Hidden Costs of Hospital-Based Delivery Among Women Using Public Hospitals in Bale Zone, Southeast Ethiopia

Merga, Melese; Debela, Tilahun Fufa; Alaro, Tesfamichael

doi:10.1177/2150132719896447

Cited by 6 publications

(15 citation statements)

References 19 publications

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“…[15][16][17] In Nigeria-and LMICs with "free" maternal care policies-the expectation of both indirect or direct payments for maternity services limits uptake of care and pushes women to receive informal care from traditional healers. [18][19][20][21][22] Anaemia is complex, and while our results highlight a generally good understanding of anaemia as a consequence of inadequate nutrition or blood loss among participants who knew what anaemia was, the role of child spacing to prevent anaemia was not well-understood. There is likely to be misunderstanding of how anaemia can be prevented at a household level, which is illustrated through the very high prevalence of maternal anaemia (72%) in Kano.…”

Section: Discussionmentioning

confidence: 74%

Maternal anaemia care in Kano state, Nigeria: an exploratory qualitative study of experiences of uptake and provision

Kuliya‐Gwarzo

Tancred²,

Gordon³

et al. 2023

F1000Res

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Background: Maternal anaemia (anaemia in pregnancy, childbirth, and the postpartum period) remains a persistent challenge, particularly in Kano State, Nigeria, which has the highest prevalence of maternal anaemia globally, at 72%. Methods: We conducted a qualitative study in Murtala Muhammad Specialist Hospital in Kano State, Nigeria. We aimed to identify factors constraining uptake and provision of maternal anaemia care, exploring perspectives across different stakeholders. We carried out 10 key informant interviews with policymakers and hospital managers, 28 in-depth interviews with healthcare providers and pregnant women using antenatal services and four focus group discussions with pregnant women’s husbands and mothers-in-law. Data were analysed thematically. Results: Issues with provision include a lack of provider training and guidelines specific to maternal anaemia and blood transfusion, insufficient staff to meet increasing demand, and inadequate resources. Issues with uptake include the inability to afford informal user fees, distrust in health services and the blood transfusion process, and a lack of understanding of the causes, consequences, and treatment for anaemia, resulting in poor uptake of care and adherence to treatment. Conclusions: This study recommends the implementation of standardized guidelines and training sessions to better support healthcare providers in offering quality services and increasing funding allocated to supporting maternal anaemia care. Education initiatives for service users and the public are also recommended to build public trust in health services and to improve understanding of maternal anaemia.

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Section: Discussionmentioning

confidence: 74%

Maternal anaemia care in Kano state, Nigeria: an exploratory qualitative study of experiences of uptake and provision

Kuliya‐Gwarzo

Tancred²,

Gordon³

et al. 2023

F1000Res

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“… 8 **Statistical method (Mean) was used to classify as cutoff point. ***Classified using terciles 1st terciles being 1000, 2nd 2000, 3rd terciles 3000, the baseline was average household income which was around (926 USD) 4012 birr in 2022 world bank report and also Merga et al 7 …”

Section: Resultsmentioning

confidence: 99%

“…Maximum sample size of 429 was obtained considering the assumption for single population mean formula with the 337.42 and 156 mean direct cost and standard deviation, respectively, were derived from a study conducted in Bale zone, 7 d assumed to be 15.12 (derived by calculating the margin of error using the formula ), sample size (409) and standard deviation (156), using the same study conducted in Bale zone, 7 95% confidence interval and using the formula, …”

Section: Methodsmentioning

confidence: 99%

“…The data was collected using a structured questionnaire adapted from the National health account 2016, 11 Mini EDHS 2019 10 and a study done in the bale zone 7 to assess the cost of maternal complication. The first part of the questionnaire contains the socio-demographic status of participants and their partners from mini EDHS 2019 10 and National health account 2016, 11 clinical characteristics of the mothers with a complication from a study done in bale zone 7 and the last part contains the institutional factors that are related with the diagnosis, treatment and other services the mothers and their attendant’s use from National health account 2016. 11…”

Section: Methodsmentioning

confidence: 99%

“…According to the WHO, above 15–20% out-of-pocket expenditure on health care is a catastrophic expenditure; recent works have been done to improve the risk people face due to high financial burden using schemes including health insurance, majorly community-based health insurance (CBHI). 6 , 7 …”

Section: Introductionmentioning

confidence: 99%

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The Cost of Maternal Complications and Its Associated Factors Among Mothers Attending Public Hospitals in Harari Region and Dire Dawa City Administration, Eastern Ethiopia: An Institution-Based Cross-Sectional Study

