Needham D M, Godfrey-Faussett P, Foster S D
MD Programme, McMaster University, Ontario, Canada.
Int J Tuberc Lung Dis. 1998 Oct;2(10):811-7.
Chest Clinic, University Teaching Hospital, Zambia.
To study the pre-diagnosis economic impact, burden, and barriers to care-seeking for tuberculosis patients in urban Zambia.
In-depth interviews conducted over a 9-week period with adult in-patients and out-patients registering with new pulmonary tuberculosis; data analysis using Epi Info.
Interviews were completed by 202 patients: 64% normally worked, but 31% stopped due to their tuberculosis, with an average of 48 days off. The mean duration of illness prior to their tuberculosis registration was 63 days, with 64% of patients delaying in presenting to the Chest Clinic. Of these, 38% blamed money shortages for their delay. In seeking diagnosis, patients incurred a mean total cost equivalent to 127% of their mean monthly income (pounds sterling UK 40 [$US 59]); direct expenditures represented 60% of this cost. In addition, patients lost, on average, 18 work days prior to diagnosis. Care-givers incurred costs equivalent to 31% of the mean monthly income (pounds sterling UK 10 [$US 15]).
The economic burden of tuberculosis on patients creates barriers to prompt diagnosis which may lead to continuing transmission of the infection. Important economic barriers include transportation expenditure, cost of 'special food', and lost income. These barriers may be reduced through interventions that reduce the number of health encounters, travel distances and duration of illness before diagnosis.
赞比亚大学教学医院胸部诊所。
研究赞比亚城市地区肺结核患者诊断前的经济影响、负担及就医障碍。
在9周内对新登记的成年肺结核住院患者和门诊患者进行深入访谈；使用Epi Info进行数据分析。
202名患者完成访谈：64%的患者正常工作，但31%因患肺结核而停止工作，平均请假48天。在登记肺结核之前，患者的平均患病时长为63天，64%的患者延迟前往胸部诊所就诊。其中，38%的患者将延迟就诊归咎于资金短缺。在寻求诊断过程中，患者平均总花费相当于其月平均收入的127%（40英镑[59美元]）；直接支出占该费用的60%。此外，患者在诊断前平均损失18个工作日。照顾者产生的费用相当于月平均收入的31%（10英镑[15美元]）。
肺结核给患者带来的经济负担造成了及时诊断的障碍，可能导致感染持续传播。重要的经济障碍包括交通支出、“特殊食物”费用和收入损失。通过减少健康问诊次数、出行距离以及诊断前的患病时长的干预措施，这些障碍可能会降低。
