{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T02:10:18Z","timestamp":1793067018332,"version":"4.5.0"},"reference-count":43,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"unspecified","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,6,18]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To quantify out-of-pocket (OOP) costs and catastrophic health expenditure (CHE) among patients hospitalised with heart failure (HF) and to identify factors associated with CHE during a single index admission in northern Tanzania.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Prospective cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Medical ward of Kilimanjaro Christian Medical Centre, a tertiary referral hospital in northern Tanzania, from 1 May to 31 October 2024.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Consecutive patients aged 14 years or older admitted with acute decompensated HF diagnosed using Framingham criteria. Of 309 eligible patients, 290 completed the study and were included in the analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>The primary outcome was CHE, defined as OOP spending exceeding 40% of household non-food expenditure for the index hospitalisation. Secondary outcomes included total inpatient OOP cost and cost distribution by category. Factors associated with CHE were assessed using multivariable logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 290 hospitalised patients with HF, 201 (69.3%) experienced CHE during the index admission. The median total cost of hospitalisation was US$229 (IQR 155\u2013405), and the median OOP payment was US$192 (IQR 39\u2013360). Diagnostic investigations accounted for the largest share of OOP expenditure. In multivariable analysis, family income US$\u2264115 (adjusted OR (aOR) 10.0, 95% CI 4.3 to 23.0) and lack of health insurance (aOR 22.9, 95% CI 9.3 to 56.1) were strongly associated with CHE. Other independent associated factors were non-use of mineralocorticoid receptor antagonists before admission (aOR 4.1, 95% CI 1.5 to 11.1), reduced left ventricular ejection fraction (aOR 3.1, 95% CI 1.2 to 8.0) and length of stay &gt;7 days (aOR 4.1, 95% CI 1.7 to 10.0).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CHE was common among patients hospitalised with HF in northern Tanzania during a single admission, driven mainly by diagnostic costs and limited financial protection. Expanding insurance coverage, improving access to guideline-directed HF therapy and reducing patient payment for essential diagnostics may lessen the financial burden of HF care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-114105","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T11:40:55Z","timestamp":1782992455000},"page":"e114105","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Out-of-pocket costs and catastrophic health expenditure among hospitalised patients with heart failure in northern Tanzania, May\u2013October 2024: a cross-sectional study"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7812-8042","authenticated-orcid":false,"given":"Abid M","family":"Sadiq","sequence":"first","affiliation":[{"name":"Department of Cardiology, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania, United Republic of"},{"name":"Faculty of Medicine, KCMC University, Moshi, Kilimanjaro, Tanzania, United Republic of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lameck","family":"Marcel","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania, United Republic of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faryal M","family":"Raza","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, KCMC University, Moshi, Kilimanjaro, Tanzania, United Republic of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faustini C","family":"Kimondo","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, KCMC University, Moshi, Kilimanjaro, Tanzania, United Republic of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon C","family":"Peter","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania, United Republic of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nyasatu G","family":"Chamba","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, KCMC University, Moshi, Kilimanjaro, Tanzania, United Republic of"},{"name":"Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania, United Republic of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloria A","family":"Temu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, KCMC University, Moshi, Kilimanjaro, Tanzania, United Republic of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah J","family":"Urasa","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, KCMC University, Moshi, Kilimanjaro, Tanzania, United Republic of"},{"name":"Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania, United Republic of"},{"name":"Director of Medical Services, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania, United Republic of"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"2026070204402628000_16.7.e114105.1","doi-asserted-by":"crossref","unstructured":"Gheorghe A , Griffiths U , Murphy A , et al . 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