title: Factors determining household expenditure for tuberculosis and coping strategies in Tajikistan.
abstract: OBJECTIVE
  To investigate factors influencing expenditure levels and the use of potentially detrimental coping strategies among tuberculosis (TB) patients. For the purpose of the present study, potentially detrimental coping strategies included borrowing money and selling assets.
  
  
  METHODS
  Questionnaire survey with an initial and a follow-up interview of each adult new pulmonary TB case registered over a period of 4 months, conducted in 12 districts with DOTS in Tajikistan, one of the poorest countries in the world.
  
  
  RESULTS
  Patients and their households faced mean expenditures of US$ 396 related to a TB episode. In multivariate mixed-effect regression models, the main determinants of out-of-pocket payments-either over the whole course of the disease or after enrolment in DOTS treatment-were 'complimentary treatment' besides the anti-TB drugs, duration of hospitalization and treatment delay. Complimentary treatment mainly consisted of vitamins and rehydrating infusions. Sex showed no association with expenditure. To cope with the costs of illness, two-thirds of patients employed a potentially detrimental coping strategy. TB patients raised on average US$ 23 through loans with interest, US$ 57 through loans without interest and US$ 102 through selling assets.
  
  
  CONCLUSIONS
  The catastrophic out-of-pocket payments faced by TB patients are correlated with receiving complimentary treatment, delay to treatment and duration of hospitalisation. The widespread use of potentially detrimental coping strategies illustrates that TB constitutes a substantial risk of impoverishment. More parsimonious use of complimentary treatment and hospitalisation could reduce illness-related costs for patients and should be carefully considered.
authors.affiliation: Swiss Tropical and Public Health Institute, Swiss Centre for International Health, Basel, Switzerland. raffael.aye@birding.ch
authors.forename: Raffael
authors.initials: R
authors.lastname: Ayé
authors.forename: Kaspar
authors.initials: K
authors.lastname: Wyss
authors.forename: Hanifa
authors.initials: H
authors.lastname: Abdualimova
authors.forename: Sadullo
authors.initials: S
authors.lastname: Saidaliev
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D017281:Cost of Illness; D005260:Female; D005382:Financing, Personal / Q000379:methods; D005102:Health Expenditures / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts / Q000706:statistics & numerical data; D013620:Tajikistan; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000191:economics* / Q000523:psychology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents