Household expenditure for tuberculosis care, its determinants and coping strategies among adults 18 years and older of Karachi, Pakistan.

Abstract

Background/Objective: Link between tuberculosis (TB) and poverty is well established. This study aimed to estimate household expenditure for TB care and its determinants among adults ≥ 18 years in Karachi, Pakistan. Methods: Four public hospitals in an urban setting was selected. Participants who had completed at least 1-month intensive phase treatment were recruited via non-probability sampling. A standardized questionnaire, “tool to estimate patient9s costs” was modified and used for getting costs information. We defined direct medical and non-medical (food and transport) costs as out of pocket payment and indirect costs as loss of income. Pre-diagnostic and diagnostic costs were estimated. Results: Out of 375 participants, 54.3% were female with mean age of 32 (±13.7) years. The median direct costs borne by patients during pre-diagnostic, diagnostic and treatment phase were estimated at US$70.6, US$55 and US$12 respectively. Median costs for hospitalization was estimated at US$109.5 and an average length of stay was 6.5 days. The median indirect costs were estimated at US$112. Approximately, 56.7% of patients opted private provider at first place, followed by public service (44.2%), pharmacy (3.2%) and dispensary (1.6%). 95.5% of patients borrowed money for treatment. Independent factors for increasing costs were found to be gender, diagnostic delay and young age (P Conclusion: Pre-diagnostic costs was substantially high. There is need to coordinate with private providers for quick referrals to free public services. Provision of transport and food vouchers, health insurance for in-patient should be incorporated into existing strategy.