care for patients and households in Africa: a systematic review [Review article]

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OBJECTIVES: To summarise the state of knowledge on the economic impact and consequences of tuberculosis (TB) diagnosis and treatment for patients/households in Africa, and to highlight any weaknesses in the work conducted to date.

METHODS: We systematically searched for published articles in English between 1990 and June 2010 in eight databases and the World Health Organization (WHO) website. Broad search terms were used (‘tuberculosis’ OR ‘tuberculosis/HIV’ AND ‘costs’ AND ‘Africa’). Only studies that reported any costs of TB care for patients/households were retained. All costs were converted to 2009 USD in accordance with WHO cost analysis guidelines.

RESULTS: Overall, 11 articles from eight countries met the inclusion criteria. Only one study met all the quality criteria for a cost-of-illness study; most of the studies focused on urban populations, reported incomplete (pre-diagnostic/average) costs, and did not report coping costs. Mean patient pre-diagnostic costs varied between US$36 and US$196, corresponding to respectively 10.4% and 35% of their annual income. Average patient treatment costs ranged between US$3 and US$662, corresponding to 0.2–30% of their annual income. Pre-diagnostic household costs accounted for 13% and 18.8% of patients' annual household income, while total household treatment costs ranged between US$26 and US$662, accounting for 2.9–9.3% of annual household income; 18–61% of patients received financial assistance from outside their household to cope with the cost of TB care.

CONCLUSION: The average patient's/household's pre-diagnostic costs for TB care were catastrophic. More properly designed studies are needed among different populations throughout Africa.

Keywords: Africa; health services; illness costs; patients; tuberculosis

Document Type: Research Article


Affiliations: 1: Department of Internal Medicine, Ebonyi State University Teaching Hospital, Abakaliki, Nigeria 2: National Tuberculosis and Leprosy Control, Ministry of Health, Ebonyi State, Abakaliki, Nigeria

Publication date: 2012-06-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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