Catastrophic expenditure associated with childhood hospitalisation for acute illness in Kenya and Uganda: a cross-sectional study
Introduction Childhood illness and hospitalisation result in both direct and indirect costs to families before, during and after admission. We aimed to estimate the catastrophic expenditure during hospitalisation for children with acute illness.Methods This was a prespecified cross-sectional substud...
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BMJ Publishing Group
2025-01-01
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| author | Sassy Molyneux Johnstone Thitiri Laura Mwalekwa Molline Timbwa Anna Vassall Kirkby D Tickell Judd L Walson James Berkley John Mukisa Ezekiel Mupere Peter Olupot-Olupot Priya Sukhtankar Sheila Murunga Julie Jemutai George Paasi Benson Singa Shalton Mwaringa Rebecca Gathoni Njuguna Yoko V Laurence Caroline Ogwang Mwanajuma Juma Narshion Ngao Christina Lancioni Md Fakhar Uddin |
| author_facet | Sassy Molyneux Johnstone Thitiri Laura Mwalekwa Molline Timbwa Anna Vassall Kirkby D Tickell Judd L Walson James Berkley John Mukisa Ezekiel Mupere Peter Olupot-Olupot Priya Sukhtankar Sheila Murunga Julie Jemutai George Paasi Benson Singa Shalton Mwaringa Rebecca Gathoni Njuguna Yoko V Laurence Caroline Ogwang Mwanajuma Juma Narshion Ngao Christina Lancioni Md Fakhar Uddin |
| author_sort | Sassy Molyneux |
| collection | DOAJ |
| description | Introduction Childhood illness and hospitalisation result in both direct and indirect costs to families before, during and after admission. We aimed to estimate the catastrophic expenditure during hospitalisation for children with acute illness.Methods This was a prespecified cross-sectional substudy nested within two prospective studies. Participants were recruited and interviewed from three rural and three urban hospitals in Kenya and Uganda. A costing questionnaire was administered to the caregivers of 731 children hospitalised for acute illness to evaluate direct and indirect costs incurred by caregivers and families. Costs incurred were compared for families with children both with and without complicated severe malnutrition (CSM). Catastrophic out-of-pocket expenditure exceeding 10% and 25% of monthly income was assessed.Results The median (IQR) total cost during hospitalisation per child was US$47 (US$24–US$84), with higher costs for children with CSM, especially during hospitalisation (US$56 (US$26–US$99) vs US$36 (US$20–US$65); p<0.001). During hospitalisation, bed charges followed by food were the main cost drivers. Caregivers reported losing a median of 7 (4–11) days of productive time during a child’s hospitalisation with a mean loss of income of US$10 (SD US$25.6, median US$0 (US$0–US$10)). 92% and 74% of households experienced catastrophic expenditure at thresholds of 10% and 25% of monthly income, respectively. Caregivers reported borrowing, selling property and withdrawing other children from school to cope with costs.Conclusions Despite intentions of free healthcare services for under 5, families of acutely ill children very commonly faced catastrophic expenditure, especially for children with CSM. Interventions aimed at supporting financial protection, reducing additional healthcare costs, and lowering health service charges may help prevent catastrophic expenditures. |
| format | Article |
| id | doaj-art-842365a72e234719b77da71ab44ff2e1 |
| institution | Kabale University |
| issn | 2753-4294 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMJ Publishing Group |
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| spelling | doaj-art-842365a72e234719b77da71ab44ff2e12025-01-17T08:45:10ZengBMJ Publishing GroupBMJ Public Health2753-42942025-01-013110.1136/bmjph-2024-001173Catastrophic expenditure associated with childhood hospitalisation for acute illness in Kenya and Uganda: a cross-sectional studySassy Molyneux0Johnstone Thitiri1Laura Mwalekwa2Molline Timbwa3Anna Vassall4Kirkby D Tickell5Judd L Walson6James Berkley7John Mukisa8Ezekiel Mupere9Peter Olupot-Olupot10Priya Sukhtankar11Sheila Murunga12Julie Jemutai13George Paasi14Benson Singa15Shalton Mwaringa16Rebecca Gathoni Njuguna17Yoko V Laurence18Caroline Ogwang19Mwanajuma Juma20Narshion Ngao21Christina Lancioni22Md Fakhar Uddin23Pandemic Sciences Institute, University of Oxford, Oxford, UK1 Clinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, KenyaClinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya1 KEMRI/Wellcome Trust Research Programme, Kilifi, KenyaDepartment of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UKDepartment of Global Health, University of Washington, Seattle, Washington, USADepartment of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USACentre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UKChildhood Acute Illness and Nutrition (CHAIN) Network, Nairobi, KenyaDepartment of Paediatrics and Child Health, School of Medicine College of Health Sciences, Makerere University, Kampala, UgandaClinical trials department, Mbale Clinical Research Institute, Mbale, UgandaDepartment of Child Health, Gloucester Hospitals NHS Foundation Trust, Gloucester, UK1 Clinical Research Deptartment, KEMRI-Wellcome Trust Research Programme, Kilifi, KenyaHealth System & Research Ethics, KEMRI-Wellcome Trust Research Programme, Kilifi, KenyaDepartment of Public Health, Mbale Clinical Research Institute, Busitema University, Mbale, UgandaCentre for Public Health Kinetics (CPHK), Delhi, IndiaClinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, KenyaHealth Systems and Research Ethics Department, KEMRI-Wellcome Trust Research Programme, Kilifi, KenyaHealth Economics for Life Sciences and Medicine, Department of Population Health Sciences, King`s College London, London, UKClinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, KenyaClinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, KenyaClinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, KenyaChildhood Acute Illness and Nutrition (CHAIN) Network, Nairobi, KenyaNutrition Research Division, International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, BangladeshIntroduction Childhood illness and hospitalisation result in both direct and indirect costs to families before, during and after admission. We aimed to estimate the catastrophic expenditure during hospitalisation for children with acute illness.Methods This was a prespecified cross-sectional substudy nested within two prospective studies. Participants were recruited and interviewed from three rural and three urban hospitals in Kenya and Uganda. A costing questionnaire was administered to the caregivers of 731 children hospitalised for acute illness to evaluate direct and indirect costs incurred by caregivers and families. Costs incurred were compared for families with children both with and without complicated severe malnutrition (CSM). Catastrophic out-of-pocket expenditure exceeding 10% and 25% of monthly income was assessed.Results The median (IQR) total cost during hospitalisation per child was US$47 (US$24–US$84), with higher costs for children with CSM, especially during hospitalisation (US$56 (US$26–US$99) vs US$36 (US$20–US$65); p<0.001). During hospitalisation, bed charges followed by food were the main cost drivers. Caregivers reported losing a median of 7 (4–11) days of productive time during a child’s hospitalisation with a mean loss of income of US$10 (SD US$25.6, median US$0 (US$0–US$10)). 92% and 74% of households experienced catastrophic expenditure at thresholds of 10% and 25% of monthly income, respectively. Caregivers reported borrowing, selling property and withdrawing other children from school to cope with costs.Conclusions Despite intentions of free healthcare services for under 5, families of acutely ill children very commonly faced catastrophic expenditure, especially for children with CSM. Interventions aimed at supporting financial protection, reducing additional healthcare costs, and lowering health service charges may help prevent catastrophic expenditures.https://bmjpublichealth.bmj.com/content/3/1/e001173.full |
| spellingShingle | Sassy Molyneux Johnstone Thitiri Laura Mwalekwa Molline Timbwa Anna Vassall Kirkby D Tickell Judd L Walson James Berkley John Mukisa Ezekiel Mupere Peter Olupot-Olupot Priya Sukhtankar Sheila Murunga Julie Jemutai George Paasi Benson Singa Shalton Mwaringa Rebecca Gathoni Njuguna Yoko V Laurence Caroline Ogwang Mwanajuma Juma Narshion Ngao Christina Lancioni Md Fakhar Uddin Catastrophic expenditure associated with childhood hospitalisation for acute illness in Kenya and Uganda: a cross-sectional study BMJ Public Health |
| title | Catastrophic expenditure associated with childhood hospitalisation for acute illness in Kenya and Uganda: a cross-sectional study |
| title_full | Catastrophic expenditure associated with childhood hospitalisation for acute illness in Kenya and Uganda: a cross-sectional study |
| title_fullStr | Catastrophic expenditure associated with childhood hospitalisation for acute illness in Kenya and Uganda: a cross-sectional study |
| title_full_unstemmed | Catastrophic expenditure associated with childhood hospitalisation for acute illness in Kenya and Uganda: a cross-sectional study |
| title_short | Catastrophic expenditure associated with childhood hospitalisation for acute illness in Kenya and Uganda: a cross-sectional study |
| title_sort | catastrophic expenditure associated with childhood hospitalisation for acute illness in kenya and uganda a cross sectional study |
| url | https://bmjpublichealth.bmj.com/content/3/1/e001173.full |
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