Catastrophic costs among tuberculosis‐affected households in Zimbabwe: A national health facility‐based survey

Timire, Collins; Ngwenya, Mkhokheli; Chirenda, Joconiah; Metcalfe, John; Kranzer, Katharina; Pedrazzoli, Debora; Takarinda, Kudakwashe C; Nguhiu, Peter; Madzingaidzo, Geshem; Ndlovu, Kwenzikweyinkosi; Mapuranga, Tawanda; Cornell, Morna; Sandy, Charles

doi:10.1111/tmi.13647

Cited by 24 publications

(29 citation statements)

References 9 publications

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“…FRP studies on CDs (n = 13) were mostly concerned with tuberculosis (TB) in LwMICs (n = 7) (Additional file 5). CHE due to TB could be as high as 80% (Zimbabwe) despite the availability of free treatments in public facilities [45]. Drug-resistant TB was responsible for about 14% to 65% higher burden than the drug-susceptible variety [45,46].…”

Section: Cds and Maternal And Perinatal Conditionsmentioning

confidence: 99%

“…CHE due to TB could be as high as 80% (Zimbabwe) despite the availability of free treatments in public facilities [45]. Drug-resistant TB was responsible for about 14% to 65% higher burden than the drug-susceptible variety [45,46]. Note that, in line with WHO's End TB Strategy to end the global TB epidemic, most TB studies defined OOP expenses as the sum of direct medical, Fig.…”

Section: Cds and Maternal And Perinatal Conditionsmentioning

confidence: 99%

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Financial risk protection from out-of-pocket health spending in low- and middle-income countries: a scoping review of the literature

Rahman

Gasbarro

Alam

2022

Health Res Policy Sys

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Background Financial risk protection (FRP), defined as households’ access to needed healthcare services without experiencing undue financial hardship, is a critical health systems target, particularly in low- and middle-income countries (LMICs). Given the remarkable growth in FRP literature in recent times, we conducted a scoping review of the literature on FRP from out-of-pocket (OOP) health spending in LMICs. The objective was to review current knowledge, identify evidence gaps and propose future research directions. Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines to conduct this scoping review. We systematically searched PubMed, Scopus, ProQuest and Web of Science in July 2021 for literature published since 1 January 2015. We included empirical studies that used nationally representative data from household surveys to measure the incidence of at least one of the following indicators: catastrophic health expenditure (CHE), impoverishment, adoption of strategies to cope with OOP expenses, and forgone care for financial reasons. Our review covered 155 studies and analysed the geographical focus, data sources, methods and analytical rigour of the studies. We also examined the level of FRP by disease categories (all diseases, chronic illnesses, communicable diseases) and the effect of health insurance on FRP. Results The extant literature primarily focused on India and China as research settings. Notably, no FRP study was available on chronic illness in any low-income country (LIC) or on communicable diseases in an upper-middle-income country (UMIC). Only one study comprehensively measured FRP by examining all four indicators. Most studies assessed (lack of) FRP as CHE incidence alone (37.4%) or as CHE and impoverishment incidence (39.4%). However, the LMIC literature did not incorporate the recent methodological advances to measure CHE and impoverishment that address the limitations of conventional methods. There were also gaps in utilizing available panel data to determine the length of the lack of FRP (e.g. duration of poverty caused by OOP expenses). The current estimates of FRP varied substantially among the LMICs, with some of the poorest countries in the world experiencing similar or even lower rates of CHE and impoverishment compared with the UMICs. Also, health insurance in LMICs did not consistently offer a higher degree of FRP. Conclusion The literature to date is unable to provide a reliable representation of the actual level of protection enjoyed by the LMIC population because of the lack of comprehensive measurement of FRP indicators coupled with the use of dated methodologies. Future research in LMICs should address the shortcomings identified in this review.

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Section: Cds and Maternal And Perinatal Conditionsmentioning

confidence: 99%

Section: Cds and Maternal And Perinatal Conditionsmentioning

confidence: 99%

Financial risk protection from out-of-pocket health spending in low- and middle-income countries: a scoping review of the literature

Rahman

Gasbarro

Alam

2022

Health Res Policy Sys

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“…However, the recent cost survey conducted in Zimbabwe, showed that 90% of DR-TB affected households experience catastrophic costs, highlighting the vulnerability and low socioeconomic status of most of these households. (11)…”

