Assessing the influencing factors of out-of-pocket costs on tuberculosis in Sichuan Province: a cross-sectional study.

BACKGROUND: Although diagnosis and treatment services for tuberculosis (TB) are provided free of charge in most countries, direct non-medical and indirect costs due to absenteeism, also place a significant burden on patients and their families. Sichuan Province has the second highest incidence of TB in China, with an incidence of approximately 100 cases per 100 000 people. However, there are limited research on out-of-pocket expenditure (OOPE) and its influencing factors in TB patients in Sichuan Province. METHODS: A retrospective cross-sectional study was conducted on TB patients in designated medical institutions for TB in Sichuan Province from 2017-2021. A face-to-face questionnaire was conducted to obtain the information related to hospitalization of patients, and the multi-level regression model was used to analyse the factors that influence OOPE and total out-of-pocket expenditure (TOOPE) of TB patients. RESULTS: A total of 2644 patients were investigated, and 74.24% of TB patients and their families experienced catastrophic total costs due to TB. The median total cost was 9223.37 CNY (1429.98 USD), in which the median direct and indirect costs of TB patients were 10185.00 CNY (1579.07 USD) and 2400.00 CNY (372.09 USD), respectively, and indirect costs contributed to 43% of total costs. The median OOPE and TOOPE costs were 6024.00 CNY (933.95 USD) and 11890.50 CNY (1843.49 USD), respectively. OOPE and TOOPE had common influencing factors including whether the patient's family had four or more members, a history of hospitalization, combination with other types of TB, the number of visits before diagnosis, and co-occurrence with chronic disease. CONCLUSIONS: The OOPE and TOOPE for TB patients and their families in Sichuan Province are still heavy. In the long run, it is necessary to strengthen education and awareness campaigns on TB related knowledge, disseminate basic medical knowledge to the public, improve healthcare-seeking behavior, and enhance the healthcare infrastructure to improve the accuracy of TB diagnosis and reduce the significant OOPE and TOOPE faced by TB patients and their families in Sichuan Province.

[Analysis on the neglected conditions and influence factors of middle school students aged 12 to 17 years old in rural areas of Shaanxi Province and Chongqing City].

OBJECTIVE: 10 learn about the neglected conditions and intuence factors of middle school students aged 12 to 17 years old in rural areas of Shaanxi Province and Chongqing City. METHODS: The scale and evaluation method formulated in "The Normal Value of Evaluation on the Neglect of Middle School Students from 12 to 17 Years Old in Rural China" was adopted. 2257 respondents among which there were 1157 male students and 1,100 female students in the rural areas of Shaanxi Province and Chongqing City were selected according to the principle of multi-stage stratified cluster sampling. The severe degree of neglect was reflected through the indicator of neglect degree. The method of binary Logistic regression analysis was adopted to analyze the influence factors of neglect. Results The total neglect degree of respondents was (51. 80 ± 9. 06). The neglect degree of middle school students in the rural areas of Chongqing was (53. 21 ± 9. 03). The neglect degree of middle school students in the rural areas of Shaanxi was 50. 50 8. 90. The statistical significance was found in the difference between the two groups (U =6. 17, P <0. 01). The neglect degree of male students was (51. 93 ± 8. 67) while the neglect degree of female students was (51. 66 ± 9. 46). The statistical significance was not found in the difference between the two groups of total neglect degree of different sexes (U = 0. 60, P > 0. 05). The statistical significance was noticed in the differences of neglect degrees of middle school students in different grades at all levels (P <0. 05). The neglect degrees of junior three and senior three students were relatively high. Their total neglect degrees were (53. 54 ± 9. 70) and (53. 36 ± 8. 69) respectively. Except social neglect and safety neglect, there was statistical significance in the differences of neglect degrees of students with different family backgrounds at all levels (P <0. 01). The neglect degree of middle school students in a remarried family was the highest. The total neglect degree was (56. 92 ± 8. 83). The factors influencing the neglect of middle school students were shown in the result of Logistic regression analysis, including the educational level of their fathers, whether they had a separate room, family types, whether the working places of their parents changed in one year, whether the incomes of their parents decreased in one year, their relationship with their parents and the relationship between their parents. CONCLUSION: The neglected conditions of middle school students in the rural areas of Shaanxi Province and Chongqing City are relatively severe and the factors influencing the neglect of children include the educational level of their fathers, whether they have a separate room, family types, whether the working places of their parents changed in one year, whether the incomes of their parents decrease in one year, their relationship with their parents and the relationship between their parents.

