|
|
|
题名
|
作者
|
年代
|
出处
|
被引量
|
| 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 | Risk factors of treatment default and death among tuberculosis patients in a resource-limited setting显示文摘Objective:To evaluate the rates,timing and determinants of default and death among adult tuberculosis patients in Nigeria.Methods:Routine surveillance data were used.A retrospective cohort study of adult tuberculosis patients treated during 2011 and 2012 in two large health facilities in Ebonyi State.Nigeria was conducted.Multivariable logistic regression analyses were used to tdentify independent predictors for treatment default and death.Results:Of 1668 treated patients,the default rate was 157(9.4%),whilst 165(9.9%) died.Also,35.7%(56) of the treatment defaults and 151(91.5%) of deaths occurred during the intensive phase of treatment.Risk of default increased with increasing age(adjusted odds ratio(aOR) 1.2;95%confidence interval(CI)1.1-1.9).smear-negative TB case(aOR 2.3:CI 1.5-3.6).extrapulmonary TB case(aOR 2.7:CI 1.3-5.2).and patients who received the longer treatment regimen(aOR 1,6;1.1-2.2).Risk of death was highest in extrapulmonary TB(aOR 3.0:CI 1.4-6.1) and smear-negative TB cases(aOR 2.4:CI1.7-3.51.rural residents(aOR 1.7:CI 1.2-2.6),HIV co-infected(aOR 2.5:CI 1.7-3.6),not receiving antiretroviral therapy(aOR 1.6:CI 1.1-2.9),and not receiving cotrimoxazole prophylaxis(aOR 1.7:CI 1.2—2.6).Conclusions:Targeted interventions to improve treatment adherence for patients with the highest risk of default or death are urgently needed.This needs to he urgently addressed by the National Tuberculosis Programme. | Isaac Alobu Sarah N.Oshi Daniel C.Oshi Kingsley N.Ukwaja | 2014 | Asian Pacific Journal of Tropical Medicine2014，7，12： | 1 |
| 3 | 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 |
您所在的机构暂未开通此部分的功能，请联系管理员