ABSTRACT
OBJECTIVE: To assess the relative costs of accessing a TB diagnosis for the poor and for women in urban Lilongwe, Malawi, a setting where public health services are accessible within 6 kilometers and provided free of charge. METHODS: Patient and household direct and opportunity costs were assessed from a survey of 179 TB patients, systematically sampled from all public and mission health facilities in Lilongwe. Poverty status was determined from the 1998 Malawi Integrated Household Survey (MIHS). FINDINGS: On average, patients spent US$ 13 (MK 996 or 18 days' income) and lost 22 days from work while accessing a TB diagnosis. For non-poor patients, the total costs amounted to 129% of total monthly income, or 184% after food expenditures. For the poor, this cost rose to 248% of monthly income or 574% after food. When a woman or when the poor are sick, the opportunity costs faced by their households are greater. CONCLUSION: Patient and household costs of TB diagnosis are prohibitively high even where services are provided free of charge. In scaling up TB services to reach the Millennium Development Goals, there is an urgent need to identify strategies for diagnosing TB that are cost-effective for the poor and their households.
Subject(s)
Cost of Illness , Health Services Accessibility/economics , Poverty , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/economics , Antitubercular Agents/therapeutic use , Cross-Sectional Studies , Female , Health Expenditures , Health Services Accessibility/organization & administration , Humans , Malawi/epidemiology , Male , Transportation , Tuberculosis, Pulmonary/drug therapyABSTRACT
We conducted a study in four prisons in Zomba district, Malawi, to determine the tuberculosis case notification rate in prison officers during the year 2000. Of 201 prison staff, 9 (4.5%) were diagnosed with TB: 2 with smear-positive pulmonary tuberculosis (PTB), 4 with smear-negative PTB and 3 with extrapulmonary TB (EPTB). This incidence in prison officers (9/201) was significantly greater than the incidence in primary school teachers in a separate (unpublished) study in Malawi the previous year (78/4,289) (OR 2.58,[95% CI, 2.44 - 2.73], p <0.015). Expressed as annual TB case notification rates, the data for prison officers in these 4 prisons was 4,478 per 100,000, compared to 1,786 per 100,000 in teachers. There may be a high incidence of TB in prison officers. Further research needs to be carried out in this group to confirm these findings and to develop an occupational health service to reduce the risk of TB for these workers.