Shawel,

Hawulte Ayele,

Dessie

et al. 2023

CEOR

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Background Pregnant women face high costs for health-care services despite being advertised as free. These costs include non-medical expenses, lost productivity, difficulties caring for family members, and long-term financial impact from complications. Limited research has been done on the cost burden of maternal services and complications, despite numerous studies on maternal health service provision. This is notable considering the government’s claim of providing free maternal health-care services. Methods A cross-sectional study was conducted in July (1–30) 2022 among 425 randomly selected mothers in Harari and Dire Dawa City, Eastern Ethiopia. Data were collected through structured questionnaires and medical record reviews. The collected data was entered into Epi-Data version 3.02 and analyzed using STATA version 14.0 after data cleaning. Descriptive statistics and linear regression analysis were used to examine the data, ensuring assumptions of linearity, independence, homoscedasticity, and normality were met. The correlation coefficient was used to assess the strength of the association. Results The median cost of maternal complications was around 4250 ETB (81.3 USD; IQR = 2900–5833.3), factors that predicted cost were monthly family income of ≥3001 birr (β=1.13; 95% CI: 1.00, 1.26), distance from hospital (β=0.73; 95% CI = 0.64–0.83), being admitted for less than 4 days (β=0.60; 95% CI = 0.53–0.69), accompanied by relatives besides their husbands (β=1.93; 95% CI = 1.52–2.46), caesarian sections delivery (β=1.17; 95% CI = 1.04–1.31), and giving birth to a normal baby (β=0.86; 95% CI = 0.77–0.97). Conclusion Maternal complications incur significant costs, with factors such as family income, travel time, hospital stay, caregiver presence, mode of delivery, and neonatal outcome predicting these costs. The Ethiopian health system should address the additional expenses faced by mothers with complications and their caregivers.

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Hidden cost of hospital-based delivery and associated factors among postpartum women attending public hospitals in Gamo zone, southern Ethiopia

Chewaka,

Ayele,

Tessema

et al. 2024

BMC Health Serv Res

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Background Since 2005, the healthcare system in Ethiopia has implemented policies to promote the provision of free maternal healthcare services. The primary goal of these policies is to enhance the accessibility of maternity care for women from various socioeconomic backgrounds. Additionally, the aim is to increase the utilization of maternity services, such as institutional deliveries, by removing financial obstacles that pregnant women may face. Even though maternity services are free of charge. The hidden cost has unquestionably been a key obstacle in seeking and utilizing health care services. Significant payments due to delivery services could create a heavy economic burden on households. Objectives To determine the hidden cost of hospital-based delivery and associated factors among postpartum women attending public hospitals in Gamo zone, southern Ethiopia 2023. Methods A facility-based cross-sectional study was conducted on 411 postpartum women in Gamo Zone Public Health Hospitals from December 1, 2022, to January 30, 2023. The systematic sampling technique was applied to reach study units. Data was collected using the Kobo Toolbox Data Collection Tool and exported to SPSS statistical software version 27 for analysis. Simple linear regression and multiple linear regression were done to see the association of variables. The significance level was declared at a P-value < 0.05 in the final model. Result The median hidden cost of hospital-based delivery was 1142 Ethiopian birr (ETB), with a range (Q) of 2262 (504–2766) ETB. Monthly income of the family (β = 0.019), obstetrics complications (β = 0.033), distance from the health facility (β = 0.003), and mode of delivery (β = 0.072), were positively associated with the hidden cost of hospital-based delivery. While, rural residence (β = −0.041) was negatively associated with the outcome variable. Conclusion This study showed the hidden cost of hospital based delivery was relatively high. Residence, monthly income of the family, obstetric complications, mode of delivery, and distance from the health facility were statistically significant. It is important to take these factors into account when designing health intervention programs and hospitals should prioritize the availability of essential drugs and medical supplies within their facilities to address direct medical costs in hospitals.

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Hidden Costs of Hospital-Based Delivery Among Women Using Public Hospitals in Bale Zone, Southeast Ethiopia

Cited by 6 publications

References 19 publications

Maternal anaemia care in Kano state, Nigeria: an exploratory qualitative study of experiences of uptake and provision

Maternal anaemia care in Kano state, Nigeria: an exploratory qualitative study of experiences of uptake and provision

The Cost of Maternal Complications and Its Associated Factors Among Mothers Attending Public Hospitals in Harari Region and Dire Dawa City Administration, Eastern Ethiopia: An Institution-Based Cross-Sectional Study

Hidden cost of hospital-based delivery and associated factors among postpartum women attending public hospitals in Gamo zone, southern Ethiopia

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