Households experiencing catastrophic costs due to tuberculosis in Uganda: magnitude and cost drivers
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RESEARCH ARTICLE
Open Access
Households experiencing catastrophic costs due to tuberculosis in Uganda: magnitude and cost drivers Winters Muttamba1* , Racheal Tumwebaze1, Levicatus Mugenyi1, Charles Batte1, Rogers Sekibira1, Abel Nkolo2, Achilles Katamba3, Simon Kasasa4, Robert Kaos Majwala2,5, Stavia Turyahabwe5, Frank Mugabe5, Kaggwa Mugagga6, Peter Lochoro7, Seyoum Dejene8, Estella Birabwa8, Claudio Marra5, Ines Garcia Baena9 and Bruce Kirenga1
Abstract Background: Tuberculosis (TB) patients in Uganda incur large costs related to the illness, and while seeking and receiving health care. Such costs create access and adherence barriers which affect health outcomes and increase transmission of disease. The study ascertained the proportion of Ugandan TB affected households incurring catastrophic costs and the main cost drivers. Methods: A cross-sectional survey with retrospective data collection and projections was conducted in 2017. A total of 1178 drug resistant (DR) TB (44) and drug sensitive (DS) TB patients (1134), 2 weeks into intensive or continuation phase of treatment were consecutively enrolled across 67 randomly selected TB treatment facilities. Results: Of the 1178 respondents, 62.7% were male, 44.7% were aged 15–34 years and 55.5% were HIV positive. For each TB episode, patients on average incurred costs of USD 396 for a DS-TB episode and USD 3722 for a Multi drug resistant tuberculosis (MDR TB) episode. Up to 48.5% of households borrowed, used savings or sold assets to defray these costs. More than half (53.1%) of TB affected households experienced TB-related costs above 20% of their annual household expenditure, with the main cost drivers being non-medical expenditure such as travel, nutritional supplements and food. Conclusion: Despite free health care in public health facilities, over half of Ugandan TB affected households experience catastrophic costs. Roll out of social protection interventions like TB assistance programs, insurance schemes, and enforcement of legislation related to social protection through multi-sectoral action plans with central NTP involvement would palliate these costs. Keywords: Catastrophic costs, Dissaving, Direct medical costs, Indirect non-medical costs
* Correspondence: [email protected] 1 Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons
