Socioeconomic consequences of tuberculosis for households in Nigeria: a longitudinal patient cost survey within an intervention engaging informal health providers

Introduction: Tuberculosis (TB) imposes a significant economic and social burden on affected households, particularly in low- and middle-income country settings. In Nigeria, many people with TB first seek care from informal healthcare providers. This study assessed the economic and social consequences of TB among patients referred by informal providers in Northeast Nigeria. Methods: A longitudinal patient cost survey was conducted alongside a case-finding intervention engaging informal providers in Adamawa and Yobe states between July and December 2022 among adults with drug-susceptible pulmonary TB referred by traditional healers or patent and proprietary medicine vendors. Participants (n=195) were interviewed at three time points during treatment to collect data on direct and indirect costs, household income and other socioeconomic consequences. Results: The mean total cost of a TB episode was US$187 (95% CI 170 to 203), with direct costs accounting for 68% of total expenditures. Despite lower average costs compared with national estimates, 27% (n=52) of households incurred catastrophic costs. Food insecurity was reported by 62% (n=122) of households during treatment. Lower pre-TB household income was strongly associated with incurrence of catastrophic costs and adverse social outcomes, including job loss and stigma. Conclusions: Engaging informal providers in TB referral may contribute to lower patient costs compared with national estimates but substantial economic and social consequences remain. Strengthening social protection measures is needed to mitigate the broader socioeconomic impact of TB, particularly among vulnerable households.