Abstract
BackgroundLarge-scale Tuberculosis (TB) control programmes in China have been hailed a success. Concerns remain, however, about whether the programme is reaching all sections of the population, particularly poorer groups within rural communities, and whether there are hidden costs. This study takes a household perspective to investigate receipt of appropriate care and affordability of services for different socio-economic groups with TB symptoms in rural China.MethodsSecondary analysis of Chinese National Household Health Survey for 2003: 40,000 rural households containing 143,991 individuals, 2,308 identified as TB suspects. Outcomes: use of services and expenditure of TB suspects, by gender and socio-economic position, indicated by household income, education, material assets, and insurance status.Results37% of TB suspects did not seek any professional care, with low-income groups less likely to seek care than more affluent counterparts. Of those seeking care, only 35% received any of the recommended diagnostic tests. Of the 182 patients with a confirmed TB diagnosis, 104 (57%) received treatment at the recommended level, less likely if lacking health insurance or material assets. The burden of payment for services amounted to 45% of annual household income for the low-income group, 16% for the high-income group.ConclusionAccess to appropriate, affordable TB services is still problematic in some rural areas of China, and receipt of care and affordability declines with declining socio-economic position. These findings highlight the current shortcomings of the national TB control programme in China and the formidable challenge it faces if it is to reach all sections of the population, including the poor with the highest burden of disease.
Highlights
Large-scale Tuberculosis (TB) control programmes in China have been hailed a success
This paper reports analyses that ask: Who gets care and who does not? What is the burden of payment for medical care for TB suspects and patients and how does it differ by socio-economic status?
Our study found that over one third of TB suspects did not seek any professional care after a persistent cough for more than 3 weeks
Summary
Large-scale Tuberculosis (TB) control programmes in China have been hailed a success. By the year 2000, there were an estimated 4.7 million prevalent cases of TB across the country, 1.6 million of whom were sputum smear-positive. The seriousness of the situation has led to the introduction by the Chinese Ministry of Health of large-scale TB control programmes, with support from the World Bank. These programmes, employing the WHO-recommended Directly Observed Therapy Strategy (DOTS), have met with considerable success in the places in which they have been introduced, as reported in The Lancet in 2004 [1]. Prevalence fell by 48% in the DOTS provinces compared with 16 percent in the provinces without the programme, resulting in an estimated 30 percent greater reduction in TB prevalence, which the authors attributed directly to the DOTS programme
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
