Factors determining household expenditure for tuberculosis and coping strategies in Tajikistan
Objective To investigate factors influencing expenditure levels and the use of potentially detrimental coping strategies among tuberculosis (TB) patients. For the purpose of the present study, potentially detrimental coping strategies included borrowing money and selling assets.
Method Questionnaire survey with an initial and a follow‐up interview of each adult new pulmonary TB case registered over a period of 4 months, conducted in 12 districts with DOTS in Tajikistan, one of the poorest countries in the world.
Results Patients and their households faced mean expenditures of US$ 396 related to a TB episode. In multivariate mixed‐effect regression models, the main determinants of out‐of‐pocket payments–either over the whole course of the disease or after enrolment in DOTS treatment–were ‘complimentary treatment’ besides the anti‐TB drugs, duration of hospitalization and treatment delay. Complimentary treatment mainly consisted of vitamins and rehydrating infusions. Sex showed no association with expenditure. To cope with the costs of illness, two‐thirds of patients employed a potentially detrimental coping strategy. TB patients raised on average US$ 23 through loans with interest, US$ 57 through loans without interest and US$ 102 through selling assets.
Conclusion The catastrophic out‐of‐pocket payments faced by TB patients are correlated with receiving complimentary treatment, delay to treatment and duration of hospitalisation. The widespread use of potentially detrimental coping strategies illustrates that TB constitutes a substantial risk of impoverishment. More parsimonious use of complimentary treatment and hospitalisation could reduce illness‐related costs for patients and should be carefully considered.
Document Type: Research Article
Affiliations: 1: Tajik Swiss Health Reform and Family Medicine Project, Project Sino, Dushanbe, Tajikistan 2: Ministry of Health and National TB Program, Dushanbe, Tajikistan
Publication date: March 1, 2011