ArticleBMJ open2019
Pathways and associated costs of care in patients with confirmed and presumptive tuberculosis in Tanzania: A cross-sectional study.
Article in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Article
- Stakeholders' perspectives on funding malaria, HIV/AIDS and tuberculosis services in Tanzania through domestic resources mobilisation: a qualitative study.BMJ public health · 2025Article
- Article
- Roadblocks and resilience: A qualitative study of the impact of pediatric tuberculosis on Tanzanian households and solutions from caregivers.Global public health · 2023Article
- Clinical-demographic markers for improving diabetes mellitus diagnosis in people with tuberculosis in Tanzania.BMC infectious diseases · 2022Article
- Patients' pathways to cancer care in Tanzania: documenting and addressing social inequalities in reaching a cancer diagnosis.BMC health services research · 2022Article
- Patient pathways and delays to diagnosis and treatment of tuberculosis in an urban setting in Indonesia.The Lancet regional health. Western Pacific · 2020Article
- Why lockdown? Why national unity? Why global solidarity? Simplified arithmetic tools for decision-makers, health professionals, journalists and the general public to explore containment options for the 2019 novel coronavirus.Infectious Disease Modelling · 2020Article
- Explaining patient delay in healthcare seeking and loss to diagnostic follow-up among patients with presumptive tuberculosis in Tanzania: a mixed-methods study.BMC health services research · 2019Article
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Authors and funding
13 authors.
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Abstract
objectiveTo assess pathways and associated costs of seeking care from the onset of symptoms to diagnosis in patients with confirmed and presumptive tuberculosis (TB).
designCross-sectional study.
settingDistrict hospital in Dar es Salaam, Tanzania.
participantsBacteriologically confirmed TB and presumptive TB patients. PRIMARY AND SECONDARY OUTCOME MEASURES: We calculated distance in metres and visualised pathways to healthcare up to five visits for the current episode of sickness. Costs were described by medians and IQRs, with comparisons by gender and poverty status.
resultsOf 100 confirmed and 100 presumptive TB patients, 44% of confirmed patients sought care first at pharmacies after the onset of symptoms, and 42% of presumptive patients did so at hospitals. The median visits made by confirmed patients was 2 (range 1-5) and 2 (range 1-3) by presumptive patients. Patients spent a median of 31% of their monthly household income on health expenditures for all visits. The median total direct costs were higher in confirmed compared with presumptive patients (USD 27.4 [IQR 18.7-48.4] vs USD 19.8 [IQR 13.8-34.0], p=0.02), as were the indirect costs (USD 66.9 [IQR 35.5-150.0] vs USD 46.8 [IQR 20.1-115.3], p<0.001). The indirect costs were higher in men compared with women (USD 64.6 [IQR 31.8-159.1] vs USD 55.6 [IQR 25.1-141.1], p<0.001). The median total distance from patients' household to healthcare facilities for patients with confirmed and presumptive TB was 2338 m (IQR 1373-4122) and 2009 m (IQR 986-2976) respectively.
conclusionsPatients with confirmed TB have complex pathways and higher costs of care compared with patients with presumptive TB, but the costs of the latter are also substantial. Improving access to healthcare and ensuring integration of different healthcare providers including private, public health practitioners and patients themselves could help in reducing the complex pathways during healthcare seeking and optimal healthcare utilisation.
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