Household costs among patients hospitalized with malaria: evidence from a national survey in Malawi, 2012

Abstract

BackgroundWith 71% of Malawians living on < $1.90 a day, high household costs associated with severe malaria are likely a major economic burden for low income families and may constitute an important barrier to care seeking. Nevertheless, few efforts have been made to examine these costs. This paper describes household costs associated with seeking and receiving inpatient care for malaria in health facilities in Malawi.MethodsA cross-sectional survey was conducted in a representative nationwide sample of 36 health facilities providing inpatient treatment for malaria from June–August, 2012. Patients admitted at least 12 h before study team visits who had been prescribed an antimalarial after admission were eligible to provide cost information for their malaria episode, including care seeking at previous health facilities. An ingredients-based approach was used to estimate direct costs. Indirect costs were estimated using a human capital approach. Key drivers of total household costs for illness episodes resulting in malaria admission were assessed by fitting a generalized linear model, accounting for clustering at the health facility level.ResultsOut of 100 patients who met the eligibility criteria, 80 (80%) provided cost information for their entire illness episode to date and were included: 39% of patients were under 5 years old and 75% had sought care for the malaria episode at other facilities prior to coming to the current facility. Total household costs averaged $17.48 per patient; direct and indirect household costs averaged $7.59 and $9.90, respectively. Facility management type, household distance from the health facility, patient age, high household wealth, and duration of hospital stay were all significant drivers of overall costs.ConclusionsAlthough malaria treatment is supposed to be free in public health facilities, households in Malawi still incur high direct and indirect costs for malaria illness episodes that result in hospital admission. Finding ways to minimize the economic burden of inpatient malaria care is crucial to protect households from potentially catastrophic health expenditures.

Health seeking behaviour and cost of fever treatment to households in a malaria endemic setting of northern Ghana: A cross sectional study

“…The average indirect cost (GH¢25.04/US$6.59) was 1.7 times higher than the direct cost (GH¢14.87/US$3.91). This is consistent with many findings where the indirect costs of malaria treatment were higher than the direct costs of treatment [11,15,33,37,38]. Therefore, efforts to improve access to health care and reduction of financial burden to households in the treatment of malaria should not only be directed to direct medical costs but also indirect costs.…”

<p>Economic Burden of Malaria and Associated Factors Among Rural Households in Chewaka District, Western Ethiopia</p>

“…This was comparable to a study done in other settings elsewhere. 6,7,9,10,14,23 The higher indirect costs of malaria illness may be due to the fact that the costs of anti-malarial drugs and diagnostics or testing were subsidized or free at public health sector of Ethiopia. 17 Nonetheless, a significant proportion of households' total costs of malaria illness (22.3%) was also attributed to direct costs.…”

“…Particularly the poorer and vulnerable households are at increased risk of the burdens of malaria and the cost of malaria is far worse for complicated cases. [6][7][8][9][10] The environmental and socio-demographic factors predominantly affect the burden of malaria at household level. 11 Ethiopia has made notable progress in decreasing the prevalence and burden of malaria through public health measures taken during the millennium development goals (MDGs) era.…”

Quality of clinical management of children diagnosed with malaria: A cross-sectional assessment in 9 sub-Saharan African countries between 2007–2018

“…Health workers may not be prescribing appropriate antimalarials because the appropriate dosage or suspension is not available, because of provider or patient preference for alternative medications, or because of high out-of-pocket costs for these medications [ 49 – 51 ]. Some studies have found that patients continue to face out-of-pocket costs for health services and commodities that are intended to be provided free in settings similar to the study countries [ 52 – 54 ]. Continued improvements in the quality of care for malaria will require a deeper investigation into the lingering barriers and facilitators of appropriate clinical management of the disease.…”