Household Costs Associated with Hospitalization of Children with Severe Pneumonia in Quito, Ecuador

Spatio-temporal patterns of childhood pneumonia in Bhutan: a Bayesian analysis

Pneumonia is one of the top 10 diseases by morbidity in Bhutan. This study aimed to investigate the spatial and temporal trends and risk factors of childhood pneumonia in Bhutan. A multivariable Zero-inflated Poisson regression model using a Bayesian Markov chain Monte Carlo simulation was undertaken to quantify associations of age, sex, altitude, rainfall, maximum temperature and relative humidity with monthly pneumonia incidence and to identify the underlying spatial structure of the data. Overall childhood pneumonia incidence was 143.57 and 10.01 per 1000 persons over 108 months of observation in children aged < 5 years and 5–14 years, respectively. Children < 5 years or male sex were more likely to develop pneumonia than those 5–14 years and females. Each 1 °C increase in maximum temperature was associated with a 1.3% (95% (credible interval [CrI] 1.27%, 1.4%) increase in pneumonia cases. Each 10% increase in relative humidity was associated with a 1.2% (95% CrI 1.1%, 1.4%) reduction in the incidence of pneumonia. Pneumonia decreased by 0.3% (CrI 0.26%, 0.34%) every month. There was no statistical spatial clustering after accounting for the covariates. Seasonality and spatial heterogeneity can partly be explained by the association of pneumonia risk to climatic factors including maximum temperature and relative humidity.

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

OBJECTIVES

To examine the health-seeking behaviour and cost of fever treatment to households in Ghana.

DESIGN

Cross-sectional household survey conducted between July and September 2015.

SETTING

Kassena-Nankana East and West districts in Upper East region of Ghana.

PARTICIPANTS

Individuals with an episode of fever in the 2 weeks preceding a visit during routine health and demographic surveillance system data collection were selected for the study. Sociodemographic characteristics, treatment-seeking behaviours and cost of treatment of fever were obtained from the respondents.

RESULTS

Out of 1845 households visited, 21% (393 of 1845) reported an episode of fever. About 50% (195 of 393) of the fever cases had blood sample taken for testing by microscopy or Rapid Diagnostic Test, and 73.3% (143 of 195) were confirmed to have malaria. Of the 393 people with fever, 70% (271 of 393) reported taking an antimalarial and 24.0% (65 of 271) took antimalarial within 24 hours of the onset of illness. About 54% (145 of 271) of the antimalarials were obtained from health facilities.The average cost (direct and indirect) incurred by households per fever treatment was GH¢27.8/US$7.3 (range: GH¢0.2/US$0.1-GH¢200/US$52.6). This cost is 4.6 times the daily minimum wage of unskilled paid jobs of Ghanaians (US$1.6). The average cost incurred by those enrolled into the National Health Insurance Scheme (NHIS) was GH¢24.8/US$6.5, and GH¢50/US$11.6 for those not enrolled.

CONCLUSIONS

Prompt treatment within 24 hours of onset of fever was low (24%) compared with the Roll Back Malaria Programme target of at least 80%. Cost of treatment was relatively high when compared with average earnings of households in Ghana and enrolment into the NHIS reduced the cost of fever treatment remarkably. It is important to improve access to malaria diagnosis, antimalarials and enrolment into the NHIS in order to improve the case management of fever/malaria and accelerate universal health coverage in Ghana.

Socioeconomic costs of children <5 years hospitalised with acute respiratory infections in Kuala Lumpur, Malaysia

BACKGROUND

Acute respiratory infections (ARI) are a major cause of morbidity and mortality in Malaysian children < 5 years. Knowledge of associated economic costs is important for policymakers to determine cost-effectiveness of interventions, such as pneumococcal or influenza vaccines, which are underused in Malaysia.

METHODS

Children < 5 years admitted with ARI to a teaching hospital in Kuala Lumpur were prospectively recruited between July 2013 and July 2015. Medical (with and without government subsidies), non-medical and indirect costs from pre-admission, admission and post-discharge were obtained by interviews with carers and from medical records. Respiratory viruses were diagnosed by immunofluorescence and virus culture.

RESULTS

200 patients were recruited, and 74 (37%) had respiratory viruses detected. For each admitted ARI, the median direct out-of-pocket cost (subsidized) was USD 189 (interquartile range, 140-258), representing a median 16.4% (10.4-22.3%) of reported monthly household income. The median total direct cost (unsubsidized) was USD 756 (564-987), meaning that government subsidies covered a median 75.2% (70.2-78.4%) of actual costs. Median direct costs for 50 respiratory syncytial virus (RSV) cases were higher than the 126 virus-negative cases (USD 803 vs 729, p = 0.03). The median societal cost (combining direct and indirect costs) was USD 871 (653-1,183), which is 1.8 times the Malaysian health expenditure per capita in 2014. Costs were higher with younger age, presence of comorbidity, prematurity, and detection of a respiratory virus.

CONCLUSION

These comprehensive estimated costs of ARI admissions in children < 5 years are high. These costs can be used as a basis for planning treatment and preventive strategies, including cost-effectiveness studies for influenza and, in future, RSV vaccines.