Background
Methods
Study setting
Sampling and eligibility
Data collection and outcome definitions
Costing approach
Statistical analysis
Ethical considerations
Results
Characteristics of survey respondents
< 5 years | ≥ 5 years | Total % | |
---|---|---|---|
n = 31 (%) | n = 46 (%) | n = 80 | |
Age in years, median (IQR) | 1.6 (1.0, 2.7) | 12.0 (5.9, 30.6) | 4.9 (2.0, 17.5) |
Sex | |||
Male | 14 (45.7) | 22 (47.8) | 37 (46.3) |
Female | 17 (54.8) | 24 (31.2) | 43 (53.8) |
Residence | |||
Rural | 30 (96.8) | 42 (91.3) | 5 (6.25) |
Urban/small town | 1 (3.22) | 4 (8.7) | 75 (93.8) |
Wealth tertile | |||
Least poor | 5 (16.1) | 20 (43.5) | 26 (32.5) |
Middle | 11 (35.5) | 15 (32.6) | 26 (32.5) |
Poorest | 15 (48.4) | 11 (23.9) | 28 (35.0) |
Health facility management | |||
MoH | 20 (64.5) | 24 (52.2) | 46 (57.5) |
CHAM | 11 (35.5) | 22 (47.8) | 34 (42.5) |
Health facility type | |||
District/central | 16 (51.6) | 18 (39.1) | 36 (45.0) |
Other hospital type | 10 (32.3) | 22 (47.8) | 33 (41.3) |
Community/rural | 5 (16.1) | 6 (13.1) | 11 (13.8) |
Days in hospital, median (IQR) | 1.4 (0.7, 2.1) | 2.0 (0.6, 2.7) | 1.5 (0.6, 2.6) |
Days of illness, median (IQR) | 1.8 (0.7, 3.5) | 3.5 (1.3, 7.5) | 2.8 (0.9, 5.8) |
Sought care prior | |||
Yes | 19 (61.3) | 40 (87.0) | 60 (75.0) |
No | 12 (38.7) | 6 (13.0) | 20 (25.0) |
Distance, home to facility (km) | |||
< 5 | 13 (41.9) | 23 (50.0) | 36 (45.0) |
≥ 5 | 18 (58.1) | 23 (50.0) | 44 (55.0) |
Travel time to and from facility in days, median (IQR) | 0.14 (0.1, 0.2) | 0.16 (0.0, 0.2) | 0.15 (0.1, 0.2) |
Total household costs
n | Mean | Median | IQR |
p value | ||
---|---|---|---|---|---|---|
Total costs | 80 | $17.48 | $9.78 | $3.66 | $23.56 | |
Facility ownership | ||||||
CHAM | 34 | $23.43 | $17.00 | $7.97 | $28.74 | 0.06 |
MOHr
| 46 | $13.09 | $6.59 | $2.08 | $14.99 | |
Facility type | ||||||
District hospital | 36 | $13.32 | $6.39 | $2.01 | $13.09 | < 0.01 |
Rural/community/other | 11 | $13.50 | $9.30 | $4.51 | $17.61 | |
Cost by age (years) | ||||||
<5 | 31 | $9.74 | $7.15 | $2.09 | $13.32 | < 0.01 |
≥5r
| 46 | $22.86 | $14.23 | $4.94 | $33.57 | |
Sex | ||||||
Male | 37 | $13.08 | $7.35 | $2.03 | $16.27 | 0.12 |
Femaler
| 43 | $21.27 | $13.05 | $6.16 | $27.71 | |
Wealth tertile | ||||||
Least poor | 26 | $28.47 | $17.00 | $6.49 | $42.62 | < 0.01 |
Middle | 26 | $9.82 | $7.58 | $2.13 | $13.34 | |
Poorestr
| 28 | $14.39 | $8.05 | $2.20 | $23.56 | |
Duration of hospital stay | ||||||
Long (≥ 2 days) | 26 | $24.53 | $19.38 | $12.67 | $30.47 | 0.16 |
Short (< 2 days)r
| 16 | $14.76 | $6.39 | $6.98 | $14.23 | |
Sought care prior | ||||||
Yes | 60 | $19.00 | $9.39 | $3.29 | $17.00 | 0.02 |
Nor
| 20 | $12.94 | $9.78 | $3.66 | $26.46 | |
