Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, CA, USA.
Center for Tuberculosis, University of California, San Francisco, San Francisco, California, USA.
BMC Public Health. 2023 Nov 25;23(1):2339. doi: 10.1186/s12889-023-17084-7.
Households of children with tuberculosis (TB) experience financial and social hardships, but TB-specific social protection initiatives primarily focus on adults.
We conducted a single-arm, pilot study of multi-component supportive benefits for children with pulmonary TB in Kampala, Uganda. At diagnosis, participants received in-kind coverage of direct medical costs, a cash transfer, and patient navigation. Caregivers were surveyed before diagnosis and 2 months into TB treatment on social and financial challenges related to their child's illness, including estimated costs, loss of income and dissaving practices.
We included 368 children from 321 households. Pre-diagnosis, 80.1% of caregivers reported that their child's illness negatively impacted household finances, 44.1% of caregivers missed work, and 24% engaged in dissaving practices. Catastrophic costs (> 20% annual income) were experienced by 18.4% (95% CI 13.7-24.0) of households. School disruption was common (25.6%), and 28% of caregivers were concerned their child was falling behind in development. Two months post-diagnosis, 12 households (4.8%) reported being negatively affected by their child's TB disease (difference -75.2%, 95% CI -81.2 to -69.2, p < 0.001), with limited ongoing loss of income (1.6%) or dissavings practices (0.8%). Catastrophic costs occurred in one household (0.4%) at 2 months post-diagnosis.
Households face financial and social challenges prior to a child's TB diagnosis, and child-sensitive social protection support may mitigate ongoing burden.
儿童结核病（TB）患者的家庭面临经济和社会困难，但针对成人的结核病特定社会保护计划主要侧重于成人。
我们在乌干达坎帕拉开展了一项针对患有肺结核儿童的多部分支持性福利的单臂试点研究。在诊断时，参与者获得了直接医疗费用的实物覆盖、现金转移和患者导航。在诊断前和 TB 治疗开始后 2 个月，护理人员接受了有关其子女疾病相关的社会和经济挑战的调查，包括估计费用、收入损失和节约行为。
我们纳入了来自 321 个家庭的 368 名儿童。在诊断前，80.1%的护理人员报告说他们孩子的疾病对家庭财务产生了负面影响，44.1%的护理人员缺勤，24%的人采取了节约行为。18.4%（95%CI 13.7-24.0）的家庭经历了灾难性的费用（超过年收入的 20%）。学校中断很常见（25.6%），28%的护理人员担心他们的孩子在发育方面落后。诊断后 2 个月，有 12 个家庭（4.8%）报告说他们的孩子的结核病受到负面影响（差异-75.2%，95%CI-81.2 至-69.2，p<0.001），收入持续损失（1.6%）或节约行为（0.8%）有限。诊断后 2 个月，有一个家庭（0.4%）发生了灾难性费用。
在儿童结核病诊断之前，家庭面临经济和社会挑战，儿童敏感的社会保护支持可能会减轻持续的负担。
