Household catastrophic payments for tuberculosis care in Nigeria: incidence, determinants, and policy implications for universal health coverage
Infectious Diseases of Poverty·
- DOI
- 10.1186/2049-9957-2-21
- PMID
- 24044368
- PMCID
- PMC3848689
- OpenAlex
- W2063605216
- Study type
- Journal article
- Publisher
- Springer Science and Business Media LLC
- Article type
- journal-article
- Integrity
- current
Why this research matters now
The findings indicate that existing cost-reduction measures are insufficient to prevent catastrophic out-of-pocket spending for tuberculosis care. Financial and social protection interventions targeting identified at-risk groups, alongside community-level efficiency improvements in the care-seeking pathway, are needed to support universal health coverage goals and inform post-2015 tuberculosis strategies.
Structured evidence summary
Research question
The study examined the frequency and predictors of catastrophic household payments for tuberculosis care in rural Nigeria.
Study design
Cross-sectional survey of 452 pulmonary tuberculosis patients from three rural health facilities in Ebonyi State, Nigeria. Catastrophic payment was defined using thresholds of >10% of household income and ≥40% of non-food income, with logistic regression used to identify determinants.
Population and setting
Pulmonary tuberculosis patients receiving care at three rural health facilities in Ebonyi State, Nigeria.
Main findings
Mean direct household costs for tuberculosis care were US$157, representing 14% of average annual household income. Catastrophic payment occurred in 44% of households overall, with 69% of the poorest income quartile and 15% of the richest quartile affected. Significant independent predictors included age over 40 years, male gender, urban residence, formal education, private facility care, poor household economic status, patient as primary earner, and HIV co-infection.
Public-health relevance
The findings indicate that existing cost-reduction measures are insufficient to prevent catastrophic out-of-pocket spending for tuberculosis care. Financial and social protection interventions targeting identified at-risk groups, alongside community-level efficiency improvements in the care-seeking pathway, are needed to support universal health coverage goals and inform post-2015 tuberculosis strategies.
Important limitations
This summary is limited to the supplied single-article abstract and metadata. The original paper is required for decision-grade interpretation, including full methodological detail, potential selection bias, generalizability beyond the three rural facilities sampled, and validation of self-reported cost and income data.
GIDS interpretation
The article was linked to tuberculosis disease classification and Nigeria country tag, making it discoverable in queries filtering for tuberculosis epidemiology, health economics, or health policy topics in sub-Saharan Africa. The health policy and treatment topic tags reflect the study's focus on out-of-pocket costs and care-seeking behavior.
Related GIDS surveillance
Literature context does not validate, explain, or change a surveillance signal. Exact and contextual relationships are shown separately.
Evidence relationships
This article has 9 auditable classifier relationships to diseases, places, topics, and study design.