[The situation of neglect state among elementary and high school students aged 6-17 years in rural areas of two western provinces of China].

OBJECTIVE: To understand the neglect situation of elementary and high school students aged 6-17 years in western rural areas of China. METHODS: Using multi-stage stratified cluster sampling method, 4 131 students were recruited from 26 rural elementary and high schools of 7 districts in Shanxi province and Chongqing from September 2012 to April 2013. The investigation was conducted based on 'The Development of Neglect Evaluation Norms and Influence Factors for Primary and Middle School Students' in rural areas of China. SAS 9.21 software was used for analyzing neglect rate and neglect degree for groups of age, sex and neglect types (including neglect of physical, emotional, medical, educational, safety and social). RESULTS: The total neglect rate and degree were 55.50% (1 943/3 501) and 49.96 ± 9.67; the neglect rates for males and females were 56.78% (1 018/1 793) and 54.16% (925/1 708) (P = 0.119); the neglect degrees were 50.08 ± 9.31 and 49.83 ± 10.02 (P = 0.479), respectively. The girls' medical neglect rate (18.25%, 348/1 907) was significantly higher than that in boys (14.72%, 294/1 997) (P < 0.01); the boys' neglect degrees of physical, educational and social neglect (50.05 ± 10.46, 49.99 ± 10.81, 57.63 ± 14.63) were significantly higher than that in girls (49.34 ± 10.70, 49.07 ± 11.30, 56.37 ± 14.80) (P < 0.05). The total neglect rates of 6-8, 9-11, 12-14 and 15-17 groups were 44.48% (310/697), 60.40% (511/846), 60.89% (601/987) and 53.66% (521/971) (P < 0.01), and the total neglect degrees among these groups were 46.89 ± 8.57, 51.88 ± 9.25, 51.88 ± 9.25 and 51.72 ± 8.89 (P < 0.01), respectively. Except the neglect rates of medical and social neglect, significant differences were found in other three neglect rates and neglect degrees. The rates of social, emotional and safety neglect in 9-11 group were higher than that in other groups (28.39% (264/930), 26.41% (239/905), 20.35% (187/919)). The 12-14 group has the highest educational neglect rate(29.41%, 317/1 078). While the physical and emotional neglect degrees in 12-14 and 15-17 group were higher than that in other groups(12-14 group: 51.59 ± 10.02, 53.43 ± 12.02, 15-17 group: 51.96 ± 9.80, 52.61 ± 11.59). The social, safety, educational and medical neglect degrees were the highest in 6-8, 9-11, 12-14 and 15-17 group (60.91 ± 13.13, 48.29 ± 11.34, 52.43 ± 10.55, 51.15 ± 17.25), respectively. The neglect rates and neglect degrees were significantly higher in minorities(68.88% (374/543) and 52.91 ± 9.14) than those in Han population (53.04% (1 569/2 958), 49.44 ± 9.67)(P < 0.01 in both indexes); and the neglect rates and neglect degrees were significantly higher in children with siblings group (58.20% (1 504/2 584), 50.58 ± 9.54) than those the in one-child group (47.87% (439/917), 48.27 ± 9.80) (P < 0.01 in both indexes); and the neglect rates and neglect degrees were significantly higher in left-hand students (61.65% (1 101/1 786), 51.41 ± 9.51) than those in living-with-parents students(49.10% (842/1 715), 48.56 ± 9.61) (P < 0.01 in both indexes). CONCLUSION: The children neglect situation is serious in western rural areas, close attention from families, schools and the society is in urgent need.