Out of pocket costs and time/productivity losses for pediatric sepsis in Uganda: a mixed-methods study

Abstract

Background Sepsis disproportionately affects children from socioeconomically disadvantaged families in low-resource settings, where care seeking may consume scarce family resources and lead to financial hardships. Those financial hardships may, in turn, contribute to late presentation or failure to seek care and result in high mortality during hospitalization and during the post discharge period, a period of increasingly recognized vulnerability. The purpose of this study is to explore the out-of-pocket costs related to sepsis hospitalizations and post-discharge care among children admitted with sepsis in Uganda. Methods This mixed-methods study was comprised of focus group discussions (FGD) with caregivers of children admitted for sepsis, which then informed a quantitative cross-sectional household survey to measure out-of-pocket costs of sepsis care both during initial admission and during the post-discharge period. All participants were families of children enrolled in a concurrent sepsis study. Results Three FGD with mothers (n = 20) and one FGD with fathers (n = 7) were conducted. Three primary themes that emerged included (1) financial losses, (2) time and productivity losses and (3) coping with costs. A subsequently developed cross-sectional survey was completed for 153 households of children discharged following admission for sepsis. The survey revealed a high cost of care for families attending both private and public facilities, although out-of-pocket cost were higher at private facilities. Half of those surveyed reported loss of income during hospitalization and a third sold household assets, most often livestock, to cover costs. Total mean out-of-pocket costs of hospital care and post-discharge care were 124.50 USD and 44.60 USD respectively for those seeking initial care at private facilities and 62.10 USD and 14.60 USD at public facilities, a high sum in a country with widespread poverty. Conclusions This study reveals that families incur a substantial economic burden in accessing care for children with sepsis.

Identifying neonates at risk for post-discharge mortality in Dar es Salaam, Tanzania, and Monrovia, Liberia: Derivation and internal validation of a novel risk assessment tool

“…However, as nearly one in five post-discharge deaths occurred while en route to a health facility, caregivers may not recognise symptoms early enough. Barriers to seeking healthcare for young children in sub-Saharan Africa include suboptimal access, high costs for families, and negative previous experiences with healthcare facilities 74 75. These may be exacerbated following a costly hospital admission for a family.…”

“…Barriers to seeking healthcare for young children in sub-Saharan Africa include suboptimal access, high costs for families, and negative previous experiences with healthcare facilities. 74 75 These may be exacerbated following a costly hospital admission for a family. Further studies assessing caregiver education regarding warning signs and symptoms that should prompt further clinical care following hospitalisation, and healthcare seeking behaviours following hospital discharge, are warranted.…”

Transitions from hospital to home: A mixed methods study to evaluate pediatric discharges in Uganda

“…We have previously demonstrated that out-of-pocket costs incurred during both admission and discharge, such as buying basic necessities (food, airtime, transportation, etc.) were financially burdensome to caregivers, and adversely affected the overall well-being of families [ 4 , 12 ]. In the absence of a national health insurance program [ 26 ], these and other treatment related costs can push households into poverty and discourage return for future care.…”

“…Healthcare services are free of charge at government owned health facilities and vary in premium fees at private-not-for-profit (PNFP) health facilities; however, patients incur substantial economic burden in accessing care regardless of facility ownership. A 2021 mixed methods study on out-of-pocket pediatric patient costs in Uganda found that total hospitalization costs, excluding missed wages, ranged from 62.1 USD among public sector regional referral hospitals to 124.5 USD among PNFP hospitals [ 12 ]. Such healthcare costs can significantly impact Ugandan families as approximately 42% of the population lives on less than $2.15 USD per day [ 13 ].…”

Cost-effectiveness analysis of Smart Triage, a data-driven pediatric sepsis triage platform in Eastern Uganda

“…In addition, these analyses focus on the perspective of the healthcare system [ 13 , 22 , 23 ], but do not consider out-of-pocket costs and productivity losses. In LMICs such as Uganda that are yet to implement universal health coverage (UHC), where patients may incur out-of-pocket costs near or exceeding that of monthly earnings [ 24 ], inclusion of the societal perspective is important to explore the economic impact of healthcare interventions on patients. Lastly, no LMIC analysis has utilized economic modelling techniques to incorporate healthcare utilization costs and link intermediate outcomes to clinical endpoints.…”