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Persistent problems of access to appropriate, affordable TB services in rural China: experiences of different socio-economic groups

BACKGROUND: Large-scale Tuberculosis (TB) control programmes in China have been hailed a success. Concerns remain, however, about whether the programme is reaching all sections of the population, particularly poorer groups within rural communities, and whether there are hidden costs. This study take...

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Autores principales: Zhang, Tuohong, Tang, Shenglan, Jun, Gao, Whitehead, Margaret
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2007
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1805429/
https://www.ncbi.nlm.nih.gov/pubmed/17288593
http://dx.doi.org/10.1186/1471-2458-7-19
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author Zhang, Tuohong
Tang, Shenglan
Jun, Gao
Whitehead, Margaret
author_facet Zhang, Tuohong
Tang, Shenglan
Jun, Gao
Whitehead, Margaret
author_sort Zhang, Tuohong
collection PubMed
description BACKGROUND: Large-scale Tuberculosis (TB) control programmes in China have been hailed a success. Concerns remain, however, about whether the programme is reaching all sections of the population, particularly poorer groups within rural communities, and whether there are hidden costs. This study takes a household perspective to investigate receipt of appropriate care and affordability of services for different socio-economic groups with TB symptoms in rural China. METHODS: Secondary analysis of Chinese National Household Health Survey for 2003: 40,000 rural households containing 143,991 individuals, 2,308 identified as TB suspects. Outcomes: use of services and expenditure of TB suspects, by gender and socio-economic position, indicated by household income, education, material assets, and insurance status. RESULTS: 37% of TB suspects did not seek any professional care, with low-income groups less likely to seek care than more affluent counterparts. Of those seeking care, only 35% received any of the recommended diagnostic tests. Of the 182 patients with a confirmed TB diagnosis, 104 (57%) received treatment at the recommended level, less likely if lacking health insurance or material assets. The burden of payment for services amounted to 45% of annual household income for the low-income group, 16% for the high-income group. CONCLUSION: Access to appropriate, affordable TB services is still problematic in some rural areas of China, and receipt of care and affordability declines with declining socio-economic position. These findings highlight the current shortcomings of the national TB control programme in China and the formidable challenge it faces if it is to reach all sections of the population, including the poor with the highest burden of disease.
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spelling pubmed-18054292007-02-27 Persistent problems of access to appropriate, affordable TB services in rural China: experiences of different socio-economic groups Zhang, Tuohong Tang, Shenglan Jun, Gao Whitehead, Margaret BMC Public Health Research Article BACKGROUND: Large-scale Tuberculosis (TB) control programmes in China have been hailed a success. Concerns remain, however, about whether the programme is reaching all sections of the population, particularly poorer groups within rural communities, and whether there are hidden costs. This study takes a household perspective to investigate receipt of appropriate care and affordability of services for different socio-economic groups with TB symptoms in rural China. METHODS: Secondary analysis of Chinese National Household Health Survey for 2003: 40,000 rural households containing 143,991 individuals, 2,308 identified as TB suspects. Outcomes: use of services and expenditure of TB suspects, by gender and socio-economic position, indicated by household income, education, material assets, and insurance status. RESULTS: 37% of TB suspects did not seek any professional care, with low-income groups less likely to seek care than more affluent counterparts. Of those seeking care, only 35% received any of the recommended diagnostic tests. Of the 182 patients with a confirmed TB diagnosis, 104 (57%) received treatment at the recommended level, less likely if lacking health insurance or material assets. The burden of payment for services amounted to 45% of annual household income for the low-income group, 16% for the high-income group. CONCLUSION: Access to appropriate, affordable TB services is still problematic in some rural areas of China, and receipt of care and affordability declines with declining socio-economic position. These findings highlight the current shortcomings of the national TB control programme in China and the formidable challenge it faces if it is to reach all sections of the population, including the poor with the highest burden of disease. BioMed Central 2007-02-08 /pmc/articles/PMC1805429/ /pubmed/17288593 http://dx.doi.org/10.1186/1471-2458-7-19 Text en Copyright © 2007 Zhang et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Zhang, Tuohong
Tang, Shenglan
Jun, Gao
Whitehead, Margaret
Persistent problems of access to appropriate, affordable TB services in rural China: experiences of different socio-economic groups
title Persistent problems of access to appropriate, affordable TB services in rural China: experiences of different socio-economic groups
title_full Persistent problems of access to appropriate, affordable TB services in rural China: experiences of different socio-economic groups
title_fullStr Persistent problems of access to appropriate, affordable TB services in rural China: experiences of different socio-economic groups
title_full_unstemmed Persistent problems of access to appropriate, affordable TB services in rural China: experiences of different socio-economic groups
title_short Persistent problems of access to appropriate, affordable TB services in rural China: experiences of different socio-economic groups
title_sort persistent problems of access to appropriate, affordable tb services in rural china: experiences of different socio-economic groups
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1805429/
https://www.ncbi.nlm.nih.gov/pubmed/17288593
http://dx.doi.org/10.1186/1471-2458-7-19
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