Introduction - Catastrophic health expenditure during COVID-19 hospitalization has altered the economic picture of households especially in low resource settings with high rates of COVID-19 infection. This study aimed to estimate the Out of Pocket (OOP) expenditure and the proportion of households that incurred catastrophic health expenditures due to COVID-19 hospitalisation in Kerala, South India. Materials and Methods - A cross-sectional study was conducted among a representative sample of 155 COVID-19 hospitalised patients in Kottayam district over four months, using a pretested interview schedule. The direct medical and non-medical costs incurred by the study participant during hospitalisation and the total monthly household expenditure were obtained from the respective COVID-19 affected households. Catastrophic health expenditure was defined as direct medical expenditure exceeding 40% of effective household income. Results - From the study, median and mean Out of Pocket (OOP) expenditures were obtained as USD 93.57 and USD 502.60 respectively. The study revealed that 49.7% of households had Catastrophic health expenditure, with 32.9% having incurred Distress financing. Multivariate analysis revealed being Below poverty line, hospitalisation in private healthcare facility and presence of co-morbid conditions as significant determinants of Catastrophic health expenditure. Conclusion - High levels of Catastrophic health expenditure and distress financing revealed by the study unveils major unaddressed challenges in the road to Universal health coverage.

Background: Diabetes mellitus (DM) is one of the most common metabolic diseases characterized by increased blood glucose levels either due to insufficiency/absence of insulin or due to decrease in the insulin sensitivity. The prevalence of chronic kidney disease (CKD) in people with type 2 diabetes is three times higher than in non-diabetic population and majority of people developing end-stage renal diseases (ESRD) have Type 2 DM. The objectives of the study were to find out the prevalence of CKD, mean GFR and associated factors of CKD, in diabetics coming to a primary health care setting in Central Kerala.Methods: A cross-sectional study among all patients attending the NCD clinic of Health Centre, Ettumanoor with confirmed diagnosis of type 2 diabetes mellitus was done between February 2017 and April 2017.Results: The prevalence of CKD among the study population was 45.3%. The proportion of CKD was 34.9% among those with nil urinary protein, 57.1% among those with 1+ urinary protein, 88.9% for those with 2+ and 87.5% among those with 3+ urinary protein. Among those with CKD mean duration of diabetes was 121.92 months against 92.72 months among those without CKD. There was statistically significant difference between RBS values of those with CKD and without CKD (238.49 mg% versus 199.41 mg%). The proportion of CKD was found increase with duration of diabetes 5 years (31.2%), 5-10 years (47.8%), 10-15 years (52.6%) and >15 years (55%).Conclusions: The study showed high prevalence of CKD among diabetics. The duration of diabetes, urinary protein levels and RBS value were found to have strong association with CKD in diabetics.

Catastrophic health expenditure during COVID-19 hospitalization has altered the economic picture of households, especially in low resource settings with high rates of COVID-19 infection. This study aimed to estimate the out of pocket (OOP) expenditure and the proportion of households that incurred catastrophic health expenditure due to COVID-19 hospitalization in Kerala, South India. Materials and Methods:A cross-sectional study was conducted among a representative sample of 155 COVID-19 hospitalized patients in Kottayam district over four months, using a pretested interview schedule. The direct medical and non-medical costs incurred by the study participants during hospitalization and the total monthly household expenditure were obtained from the respective COVID-19 affected households. Catastrophic health expenditure was defined as direct medical expenditure exceeding 40% of the household's capacity to pay. Results: From the study, median and mean OOP expenditure was obtained as USD 93.57 and USD 502.60 respectively. The study revealed that 49.7% of households had catastrophic health expenditure, with 32.9% having incurred distress financing. Multivariate analysis revealed being below poverty line, hospitalization in private healthcare facility, and presence of co-morbid conditions as significant determinants of catastrophic health expenditure. Conclusion: High levels of catastrophic health expenditure and distress financing revealed by the study have unveiled major unaddressed challenges in the road to universal health coverage.