title: The cost of medical care and people's health-seeking behaviour before being suspected of tuberculosis in three local health systems, Nicaragua.
abstract: OBJECTIVE
  To assess the medical costs incurred by users and delay between first contact with a care provider and sputum test for acid-fast bacilli (AFB) in three areas of Nicaragua.
  
  
  METHODS
  Directed interviews of consecutive series of tuberculosis (TB) suspects whose sputum had been examined for AFB.
  
  
  RESULTS
  Of 252 TB suspects interviewed, 52% used more than one type of care giver and 35% used private practitioners. As a consequence, 18%, 21% and 29% of the interviewees in Carazo, El Viejo and Matagalpa, respectively, spent more than 1 month of the country's median income per inhabitant on medical care between the first visit to a care provider and the first sputum examination. Furthermore, more than 3 months elapsed on that part of the care pathway for 30%, 17% and 3% of interviewees in Matagalpa, El Viejo and Carazo, respectively.
  
  
  CONCLUSIONS
  This study sheds light on the costs and delays incurred by TB suspects before reaching a laboratory for sputum smear examination. Both costs are lower for those suspects who exclusively use first-line governmental health services (FLGHS). This has been relatively little documented in Latin America to date and could be used as an argument to develop strategies to strengthen the credibility of FLGHS.
authors.affiliation: Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium. jmacq@ulb.ac.be
authors.forename: J
authors.initials: J
authors.lastname: Macq
authors.forename: A
authors.initials: A
authors.lastname: Solis
authors.forename: M
authors.initials: M
authors.lastname: Ibarra
authors.forename: P
authors.initials: P
authors.lastname: Martiny
authors.forename: B
authors.initials: B
authors.lastname: Dujardin
mesh_terms: D001431:Bacteriological Techniques / Q000191:economics; D057210:Delayed Diagnosis / Q000191:economics; D017048:Health Care Costs; D006304:Health Status; D006801:Humans; D009527:Nicaragua; D010342:Patient Acceptance of Health Care; D012959:Socioeconomic Factors; D013183:Sputum / Q000382:microbiology; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy