title: The economic burden of tuberculosis care for patients and households in Africa: a systematic review.
abstract: OBJECTIVE
  To summarise the state of knowledge on the economic impact and consequences of tuberculosis (TB) diagnosis and treatment for patients/households in Africa, and to highlight any weaknesses in the work conducted to date.
  
  
  METHODS
  We systematically searched for published  articles in English between 1990 and June 2010 in eight databases and the World Health Organization (WHO) website. Broad search terms were used ('tuberculosis' OR 'tuberculosis/HIV' AND 'costs' AND 'Africa'). Only studies that reported any costs  of TB care for patients/households were retained. All costs were converted to 2009 USD in accordance with WHO cost analysis guidelines.
  
  
  RESULTS
  Overall, 11 articles from eight countries met the inclusion criteria. Only one study met all the quality criteria for a cost-of-illness study;  most of the studies focused on urban populations, reported incomplete (pre-diagnostic/average) costs, and did not report coping costs. Mean patient pre-diagnostic costs varied between US$36 and US$196, corresponding to respectively 10.4% and 35% of their annual income. Average  patient treatment costs ranged between US$3 and US$662, corresponding to 0.2-30% of their annual income. Pre-diagnostic household costs accounted for 13% and 18.8% of patients' annual household income, while total household treatment costs ranged between US$26 and  US$662, accounting for 2.9-9.3% of annual household income; 18-61% of patients received financial assistance from outside their household to cope with the cost of TB care.
  
  
  CONCLUSIONS
  The average patient's/household's pre-diagnostic costs for TB care were catastrophic.  More properly designed studies are needed among different populations throughout Africa.
authors.affiliation: Department of Internal Medicine, Ebonyi State University Teaching Hospital, Abakaliki, Nigeria. ukwajakingsley@yahoo.co.uk
authors.forename: K N
authors.initials: KN
authors.lastname: Ukwaja
authors.forename: O
authors.initials: O
authors.lastname: Modebe
authors.forename: C
authors.initials: C
authors.lastname: Igwenyi
authors.forename: I
authors.initials: I
authors.lastname: Alobu
mesh_terms: D000223:Adaptation, Psychological; D000349:Africa / Q000453:epidemiology; D060085:Coinfection / Q000191:economics / Q000628:therapy; D017281:Cost of Illness; D003906:Developing Countries / Q000191:economics*; D005191:Family Characteristics; D005382:Financing, Personal; D015658:HIV Infections / Q000191:economics / Q000628:therapy; D017048:Health Care Costs; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D007182:Income; D018803:Models, Economic; D014376:Tuberculosis / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*