Distance from home to HF (km) | ||||||
< 5 | 36 | $15.78 | $8.05 | $3.29 | $17.00 | 0.54 |
≥ 5r
| 44 | $18.88 | $13.01 | $3.66 | $26.46 | |
Residence | ||||||
Rural | 75 | $15.27 | $8.60 | $3.02 | $19.47 | < 0.01 |
Urban/small townr
| 5 | $50.68 | $26.57 | $22.04 | $63.10 |
Coefficient (β) | Robust standard error | Ratio of arithmetic meansa
| 95% confidence interval |
p value | ||
---|---|---|---|---|---|---|
Full model
| ||||||
Sex (female vs. male) | 0.48 | 0.47 | 1.62 | 0.65 | 4.06 | 0.302 |
Age < 5 years vs. ≥ 5 years | −0.51 | 0.08 | 0.60 | 0.51 | 0.71 | < 0.01 |
Wealth tertile, middle vs. least poor and poorest | −0.54 | −4.18 | 0.59 | 0.46 | 0.75 | < 0.01 |
Wealth tertile, poorest vs. least poor and middle | −0.45 | −2.58 | 0.64 | 0.45 | 0.90 | 0.01 |
CHAM vs. MoH | 0.40 | 0.05 | 1.49 | 1.35 | 1.65 | < 0.01 |
Rural vs. urban residence | −0.20 | 0.27 | 0.82 | 0.48 | 1.38 | 0.456 |
Days in hospital | 0.02 | 0.00 | 1.02 | 1.01 | 1.03 | < 0.01 |
Distance to health facility (< 5 km vs. ≥ 5 km) | −0.64 | 0.26 | 0.53 | 0.31 | 0.88 | 0.015 |
Restricted model
| ||||||
Age < 5 years vs. ≥ 5 years | −0.51 | 0.09 | 0.60 | 0.51 | 0.71 | < 0.01 |
Wealth tertile, least poor vs. middle and poorest | 0.60 | 0.08 | 1.82 | 1.57 | 2.11 | < 0.01 |
CHAM vs. MoH | 0.42 | 0.06 | 1.52 | 1.36 | 1.70 | < 0.01 |
Days in hospital | 0.02 | 0.01 | 1.02 | 1.00 | 1.04 | 0.03 |
Distance to health facility (< 5 km vs. ≥ 5 km) | −0.50 | 0.05 | 0.61 | 0.55 | 0.67 | < 0.01 |
Direct household costs
Mean | Median | IQR | ||
---|---|---|---|---|
Total direct costs | $7.59 | $3.12 | $0.91 | $9.51 |
Direct medical costs | $2.39 | $0.00 | $0.00 | $2.62 |
Medications | $2.38 | $0.00 | $0.00 | $2.62 |
Direct non-medical costs | $5.20 | $1.89 | $0.11 | $6.22 |
Travel to and from HF | $3.70 | $1.04 | $0.00 | $3.23 |
Accommodation | $0.05 | $0.00 | $0.00 | $0.00 |
Meals | $4.42 | $1.94 | $0.61 | $5.81 |
MoHa
| CHAMb
|
p value | |||||||
---|---|---|---|---|---|---|---|---|---|
Mean | Median | IQR | Mean | Median | IQR | ||||
Total direct costs | $5.59 | $2.15 | $0.69 | $6.40 | $10.28 | $4.75 | $1.65 | $13.67 | 0.05 |
Direct medical costs | $1.06 | $0.00 | $0.00 | $0.82 | $4.19 | $2.13 | $0.00 | $5.85 | 0.01 |
Medications | $1.06 | $0.00 | $0.00 | $0.82 | $4.16 | $1.95 | $0.00 | $5.85 | 0.01 |
Direct non-medical costs | $4.54 | $1.92 | $0.32 | $4.94 | $6.09 | $1.83 | $0.00 | $6.04 | 0.42 |
Travel to and from HF | $3.29 | $1.65 | $0.00 | $3.06 | $4.26 | $0.36 | $0.00 | $4.02 | 0.53 |
Accommodation | $0.09 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | 0.31 |
Meals | $3.80 | $1.65 | $0.61 | $4.02 | $5.20 | $2.20 | $0.37 | $5.73 | 0.42 |
Patients < 5 years
c
|
Patients ≥ 5 years
d
| ||||||||
