Pathways and associated costs of care in patients with confirmed and presumptive tuberculosis in Tanzania: A cross-sectional study.

Mhalu, Grace; Hella, Jerry; Mhimbira, Francis; Said, Khadija; Mosabi, Thomas; Mlacha, Yeromin P; Schindler, Christian; Gagneux, Sébastien; Reither, Klaus; de Hoogh, Kees; Weiss, Mitchell G; Zemp, Elisabeth; Fenner, Lukas (2019). Pathways and associated costs of care in patients with confirmed and presumptive tuberculosis in Tanzania: A cross-sectional study. BMJ open, 9(4), e025079. BMJ Publishing Group 10.1136/bmjopen-2018-025079

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OBJECTIVE To assess pathways and associated costs of seeking care from the onset of symptoms to diagnosis in patients with confirmed and presumptive tuberculosis (TB). DESIGN Cross-sectional study. SETTING District hospital in Dar es Salaam, Tanzania. PARTICIPANTS Bacteriologically 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. RESULTS Of 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. CONCLUSIONS Patients 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.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

UniBE Contributor:

Fenner, Lukas


600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services




BMJ Publishing Group




Doris Kopp Heim

Date Deposited:

23 Apr 2019 13:52

Last Modified:

24 Oct 2019 06:03

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

direct costs health care health-seeking indirect costs pathways to care tuberculosis




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