Costs and Economic Burden of Childhood Diarrhea in Uganda

Abstract

Abstract Background: Diarrhea is one of the leading -causes of morbidity and mortality among children under age five in Uganda. While there is an abundance of literature on disease burden, there is limited available evidence on the costs and economic burden of childhood diarrhea in Uganda. To fill this gap, we estimated the cost of childhood diarrhea in Uganda from a societal perspective. Methods: We used an incidence-based cost-of-illness approach capturing monthly healthcare facility data on staff, medications, capital costs, and hospital-related expenditures for childhood diarrhea patients in Uganda. We interviewed caregivers of children with diarrhea at 48 selected healthcare facilities in the public and private (for-profit and not-for-profit) sectors. We conducted phone interviews with caregivers 7-14 days post-discharge to capture additional out-of-pocket expenses and associated costs. We also captured caregiver costs related to diarrhea illness including, productivity/time loss, income, food, travel costs and other household characteristics. These costs were then aggregated into direct (medical and non-medical) and indirect costs and estimated by age, gender, type of care (outpatient, inpatient), type of facility, and wealth quintile. The impact of diarrheal disease to households in terms of catastrophic health expenditure was measured. Results: Overall, total cost of illness per diarrhea episode was $29.21 from the caregiver perspective. The average direct (medical and non-medical) and indirect costs were $15.76 and $2.51 respectively. From the government perspective, the average cost of treatment for an episode of childhood diarrhea varied for an ambulatory case ($4.41) and inpatient case ($8.26). These costs also varied depending on the ownership the type of the facility and the district where the facility was located. From a societal perspective, a hospitalized and an ambulatory episode of diarrhea cost $53 and $14 respectively. Caregivers incurred on average $29 in economic costs and $16 in out-of-pocket for an episode of diarrhea. The economic cost of an episode of diarrhea accounted for approximately 5% of the annual national gross domestic product (GDP) per capita. Furthermore, the proportion of households that experienced catastrophic health expenditures decreased with richer quintiles. Conclusion: This is one of the first cost-of-illness studies using primary data to quantify the economic burden of childhood diarrhea in Uganda. Costs of care from the caregiver perspective significantly varied by child’s age, district location, length of stay and wealth quintiles, which information is essential for decision-making.