Section: Discussionmentioning

confidence: 99%

“…Major drivers of catastrophic costs are outside the health system and include food, transport, and income loss. Across settings, DR-TB affected households incur higher costs than households affected by drug-susceptible TB, (9)(10)(11)(12)(13)(14) which may push households into financial catastrophes, and may act as barriers to accessing TB diagnostic and treatment services. (15) The End TB strategy acknowledges the need for greater action on the social determinants of TB through implementing universal health coverage and social protection.…”

Section: Introductionmentioning

confidence: 99%

Coverage and effectiveness of conditional cash transfer for people with drug resistant tuberculosis in Zimbabwe: a mixed methods study

Timire

Sandy

Ferrand

et al. 2022

Preprint

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Background The End TB strategy recommends social protection to mitigate socio-economic impacts of tuberculosis. Zimbabwe started implementing a conditional cash transfer (CCT) programme for people on drug resistant tuberculosis (DR-TB) treatment in 2013. We aimed to determine the proportion of people receiving CCT and effectiveness of CCT in improving treatment outcomes, explore their experiences with registering for CCT and understand the impact of CCT from the perspective of beneficiaries. Methods Data from 2014-2021 were extracted from TB registers and CCT payment records within the National TB Programme. Sixteen in-depth interviews were conducted with people who were completing treatment or had completed treatment within two months. Poisson regression, adjusted for province, year of treatment, age and sex was used to investigate associations between receiving CCT and successful treatment outcomes among people who were in DR-TB care for at least 3 months after treatment initiation. Qualitative data were analyzed using thematic analysis. Results A total of 481 people were included in the quantitative study. Of these, 53% (254/481) received CCT at some point during treatment. People who exited DR-TB care within three months were 73% less likely to receive CCT than those who did not (prevalence ratio (PR)=0.27 [95%CI: 0.18-0.41]). Among those who were alive and in care three months after treatment initiation, CCT recipients were 32% more likely to have successful outcomes than those who did not (adjusted PR=1.32, [95%CI: 1.00-1.75]). Qualitative results revealed lack of knowledge about availability of CCT among people with DR-TB and missed opportunities by healthcare providers to provide information about availability of CCT. Delays and inconsistencies in disbursements of CCT were frequent themes. Conclusion CCT were associated with successful treatment outcomes. Improvements in coverage, timeliness and predictability of disbursements are recommended.

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“…The direct and indirect costs supported by these millions of people in need of care are both the cause and the consequence of the socio-economic impact of TB on the poorest populations 2 – 4 . In this sense, inadequate access to care is a major contributor to the dramatic spiral of poverty and uncontrolled disease transmission.…”

Section: Introductionmentioning

confidence: 99%

Data-driven identification of communities with high levels of tuberculosis infection in the Democratic Republic of Congo

Faccin

Rusumba

Ushindi

et al. 2022

Sci Rep

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When access to diagnosis and treatment of tuberculosis is disrupted by poverty or unequal access to health services, marginalized communities not only endorse the burden of preventable deaths, but also suffer from the dramatic consequences of a disease which impacts one’s ability to access education and minimal financial incomes. Unfortunately, these pockets are often left unrecognized in the flow of data collected in national tuberculosis reports, as localized hotspots are diluted in aggregated reports focusing on notified cases. Such system is therefore profoundly inadequate to identify these marginalized groups, which urgently require adapted interventions. We computed an estimated incidence-rate map for the South-Kivu province of the Democratic Republic of Congo, a province of 5.8 million inhabitants, leveraging available data including notified incidence, level of access to health care and exposition to identifiable risk factors. These estimations were validated in a prospective multi-centric study. We could demonstrate that combining different sources of openly-available data allows to precisely identify pockets of the population which endorses the biggest part of the burden of disease. We could precisely identify areas with a predicted annual incidence higher than 1%, a value three times higher than the national estimates. While hosting only 2.5% of the total population, we estimated that these areas were responsible for 23.5% of the actual tuberculosis cases of the province. The bacteriological results obtained from systematic screenings strongly correlated with the estimated incidence (r = 0.86), and much less with the incidence reported by epidemiological reports (r = 0.77), highlighting the inadequacy of these reports when used alone to guide disease control programs.

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Catastrophic costs among tuberculosis‐affected households in Zimbabwe: A national health facility‐based survey

Cited by 24 publications

References 9 publications

Financial risk protection from out-of-pocket health spending in low- and middle-income countries: a scoping review of the literature

Financial risk protection from out-of-pocket health spending in low- and middle-income countries: a scoping review of the literature

Coverage and effectiveness of conditional cash transfer for people with drug resistant tuberculosis in Zimbabwe: a mixed methods study

Data-driven identification of communities with high levels of tuberculosis infection in the Democratic Republic of Congo

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