Background
Methods
Study setting
Study population and sample size
Hospital | Number of patients | Sample size | Percentage |
---|---|---|---|
Accra | 11,256 | 228 | 51.8 |
Pantang | 6780 | 138 | 31.4 |
Ankaful | 3660 | 74 | 16.8 |
Total | 21,696 | 440 | 100.0 |
Data collection and tools
Variables
Domain | Number of items | Cronbach’s alpha |
---|---|---|
Mental health status | ||
Depression | 7 | 0.67 |
Anxiety | 7 | 0.80 |
Stress | 7 | 0.83 |
Quality of life | ||
Physical | 7 | 0.82 |
Psychological | 6 | 0.77 |
Social | 3 | 0.56 |
Environmental | 8 | 0.81 |
Zarit burden index | 12 | 0.83 |
Data analysis
Characteristic | Number | (%) |
---|---|---|
Sex | ||
Male | 193 | 43.5 |
Female | 251 | 56.5 |
Age | ||
< 20 | 3 | 0.7 |
20–29 | 51 | 11.5 |
30–39 | 95 | 21.4 |
40–49 | 103 | 23.2 |
50–59 | 89 | 20.0 |
60–69 | 76 | 17.1 |
> 69 | 27 | 6.1 |
Marital Status | ||
Married | 294 | 66.2 |
Single | 150 | 33.8 |
Religion | ||
Christian | 393 | 88.5 |
Muslim | 45 | 10.1 |
Traditionalist | 2 | 0.5 |
Other | 4 | 0.9 |
Educational Level | ||
No education | 50 | 11.3 |
Primary | 146 | 32.8 |
Secondary | 149 | 33.6 |
Tertiary-Graduate/Post Graduate | 99 | 22.3 |
Employment Status | ||
Self employed | 240 | 54.2 |
Private sector | 70 | 15.8 |
Public sector | 41 | 9.2 |
Unemployed | 78 | 17.6 |
Student/Apprentice | 14 | 3.2 |
Results
Background characteristics of caregivers
Economic costs of caregiving
Cost component | N | Total costa (US$) | Standard deviation | Cost profileb (%) | Average cost (US$) |
---|---|---|---|---|---|
Direct costs | |||||
Direct medical cost | |||||
Consultation | 444 | 1411.02 | 7.02 | 1.8 | 3.17 |
Drugs | 444 | 6668.49 | 22.59 | 8.7 | 15.01 |
Lab/Diagnostics | 442 | 428.20 | 5.38 | 0.5 | 0.97 |
Other | 442 | 144.64 | 4.20 | 0.2 | 0.33 |
Sub total | 8652.36 | 11.2 | 19.50 | ||
Direct non- medical costs | |||||
Transportation | 444 | 3675.57 | 9.62 | 4.8 | 8.28 |
Meals | 442 | 843.15 | 5.56 | 1.1 | 1.90 |
Lodging | 442 | 153.20 | 5.05 | 0.2 | 0.35 |
Miscellaneous | 442 | 142.69 | 1.20 | 0.2 | 0.33 |
Sub total | 4814.62 | 6.3 | 10.85 | ||
Total direct costs | 13,466.97 | 17.5 | 30.36 | ||
Indirect costs | |||||
Formal sector | 131 | 9118.97 | 40.26 | 11.9 | 69.61 |
Informal sector | 313 | 54,253.59 | 88.38 | 70.6 | 173.33 |
Total indirect costs | 444 | 63,372.56 | 82.5 | 242.95 | |
Grand Total Cost | 76,839.54 | 100 | 273.28 |
Intangible costs of caregiving
Caregivers’ quality of life
Physical | Psychological | Social | Environmental | Total | ||||||
---|---|---|---|---|---|---|---|---|---|---|
Mean (SD) |
p-value | Mean (SD) |
p-value | Mean (SD) |
p-value | Mean (SD) |
p-value | Mean (SD) |
p-value | |
Agea
| 0.303 | 0.257 | <0.05 | 0.434 | 0.511 | |||||
< 30 | 20.1 (17.5) | 31.6(24.1) | 35.2(27.0) | 33.6(23.3) | 30.1(13.3) | |||||
30–39 | 20.4 (17.6) | 32.2(25.7) | 30.2(24.6) | 31.1(24.3) | 28.5(11.7) | |||||
40–49 | 19.7 (15.9) | 26.2(22.2) | 27.6(24.7) | 37.2(25.9) | 27.8(11.3) | |||||
