Background
Methods
Search strategy and inclusion criteria
Inclusion and exclusion criteria
Search strategy
Data extraction and analysis
Quality and risk of bias assessment
Results
Study selection
Characteristics of the included studies and quality of data
Incidence and intensity of catastrophic health expenditure in SSA countries
Region (countries) | Articles that reported CHE; n (%) | CHE incidence: % range [threshold] | CHE intensity; % range [threshold] | ||
---|---|---|---|---|---|
General health care | Diagnostics1 | General health care | Diagnostics2 | ||
Region 1: West Africa countries: Benin = 1; Burkina Faso = 1; Côte d’Ivoire = 1; Mali = 1; Nigeria = 11; Senegal = 1; Ghana = 1 | 17 (50%) [2, 4, 5, 7, 10, 11, 15–17, 19–21, 24, 26, 28, 30, 33] | 2.4–25.4[*] 1.7–27[**] | 8.2–71.8[*] 9.8–44[**] | 3.4–7.8[*] | 6–7.8 [*] 8.3 [**] |
Region 2: East Africa countries: Kenya = 4; Uganda = 2; Tanzania = 1 | 8 (24%) [1, 3, 6, 8, 9, 13, 31, 34] | 1.5–22.8[*] 2.9–18[**] | None | 2.5–11[*] 5.7–25[**] | None |
Region 3: South African countries: South Africa = 2; Zambia = 1; Malawi = 2; Madagascar = 1; Botswana = 1; Lesotho = 1; Mozambique = 1 | 7 (21%) [12, 14, 22, 23, 25, 29, 32] | 0.09–11.2[*] 0.7–9.3[**] | 9–39.9[*] 4.5–34[**] | 1.01[*] 0.1[**] | None |
Region 4: Central Africa countries: Democratic Republic of Congo = 1 | 1 (3%) [27] | None | 46.4[*] 81.1 [**] | None | None |
Region 5: Multi-region South Africa, Ghana, Tanzania = 1 | 1 (3%) [18] | 0.1–2.4[**] | None | None | None |
Determinants of catastrophic health expenditure
Determinants of catastrophic health expenditure (CHE) | Western Africa | South Africa | East and Central Africa | Total studies per determinant |
---|---|---|---|---|
Household economic status: Poor-income households Middle-income households High-income households | 4 [5, 15, 28, 33] | 2 [12, 14] | 4 [1, 6, 13, 27*] | 10 |
Type of health care provider: Private Public | 2 [11, 24] | 1 [14] | 5 [1, 9, 13, 27*, 34] | 8 |
Type of illness: HIV-ART Tuberculosis Obstetrics Malaria Chronic illnesses | 5 [5, 10, 11, 24, 33] | 2 [12, 29] | 5 [1, 6, 9, 13, 27*] | 12 |
Household member characteristics Employment status Education level Gender/sex Age of household members | 5 [5, 15, 24, 28, 33] | 3 [12, 22, 29] | 7 [1, 6, 9, 13, 27*, 31, 34] | 15 |
Geographical location Distance to the health facility Residence (rural/urban) | 3 [24, 11, 15] | 3 [14, 22, 29] | 5 [1, 6, 9, 31, 34] | 11 |
Social insurance/health scheme Health insurance Social network scheme | 3 [5, 11, 28] | Nil | 1 [9] | 4 |
Household size and composition Number of household members Household with elderly people Household with under 5 children | 5 [5, 10,11, 24, 33] | 2 [12, 22] | 6 [1, 6, 9, 13, 31, 34] | 13 |
Household economic/income status
Type of health care provider
Type of illness
Characteristics of household members
Geographical location and distance to health facility
Social insurance/welfare scheme
Household size and composition
Household impoverishment in Sub Saharan-Africa countries
Author | County | Pre-payment poverty head count (%) | Post-payment poverty head count (%) | Households impoverished (%) | Relative difference (%) |
---|---|---|---|---|---|
Kenya | 29α | 30.5 | 1.5 | 5 | |
Kwesiga et al., 2015 [57] | Uganda | 24.5β | 29 | 4.5 | 18 |
Barasa et al., 2017 [52] | Kenya | 66.6β | 68.21 | 1.61 | 2 |
Ichoku and Fonta, 2009 [41] | Nigeria | 69.4β | 72 | 2.6 | 4 |
Chuma and Maina, 2012 [59] | Kenya | 54.9β | 57.6 | 2.7 | 5 |
Sene and Cisse, 2015 [30] | Senegal | 46.71β | 48.14 | 1.43 | 3 |
Mchenga et al., 2017 [37] | Malawi | 50.98β | 51.9 | 0.92 | 2 |
Ichoku et al., 2009 [36] | Nigeria | 57β | 61 | 4.14 | 7 |
Wang et al., 2016 [58] | Malawi | 43ϕ | 44.7 | 1.7 | 4 |