Social and Economic Consequences of Pulmonary Tuberculosis – Perspectives of Patients, Their Families, the Community, and Health Care Providers Who Care for TB Patients in Mbeya and Songwe Regions, Tanzania,

Abstract

Tuberculosis (TB) is a significant health concern that profoundly affects individuals and communities, especially in low-income areas. The disease not only causes physical and psychological harm but also imposes heavy financial and economic burdens, especially on people with low incomes, who face limited access to healthcare facilities (HCFs). Pulmonary TB (PTB) is a highly contagious airborne disease that demands early diagnosis and prompt treatment to prevent severe complications and limit its spread. However, individuals in remote or rural areas face significant challenges in accessing timely care, further exacerbating the burdens associated with the disease. This study aimed to enhance understanding of the social and economic impacts of PTB from the perspectives of PTB patients, their family representatives, PTB survivors, and healthcare Providers (HCPs) in the Mbeya and Songwe regions of Tanzania. Specifically, this study aim to describe financial burdens experienced by patients, their families, TB survivors and HCPs before and during PTB treatment. To explore the social and economic consequences of PTB as perceived by multiple stakeholders and investigate the coping strategies they employed with particular emphasis on the role of social support in managing illness and treatment. This was a cross-sectional study nested in an observational longitudinal study called ‘The TB Sequel Project.’ It employed both qualitative and quantitative data to achieve its specific objectives. Quantitative data drawn from 261 laboratory-confirmed TB patients were used to address objective one. For objectives two and three, qualitative data were collected through key informant interviews with HCPs and in-depth interviews with patients and PTB survivors. All participants provided informed consent. The study found that PTB patients and survivors in the study regions faced significant social and economic challenges, including stigma, financial hardship, and limited access to healthcare services. Psychological distress was frequently reported, particularly among patients lacking anticipated social support from their close relatives or broader community which sometimes hindered treatment adherence. The majority of TB patients spent most of their financial resources seeking care from inappropriate sources, such as traditional healers or unregulated drug vendors. Nearly three-quarters (72.8%) of participants reported delaying their visit to a health facility for more than four weeks after the onset of symptoms. These testimonies reaffirm existing evidence indicating that, although TB diagnosis and treatment in 9 Tanzania are provided free of charge, still many patients delay seeking medical attention due to pre-diagnosis costs, limited awareness of TB symptoms, and the pervasive stigma associated with TB and HIV. The implications of this delay in seeking care is significant because postponed care can lead to delayed diagnosis, increased disease transmission, worsening of clinical symptoms, and long-term health consequences. Furthermore, the delays not only undermines timely TB control efforts but also increase the risk of poor treatment outcomes and continue community transmission. TB Survivors similarly reported persistent challenges even after completing treatment, including economic hardship, ongoing stigma, and psychological distress. HCPs confirmed the prevalence delays in diagnosis and access to care, frequently attributing them to stigma, and financial constraints. The findings suggest an urgent need for a holistic approach to PTB case management that incorporates social support, including both moral and financial ones, since they are important for encouraging the patients and the survivors. Also, multisectoral strategies involving commitments geared towards strengthening the existing healthcare infrastructure and expanding financial assistance programs are essential steps toward enhancing TB care and achieving the End TB Strategy 2035 goals.