50–59 | 18.8 (14.4) | 25.9(21.1) | 23.4(21.2) | 38.1(25.1) | 26.6(12.1) | |||||
60+ | 19.3 (15.5) | 30.6(24.9) | 31.6(24.6) | 33.6(24.3) | 28.8(12.2) | |||||
Sex b
| <0.001 | <0.01 | <0.05 | <0.05 | <0.05 | |||||
Male | 20.0 (16.1) | 30.8(25.0) | 31.0(26.3) | 36.4(26.1) | 29.6(12.6) | |||||
Female | 19.3 (16.1) | 27.9(22.7) | 27.7(22.9) | 33.6(23.8) | 27.1(11.5) | |||||
Marital statusb
| ||||||||||
Married | 20.0(15.7) | 30.0(24.1) | 29.1(23.6) | 33.6(24.7) | 28.1(11.7) | |||||
Single | 19.0(16.4) | 0.270 | 28.1(23.1) | 0.330 | 29.4(26.1) | 0.071 | 37.2(24.9) | 0.436 | 28.4(12.5) | 0.863 |
Religionc
| <0.05 | 0.872 | 0.486 | 0.270 | 0.972 | |||||
Christian | 19.1(15.4) | 28.8(23.4) | 29.6(24.6) | 35.1(24.9) | 28.2(11.9) | |||||
Muslim | 23.9(20.3) | 31.6(26.6) | 25.8(23.4) | 32.5(24.4) | 28.513.0) | |||||
Educationa
| <0.01 | <0.001 | <0.001 | <0.001 | <0.001 | |||||
None | 19.1(16.4) | 22.3(17.5) | 23.2(19.4) | 27.7(21.3) | 23.1(8.4) | |||||
Primary | 19.5(17.9) | 26.2(20.2) | 23.5(22.1) | 30.6(24.7) | 24.9(11.5) | |||||
Secondary | 20.0(16.2) | 28.3(22.5) | 30.3(24.7) | 35.4(23.7) | 28.5(12.0) | |||||
Tertiary | 19.1(14.8) | 36.1(29.1) | 31.9(26.5) | 38.9(28.3) | 31.5(12.7) | |||||
Employmenta
| 0.703 | 0.140 | 0.911 | 0.247 | 0.558 | |||||
Unemployed | 21.4(19.0) | 31.6(25.6) | 32.0(25.2) | 32.7(23.8) | 29.4(13.8) | |||||
Self-employed | 19.6(15.7) | 27.3(22.2) | 29.0(24.6) | 35.2(25.3) | 27.8(11.3) | |||||
Private sector | 17.4(12.5) | 32.2(26.4) | 27.7(24.4) | 38.0(26.1) | 28.8(11.8) | |||||
Public sector | 19.6(16.3) | 28.3(23.1) | 26.6(22.5) | 31.5(21.7) | 26.6(12.3) | |||||
Total | 19.6 (16.0) | 29.1(23.7) | 29.2(24.5) | 34.8(24.8) | 28.2(12.0) |
Predictors of costs and QoL
Cost | ||||
---|---|---|---|---|
Direct | Indirect | Joint effect | ||
Covariates |
β (95% CI) |
β (95% CI) | F-test statistic |
p-value |
** | ||||
0.71 | 3.25 | |||
Age in years | (−0.17,1.59) | (0.99,5.52) | 10.18 | 0.0001*** |
Sex | * | |||
Female |
Ref
|
Ref
| ||
Male | 12.06 | −61.09 | 3.65 | 0.0269* |
(−11.58,35.70) | (−121.77,-0.41) | |||
Marital status | ||||
Single |
Ref
|
Ref
| ||
Married | 19.30 | 53.42 | 3.93 | 0.0203* |
(−5.58,44.17) | (−10.43,117.28) | |||
Proximity | * | |||
Close |
Ref
|
Ref
| ||
Far | 32.33 | 0.84 | 2.91 | 0.0554 |
(5.52,59.15) | (−68.00,69.67) | |||
Education | *** | |||
None |
Ref
|
Ref
| ||
Primary/junior high school | 12.27(−26.56,51.11) | −64.17(−163.87,35.52) | 18.61 | 0.0001*** |
Secondary | 16.19(−22.77,55.16) | −79.76(−179.78,20.27) | ||
Tertiary | 39.84(−4.43,84.11) | −215.75(−329.41,-102.10) | ||
Employment status | *** | |||
None |
Ref
|
Ref
| ||
Private | 1.07(−40.83,42.96) | −327.68(−435.22,-220.14) | ||
Public | 5.58(−41.69,52.86) | −302.55(−423.91,-181.19) | 2.36 | 0.0953 |
Self-employed | 7.35(−25.48,40.17) | −45.51(−129.79,38.76) | ||
Student/apprentice | 66.56(−6.26,139.38) | −19.64(−206.58,167.30) | ||
R
2
