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Free Content Direct costs of pulmonary tuberculosis among patients receiving treatment in Bauchi State, Nigeria

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BACKGROUND: To access tuberculosis (TB) services, patients have to bear the costs of out-of-pocket expenditures or direct costs for transport, drugs and other services that are not provided free-of-charge. These costs could represent a barrier to care, especially in a country such as Nigeria, where per capita gross national income is only US$1160 and 46% of the urban population live below the poverty line.

OBJECTIVE: To describe the direct costs of TB diagnosis and treatment in Bauchi State, Nigeria, from the patient's perspective.

METHODS: A cross-sectional study. A sample size of 255 patients was randomly selected from 27 of 67 facilities in Bauchi State, Nigeria.

RESULTS: The median out-of-pocket cost for hospitalised patients was estimated at US$166.11, while ambulatory patients paid an estimated median cost of US$94.16, equivalent to about 9–38% of their average annual income. Female patients spent a higher proportion of their income on diagnosis and treatment than males (P < 0.0001). The median out-of-pocket costs borne by patients before, during and after diagnosis were estimated at respectively US$35.23, US$27.12 and US$23.43 for ambulatory patients, and additional average out-of-pocket spending of US$66.44 for patients hospitalised during their illness. Pre-diagnosis, diagnosis and post-diagnosis out-of-pocket spending did not vary significantly by human immunodeficiency virus status (P > 0.05) and sex (P > 0.05).

CONCLUSION: The costs of anti-tuberculosis treatment found in this study are expensive and potentially catastrophic for many patients and their families.
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Keywords: Bauchi; HIV; Nigeria; cost; tuberculosis

Document Type: Research Article

Affiliations: 1: School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK; Directorate of Planning, Research and Statistics, Bauchi State Agency for the Control of HIV/AIDS, Tuberculosis, Leprosy and Malaria, Bauchi, Nigeria 2: School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK; Infectious Diseases Unit, Health Protection Agency, London, UK 3: School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK

Publication date: June 1, 2012

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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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