Total direct costs | $5.30 | $2.15 | $1.29 | $7.50 | $9.43 | $4.02 | $0.64 | $13.87 | 0.06 |
Direct medical costs | $2.00 | $0.00 | $0.00 | $2.13 | $2.79 | $0.00 | $0.00 | $3.17 | 0.40 |
Medications | $2.00 | $0.00 | $0.00 | $2.13 | $2.79 | $0.00 | $0.00 | $3.17 | 0.42 |
Direct non-medical costs | $3.30 | $1.56 | $0.21 | $4.30 | $6.63 | $2.10 | $0.00 | $6.40 | 0.06 |
Travel to and from HF | $2.65 | $0.82 | $0.00 | $2.74 | $4.58 | $1.65 | $0.00 | $3.84 | 0.22 |
Accommodation | $0.00 | $0.00 | $0.00 | $0.00 | $0.05 | $0.00 | $0.00 | $0.54 | 0.39 |
Meals | $2.52 | $0.62 | $0.55 | $2.56 | $5.52 | $2.12 | $0.98 | $6.86 | 0.13 |
Indirect costs
Productive days lost due to malaria episode | Associated productivity costs | ||||||||
---|---|---|---|---|---|---|---|---|---|
n | Mean | Median | IQR | Mean | Median | IQR | |||
Total indirect costs (combined patient and caregiver costs)
| 80 | 8.5 | 4.1 | 0.0 | 11.1 | $9.90 | $4.74 | $0.00 | $12.84 |
Total indirect costs < 14 years | 57 | 4.1 | 0.0 | 0.0 | 6.2 | $4.73 | $0.00 | $0.00 | $7.13 |
Total indirect costs ≥ 14 years | 23 | 19.6 | 13.9 | 7.1 | 20.3 | $22.70 | $16.08 | $8.23 | $23.49 |
Lost productivity for patients≥ 14 years | 23 | 10.4 | 6.1 | 5.2 | 9.2 | $15.89 | $8.31 | $5.97 | $16.50 |
Lost productivity prior to the current admissiona
| 23 | 12.0 | 6.5 | 2.9 | 12.2 | $13.97 | $7.54 | $3.33 | $14.11 |
Lost productivity during current admissionb
| 23 | 1.7 | 0.7 | 0.1 | 2.4 | $1.92 | $0.78 | $0.13 | $2.79 |
Lost productivity for caregivers | 80 | 9.2 | 7.1 | 4.3 | 11.1 | $10.65 | $8.27 | $5.03 | $12.84 |
Lost productivity prior to the current admissiona
| 80 | 5.6 | 3.4 | 1.0 | 7.0 | $6.47 | $3.98 | $1.16 | $8.12 |
Lost productivity during current admissionb
| 80 | 3.6 | 3.1 | 2.1 | 4.4 | $4.19 | $3.58 | $2.40 | $5.13 |
Lost productivity for caregivers for patients < 5 years | 31 | 7.9 | 6.1 | 4.2 | 8.4 | $9.18 | $7.11 | $4.81 | $9.76 |
Lost productivity prior to the current admissiona
| 31 | 4.6 | 2.8 | 1.4 | 5.1 | $5.34 | $3.29 | $1.59 | $5.94 |
Lost productivity during current admissionb
| 31 | 3.3 | 3.1 | 2.1 | 4.2 | $3.84 | $3.63 | $2.49 | $4.82 |
Lost productivity for caregivers for patients ≥ 5 years | 46 | 9.9 | 8.3 | 5.0 | 11.7 | $11.48 | $9.68 | $5.82 | $13.56 |
Lost productivity prior to the current admissiona
| 46 | 6.3 | 3.5 | 1.0 | 7.8 | $7.33 | $4.06 | $1.16 | $8.99 |
Lost productivity during current admissionb
| 46 | 3.6 | 3.1 | 1.5 | 5.6 | $4.15 | $3.55 | $1.79 | $6.47 |
Total indirect costs by wealth index | |||||||||
Least poor | 26 | 16.5 | 8.3 | 2.7 | 14.3 | $16.67 | $8.15 | $0.00 | $17.66 |
Middle | 26 | 7.0 | 6.1 | 3.1 | 9.7 | $4.88 | $3.53 | $0.00 | $8.29 |
Poorest | 28 | 9.0 | 6.0 | 2.1 | 10.2 | $8.27 | $3.87 | $0.00 | $9.43 |