| 50.8% | 64.2% |
Covariates |
β
| 95% CI |
---|---|---|
Age in years | −0.01 | (−0.07, 0.05) |
Sex | ||
Female |
Ref
| |
Male | −0.42 | (−1.89, 1.05) |
Marital status: | ||
Single |
Ref
| |
Married | −0.09 | (−1.64, 1.46) |
Proximity | ||
Close |
Ref
| |
Far | 0.90 | (−0.78, 2.58) |
Education | ||
None |
Ref
| |
Primary/junior high school | 0.10 | (−2.34, 2.55) |
Secondary | −4.43 | (−2.92, 2.06) |
Tertiary | −1.01 | (−3.86, 1.84) |
Employment status** | ||
None |
Ref
| |
Private | 3.47 | (0.74, 6.19) |
Public | 6.09 | (3.10, 9.07) |
Self-employed | 1.79 | (−0.30, 3.88) |
Student/apprentice | 0.17 | (−4.37, 4.71) |
Direct cost | 0.01 | (−0.001, 0.01) |
Indirect cost | 0.002 | (−0.002, 0.01) |
Duration of care given | 0.002 | (−0.01, 0.01) |
Daily care given time in hours | −0.10 | (−0.32, 0.13) |
Other family | ||
No |
Ref
| |
Yes | 0.42 | (−1.03, 1.87) |
Anxiety** | ||
Normal |
Ref
| |
Moderate | 2.82 | (1.05, 4.59) |
Severe | 3.80 | (1.02, 6.59) |
Depression*** | ||
Normal |
Ref
| |
Moderate | 3.24 | (1.54, 4.94) |
Severe | 8.25 | (4.71, 11.80) |
Stress*** | ||
Normal |
Ref
| |
Moderate | 5.08 | (2.91, 7.24) |
Severe | 7.70 | (4.70, 10.70) |
R
2
| 51.9 |
Domains measuring quality of life | ||||||
---|---|---|---|---|---|---|
Physical | Psychological | Social | Environment | Joint effect | ||
Covariates |
β (95% CI) p-value |
β (95% CI) p-value |
β (95% CI) p-value |
β (95% CI) p-value | F-test statistic |
p-value |
−0.14 | −0.09 | −0.06 | −0.05 | |||
Age in years | (−0.22, −0.06) | (−0.18, 0.002) | (−0.17, 0.04) | (−0.13, 0.04) | 3.19 | 0.0133* |
Sex | *** | ** | *** | * | ||
Female |
Ref
|
Ref
|
Ref
|
Ref
| ||
Male | 4.08(2.15, 6.01) | 2.93(0.68, 5.17) | 5.66(3.09, 8.22) | 2.22(0.16, 4.28) | 6.14 | 0.0001*** |
Marital status: | *** | |||||
Single |
Ref
|
Ref
|
Ref
|
Ref
| ||
Married | 0.45(−1.59, 2.48) | −1.73(−4.10, 0.63) | −5.68(−8.38, −2.98) | −2.18(−4.35, −0.02) | 5.08 | 0.0005*** |
Proximity | *** | * | * | ** | ||
Close |
Ref
|
Ref
|
Ref
|
Ref
| ||
Far | −5.88(−8.10, −3.66) | −3.01(−5.59, −0.43) | −3.57(−6.52, −0.63) | −3.66(−6.02, −1.30) | 6.68 | 0.0001*** |
Education | *** | *** | * | *** | ||
None |
Ref
|
Ref
|
Ref
|
Ref
| ||
Primary/junior high school | 2.20(−1.00, 5.40) | 3.59(−0.13, 7.31) | 6.79(2.54, 11.05) | 5.24(1.83, 8.65) | ||
Secondary | 3.02(−0.24, 6.29) | 5.12(1.33, 8.91) | 5.23(0.90, 9.57) | 6.53(3.06, 10.01) | ||
Tertiary | 7.05(3.32, 10.79) | 11.04(6.69, 15.38) | 9.81(4.84, 14.77) | 14.55(10.57, 18.53) | 12.03 | 0.0001*** |
Employment status | ||||||
None |
Ref
|
Ref
|
Ref
|
Ref
| ||
Private | 2.41(−1.18, 6.01) | 0.07(−4.11, 4.25) | −1.61(−6.39, 3.16) | 1.49(−2.35, 5.32) | ||
Public | 1.12(−2.86, 5.11) | −1.79(−6.42, 2.84) | −5.02(−10.32, 0.27) | −1.26(−5.50,2.99) | ||
Self-employed | 2.81(0.06, 5.56) | 1.57(−1.63, 4.76) | −0.90(−4.55, 2.75) | 2.86(−0.07, 5.79) | ||
Student/apprentice | −2.91(−8.85, 3.03) | −1.61(−8.51, 5.30) | −5.36(−13.25, 2.53) | 1.51(−4.82, 7.84) | 1.38 | 0.2412 |
