Pathways and associated costs of care in patients with confirmed and presumptive tuberculosis in Tanzania: A cross-sectional study

ObjectiveTo assess pathways and associated costs of seeking care from the onset of symptoms to diagnosis in patients with confirmed and presumptive tuberculosis (TB).DesignCross-sectional study.SettingDistrict hospital in Dar es Salaam, Tanzania.ParticipantsBacteriologically confirmed TB and presumptive TB patients.Primary and secondary outcome measuresWe calculated distance in metres and visualised pathways to healthcare up to five visits for the current episode of sickness. Costs were described by medians and IQRs, with comparisons by gender and poverty status.ResultsOf 100 confirmed and 100 presumptive TB patients, 44% of confirmed patients sought care first at pharmacies after the onset of symptoms, and 42% of presumptive patients did so at hospitals. The median visits made by confirmed patients was 2 (range 1–5) and 2 (range 1–3) by presumptive patients. Patients spent a median of 31% of their monthly household income on health expenditures for all visits. The median total direct costs were higher in confirmed compared with presumptive patients (USD 27.4 [IQR 18.7–48.4] vs USD 19.8 [IQR 13.8–34.0], p=0.02), as were the indirect costs (USD 66.9 [IQR 35.5–150.0] vs USD 46.8 [IQR 20.1–115.3], p