Prevalence and factors associated with catastrophic health expenditure among slum and non-slum dwellers undergoing emergency surgery in a metropolitan area of South Western Nigeria

Abstract

Background Out of Pocket (OOP) payment continues to persist as the major mode of payment for healthcare in Nigeria despite the introduction of the National Health Insurance Scheme (NHIS). Although the burden of health expenditure has been examined in some populations, the impact of OOP among slum dwellers in Nigeria when undergoing emergencies, is under-researched. This study sought to examine the prevalence, factors and predictors of catastrophic health expenditure amongst selected slum and non-slum communities undergoing emergency surgery in Southwestern Nigeria. Methods The study utilised a descriptive cross-sectional survey design to recruit 450 households through a multistage sampling technique. Data were collected using pre-tested semi-structured questionnaires in 2017. Factors considered for analysis relating to the payer were age, sex, relationship of payer to patient, educational status, marital status, ethnicity, occupation, income and health insurance coverage. Variables factored into analysis for the patient were indication for surgery, grade of hospital, and type of hospital. Households were classified as incurring catastrophic health expenditure (CHE), if their OOP expenditure exceeded 5% of payers’ household budget. Analysis of the data took into account the multistage sampling design. Results Overall, 65.6% (95% CI: 55.6–74.5) of the total population that were admitted for emergency surgery, experienced catastrophic expenditure. The prevalence of catastrophic expenditure at 5% threshold, among the population scheduled for emergency surgeries, was significantly higher for slum dwellers (74.1%) than for non-slum dwellers (47.7%) (F = 8.59; p = 0.019). Multiple logistic regression models revealed the significant independent factors of catastrophic expenditure at the 5% CHE threshold to include setting of the payer (whether slum or non-slum dweller) (p = 0.019), and health insurance coverage of the payer (p = 0.012). Other variables were nonetheless significant in the bivariate analysis were age of the payer (p = 0.017), income (p<0.001) and marital status of the payer (p = 0.022). Conclusion Although catastrophic health expenditure was higher among the slum dwellers, substantial proportions of respondents incurred catastrophic health expenditure irrespective of whether they were slum or non-slum dwellers. Concerted efforts are required to implement protective measures against catastrophic health expenditure in Nigeria that also cater to slum dwellers.

Investigating catastrophic health expenditure among people living with HIV and AIDS in South Western Nigeria

“…The delivery of the healthcare system is being faced with a lot of inequalities, with CHE serving as a fundamental challenge to it. Evaluating the incidence and intensity of HIV-related CHE will help in providing insight into the UHC and also reflect the economic burden of HIV on patients and their families [17,18]. There was a predominance of female respondents of 59.2% in this study, which is consistent with the outcome obtained from another study in Nigeria with 60% females.…”

Factors associated with catastrophic health expenditure in sub-Saharan Africa: A systematic review

“…For households that sought surgical or trauma care, CHE incidence was associated with residence, socioeconomic status, health insurance status, and sex, age, marital status, education, and employment status of household head– Table 4 . Other factors include old age, hospitalization, healthcare provider type, specialist care, intensive care unit admission, and emergency surgery [ 31 , 40 , 79 , 81 , 82 , 84 , 89 , 90 ].…”

Multimorbidity Among Urban Poor in India: Findings From LASI, Wave-1

“…Furthermore, we found an increase in healthcare expenditure with each additional condition which is consistent with the findings of a previous study which showed mean out of pocket expenditure for OPD visit increased from INR 262.2 for participants with no NCD to INR 431 amongst those who had multimorbidity. Here, it is worth noting that higher OOPE implies a need to pay directly from pocket for utilizing healthcare facilities which gets hampered by the inability to pay as in the case of urban poor ( 33 ). Multimorbidity requires long term use of multiple drugs, periodic investigations and visits to doctor ( 34 ) which is easy for poorer group, an explanation for easy access to healthcare and hence, better diagnosis and continuity of care among this group than the poorest.…”