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| 1 | Household catastrophic payments for tuberculosis care in Nigeria: incidence, determinants, and policy implications for universal health coverage显示文摘Background:Studies on costs incurred by patients for tuberculosis(TB)care are limited as these costs are reported as averages,and the economic impact of the costs is estimated based on average patient/household incomes.Average expenditures do not represent the poor because they spend less on treatment compared to other economic groups.Thus,the extent to which TB expenditures risk sending households into,or further into,poverty and its determinants,is unknown.We assessed the incidence and determinants of household catastrophic payments for TB care in rural Nigeria.Methods:Data used were obtained from a survey of 452 pulmonary TB patients sampled from three rural health facilities in Ebonyi State,Nigeria.Using household direct costs and income data,we analyzed the incidence of household catastrophic payments using,as thresholds,the traditional>10%of household income and the≥40%of non-food income,as recommended by the World Health Organization.We used logistic regression analysis to identify the determinants of catastrophic payments.Results:Average direct household costs for TB were US$157 or 14%of average annual incomes.The incidence catastrophic payment was 44%;with 69%and 15%of the poorest and richest household income-quartiles experiencing catastrophic activity,respectively.Independent determinants of catastrophic payments were:age>40 years(adjusted odds ratio[aOR]3.9;95%confidence interval[CI],2.0,7.8),male gender(aOR 3.0;CI 1.8,5.2),urban residence(aOR 3.8;CI 1.9,7.7),formal education(aOR 4.7;CI 2.5,8.9),care at a private facility(aOR 2.9;1.5,5.9),poor household(aOR 6.7;CI 3.7,12),household where the patient is the primary earner(aOR 3.8;CI 2.2,6.6]),and HIV co-infection(aOR 3.1;CI 1.7,5.6).Conclusions:Current cost-lowering strategies are not enough to prevent households from incurring catastrophic out-of-pocket payments for TB care.Financial and social protection interventions are needed for identified at-risk groups,and community-level interventions may reduce inefficiencies in the care-seeking pathway.These observations should inform post-2015 TB strategies and influence policy-making on health services that are meant to be free of charge. | Kingsley Nnanna Ukwaja Isaac Alobu Seye Abimbola Philip Christy Hopewell | 2013 | Infectious Diseases of Poverty2013，2，1： | 7 |
| 2 | Profile and treatment out- come of smear-positive TB patients who failed to smear convert af- ter 2 months of treatment in Nigeria 显示文摘 | Ukwaja KN Oshi DC Oshi SN | 2014 | Trans R Soc Trop Med Hyg2014，108，7： | 1 |
| 3 | Healthcare-seeking be- havior, treatment delays and its determinants among pulmonary tu- berculosis patients in rural Nigeria: a cross-sectional study显示文摘 | UKWAJA KN ALOBU I NWEKE CO | 2013 | BMC Health Serv Res2013，，13： | 1 |
| 4 | The economic burden of tuberculosis care for patients and households in Africa: a systematic review 显示文摘 | Ukwaja KN Modebe O Igwenyi C | 2012 | International Journal of Tuberculosis & Lung Disease2012，16，6： | 1 |
| 5 | Tuberculosis treatment default in a large tertiary care hospital in urban Nigeria: Prevalence, trend, timing and predictors显示文摘 | Ngozi A. Ifebunandu Kingsley N. Ukwaja | 2012 | Journal of Infection and Public Health2012，，5： | 1 |
| 6 | The economic burden of tuberculosis care for patients and households in Africa: a systematic review显示文摘 | Ukwaja KN Modebe O Igwenyi C | 2012 | Int JTuberc Lung Dis2012，16，6： | 1 |
| 7 | The economic burdenof tuberculosis care for patients and households in Africa:a systematic review显示文摘 | UKwaja KN Modebe O Lgwenyi C | 2012 | Int J Tuberc Lung Dis2012，16，6： | 1 |
| 8 | The high cost of free tu berculosis services:patient and household costs associated with tu berculosis care in Ebonyi State, Nigeria显示文摘 | Ukwaja KN Alobu I Lgwenyi C | 2013 | PLoS One2013，8，8： | 1 |
| 9 | Profile and determinants of unsuccessful tuberculosis outcome in rural Nigeria:Implications for tuberculosis control显示文摘AIM: To determine the treatment outcomes and predictors for unsuccessful tuberculosis(TB) outcomes in rural Nigeria.METHODS: Adult rural TB patients treated during 2011 and 2012 in two healthcare facilities(one urban public and one rural private) were identified from the TB treatment registers and retrospectively reviewed. Tuberculosis treatment outcomes were assessed according to World Health Organisation guidelines. Determinants of unsuccessful treatment outcomes were identified using a multivariable logistic regression analysis.RESULTS: Between January 2011 to December 2012, 1180 rural TB patients started treatment, of whom 494(41.9%) were female. The treatment success rate was 893(75.7%), while the rates of death, loss-tofollow-up, and treatment failure were 129(10.9%), 100(8.5%), and 18(1.5%) respectively. In the final multivariable logistic regression model, the odds of unsuccessful treatment outcome were higher among patients who received care at the urban public facility(a OR = 2.9, 95%CI: 1.9-4.4), smear-negative(1.3,1.0-1.8) and extrapulmonary(2.7, 1.3-5.6) TB patients, human immunodeficiency virus(HIV) co-infected(2.1, 1.5-3.0), and patient who received the longer(8-mo) anti-TB regimen(1.3, 1.1-1.8).CONCLUSION: Treatment success among rural TB patient in Nigeria is low. High risk groups should be targeted for closer monitoring, socio-economic support, and expansion of TB/HIV activities. | Kingsley N Ukwaja Sarah N Oshi Isaac Alobu Daniel C Oshi | 2016 | World Journal of Methodology2016，6，1： | 0 |
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