Emergency obstetric care in Mali: catastrophic spending and its impoverishing effects on households

Arsenault, Catherine; Fournier, Pierre; Philibert, Aline; Sissoko, Koman; Coulibaly, A.; Tourigny, Caroline; Traoré, Mamadou; Dumont, Alexandre

doi:10.2471/blt.12.108969

Cited by 90 publications

(121 citation statements)

References 27 publications

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Section: Discussionmentioning

confidence: 99%

“…25,26 The cost of emergency caesarean sections can be catastrophic for households. 25,26 Although user fee exemptions have been one of the key strategies to increase access to delivery care in subSaharan Africa, 27 their impact on caesarean delivery rates has yet to be rigorously evaluated. While such fee exemptions may have contributed to the rises seen in caesarean delivery rates in countries such as Ghana and Senegal, 28,29 such rises cannot be categorically attributed to the exemptions.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Trends in caesarean delivery by country and wealth quintile: cross-sectional surveys in southern Asia and sub-Saharan Africa

Cavallaro

Cresswell

França

et al. 2013

Bull. World Health Organ.

206

183

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Trends in caesarean delivery by country and wealth quintile: cross-sectional surveys in southern Asia and sub-Saharan Africa

Cavallaro

Cresswell

França

et al. 2013

Bull. World Health Organ.

206

183

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“…Of note, although many countries have financing in place specifically for C-sections, this financing does not always protect against catastrophic expenditure. 42 The gradient of utilization across nations comes from a small sample of countries, which introduces uncertainty into our equity results. Data on disease burden is limited as well.…”

Section: Limitations and Strengthsmentioning

confidence: 99%

Catastrophic expenditure to pay for surgery worldwide: a modelling study

Shrime

Dare

Alkire

et al. 2015

The Lancet Global Health

248

236

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Purpose Approximately 150 million individuals face catastrophic expenditure each year from medical costs alone, and many more from the nonmedical costs of accessing care. The proportion of this expenditure arising from surgical conditions is unknown. Because World Bank has proposed eliminating medical impoverishment by 2030, the impact of surgical conditions on financial catastrophe must be quantified so that any financial risk protection mechanisms can appropriately incorporate surgery. Methods To determine the global incidence of catastrophic expenditure due to surgery, a stochastic model was built. The income distribution of each country, the probability of requiring surgery, and the medical and nonmedical costs faced for surgery were incorporated. Sensitivity analyses were run to test model robustness. Findings 3.7 billion people risk catastrophic expenditure if they need surgery. Every year, 33 million of them are driven to financial catastrophe from the costs of surgery alone, and 48 million from nonmedical costs, leading to 81 million cases worldwide. The burden of catastrophic expenditure is highest in low- and middle-income countries; within any country, it falls on the poor. Estimates are sensitive to the definition of catastrophic expenditure and the costs of care. The inequitable burden distribution is robust to model assumptions. Interpretation Half the global population is at risk of financial catastrophe from surgery. Annually, 81 million individuals, especially the poor, face catastrophic expenditure due to surgical conditions, of which less than half is attributable to medical costs. These findings highlight the need for financial risk protection for surgery in health system design. Funding Partial funding for Dr. Shrime from NIH/NCI R25CA92203.

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“…The average direct costs of maternal death was up to US$ 4,119, and the economic burden, which referred to the ratio of out-of-pocket costs to total household annual income, was 37.0%, being approximately four times as high as the threshold for being considered catastrophic [6]. In recent years, emergency obstetric care have been found to be a useful complement to investigation of maternal mortality, and a few studies have estimated the impact of these cases on household economy [7]–[9]. However, knowledge is still lacking about the precise long-term impact of maternal death on household economy.…”

Section: Introductionmentioning

confidence: 99%

Economic Impact of Maternal Death on Households in Rural China: A Prospective Cohort Study

Wang

et al. 2013

PLoS ONE

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ObjectiveTo assess the economic impact of maternal death on rural Chinese households during the year after maternal death.MethodsA prospective cohort study matched 183 households who had suffered a maternal death to 346 households that experienced childbirth without maternal death in rural areas of three provinces in China. Surveys were conducted at baseline (1–3 months after maternal death or childbirth) and one year after baseline using the quantitative questionnaire. We investigated household income, expenditure, accumulated debts, and self-reported household economic status. Difference-in-Difference (DID), linear regression, and logistic regression analyses were used to compare the economic status between households with and without maternal death.FindingsThe households with maternal death had a higher risk of self-reported “household economy became worse” during the follow-up period (adjusted OR = 6.04, p<0.001). During the follow-up period, at the household level, DID estimator of income and expenditure showed that households with maternal death had a significant relative reduction of US$ 869 and US$ 650, compared to those households that experienced childbirth with no adverse event (p<0.001). Converted to proportions of change, an average of 32.0% reduction of annual income and 24.9% reduction of annual expenditure were observed in households with a maternal death. The mean increase of accumulated debts in households with a maternal death was 3.2 times as high as that in households without maternal death (p = 0.024). Expenditure pattern of households with maternal death changed, with lower consumption on food (p = 0.037), clothes and commodity (p = 0.003), traffic and communication (p = 0.022) and higher consumption on cigarette or alcohol (p = 0.014).ConclusionCompared with childbirth, maternal death had adverse impact on household economy, including higher risk of self-reported “household economy became worse”, decreased income and expenditure, increased debts and changed expenditure pattern.

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Emergency obstetric care in Mali: catastrophic spending and its impoverishing effects on households

Cited by 90 publications

References 27 publications

Trends in caesarean delivery by country and wealth quintile: cross-sectional surveys in southern Asia and sub-Saharan Africa

Trends in caesarean delivery by country and wealth quintile: cross-sectional surveys in southern Asia and sub-Saharan Africa

Catastrophic expenditure to pay for surgery worldwide: a modelling study

Economic Impact of Maternal Death on Households in Rural China: A Prospective Cohort Study

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