Direct cost | −0.003(−0.01, 0.005) | −0.005(−0.014, 0.004) | −0.0008(−0.01, 0.01) | −0.003(−0.01, 0.01) | 0.35 | 0.8468 |
Indirect cost | 0.0001(−0.005, 0.005) | −0.007(−0.01, −0.001) | −0.001(−0.01, 0.01) | −0.004(−0.01, 0.001) | 1.46 | 0.2151 |
*** | *** | |||||
Zarit | −0.25(−0.38, −0.13) | −0.27(−0.42, −0.12) | −0.06(−0.23, 0.11) | −0.10(−0.23, 0.04) | 5.30 | 0.0004*** |
Duration of care given | −0.003(−0.013, 0.007) | −0.004(−0.02, 0.01) | 0.01(−0.01, 0.02) | 0.002(−0.01, 0.01) | 0.85 | 0.4931 |
Daily care given time in hrs | 0.14(−0.16, 0.44) | 0.17(−0.18, 0.52) | 0.002(−0.40, 0.40) | 0.27(−0.05, 0.59) | 0.63 | 0.6409 |
Other family | * | ** | ||||
No |
Ref
|
Ref
|
Ref
|
Ref
| ||
Yes | 2.38(0.47, 4.29) | 2.90(0.68, 5.12) | −2.33(−4.87, 0.20) | 0.56(−1.48, 2.59) | 6.24 | 0.0001*** |
Anxiety | ** | |||||
Normal |
Ref
| |||||
Moderate | 0.13(−2.22, 2.47) | 1.29(−1.43, 4.01) | 0.07(−3.04, 3.18) | 0.74(−1.75, 3.24) | ||
Severe | −2.80(−6.48, 0.87) | 5.12(0.84, 9.39) | −0.18(−5.06, 4.70) | 3.60(−0.31, 7.52) | 4.06 | 0.0030** |
Depression | *** | *** | *** | *** | ||
Normal |
Ref
|
Ref
|
Ref
|
Ref
| ||
Moderate | −2.73(−5.00, −0.47) | −6.02(−8.66, −3.39) | −3.30(−6.31, −0.29) | −5.11(−7.52, −2.70) | ||
Severe | −8.39(−13.15, −3.64) | −17.39(−22.92, −11.87) | −12.29(−18.60, −5.97) | −16.40(−21.47, −11.34) | 19.20 | 0.0001*** |
Stress | ** | |||||
Normal |
Ref
|
Ref
|
Ref
|
Ref
| ||
Moderate | 2.46(−0.45, 5.36) | 3.04(−0.34, 6.41) | 0.30(−3.56, 4.15) | 2.34(−0.76, 5.44) | ||
Severe | −2.44(−6.48, 1.60) | −1.26(−5.96, 3.44) | −10.43 (−15.80, −5.06) | −1.33(−5.64, 2.988) | 3.73 | 0.0054** |
R
2
| 68.5 | 69.8 | 64.3 | 67.2 |
Covariates | Overall quality of life score | |
---|---|---|
β
| 95% CI | |
Age in years | −0.08 | (−0.15, −0.1) |
Sex*** | ||
Female |
Ref
| |
Male | 3.72 | (1.99, 5.45) |
Marital status* | ||
Single |
Ref
| |
Married | −2.29 | (−4.11, −0.47) |
Proximity*** | ||
Close |
Ref
| |
Far | −4.03 | (−6.01, −2.05) |
Education*** | ||
None |
Ref
| |
Primary/junior high school | 4.46 | (1.59, 7.32) |
Secondary | 4.98 | (2.06, 7.89) |
Tertiary | 10.61 | (7.27,13.96) |
Employment status | ||
None |
Ref
| |
Private | 0.59 | (−2.63, 3.81) |
Public | −1.74 | (−5.30, 1.83) |
Self-employed | 1.59 | (−0.87, 4.05) |
Student/apprentice | −2.09 | (−7.41, 3.22) |
Direct cost | −0.003 | (−0.01,0.004) |
Indirect cost | −0.003 | (−0.01, 0.001) |
Zarit | −0.17 | (−0.28, −0.06) |
Duration of care given | 0.0002 | (−0.01, 0.01) |
Daily Care given time in hours | 0.15 | (−0.12, 0.41) |
Other family | ||
No |
Ref
| |
Yes | 0.88 | (−0.83, 2.58) |
Anxiety | ||
Normal |
Ref
| |
Moderate | 0.56 | (−1.54, 2.65) |
Severe | 1.43 | (−1.85, 4.72) |
Depression*** | ||
Normal |
Ref
| |
Moderate | −4.29 | (−6.32, −2.26) |
Severe | −13.62 | (−17.87, −9.37) |
Stress** | ||
Normal |
Ref
| |
Moderate | 2.03 | (−0.57, 4.63) |
Severe | −3.87 | (−7.48, −0.25) |
R
2
| 70.1 |