Marianela Castillo-Riquelme1, Diane McIntyre, Karen Barnes. 1. Health Economic Unit, Department of Public Health & Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. marianela.castillo-riquelme@uct.ac.za
Abstract
OBJECTIVES: To evaluate treatment-seeking behaviour, financial impact and time lost due to malaria events, in southern Mozambique and eastern South Africa. METHODS: In-depth household surveys (828 in Mozambique and 827 in South Africa) were analysed. An asset index was calculated using principal component analysis to allow comparison across socio-economic groups. Direct costs of seeking care and the time lost due to malaria were determined. The extent of catastrophic payments was assessed using as thresholds the traditional 10% of household income and 40% of non-food income, as recently recommended by WHO. RESULTS: Poverty was highly prevalent: 70% of the South African and 95% of Mozambican households studied lived on less than $1 per capita per day. Around 97% of those with recent malaria sought healthcare, mainly in public facilities. Out-of-pocket household expenditure per malaria episode averaged $2.30 in South Africa and $6.50 in Mozambique. Analysis at the individual household level found that 32-34% of households in Mozambique, compared with 9-13% of households in South Africa, incurred catastrophic payments for malaria episodes. Results based on mean values underestimated the prevalence of catastrophic payments. Days off work/school were higher in Mozambique. CONCLUSIONS: The high rate of health seeking in public health facilities seems unusual in the African context, which bodes well for high coverage with artemisinin-based combinations, even if only deployed within the public sector. However, despite no or modest charges for public sector primary healthcare, households frequently incur catastrophic expenditure on a single malaria episode.
OBJECTIVES: To evaluate treatment-seeking behaviour, financial impact and time lost due to malaria events, in southern Mozambique and eastern South Africa. METHODS: In-depth household surveys (828 in Mozambique and 827 in South Africa) were analysed. An asset index was calculated using principal component analysis to allow comparison across socio-economic groups. Direct costs of seeking care and the time lost due to malaria were determined. The extent of catastrophic payments was assessed using as thresholds the traditional 10% of household income and 40% of non-food income, as recently recommended by WHO. RESULTS: Poverty was highly prevalent: 70% of the South African and 95% of Mozambican households studied lived on less than $1 per capita per day. Around 97% of those with recent malaria sought healthcare, mainly in public facilities. Out-of-pocket household expenditure per malaria episode averaged $2.30 in South Africa and $6.50 in Mozambique. Analysis at the individual household level found that 32-34% of households in Mozambique, compared with 9-13% of households in South Africa, incurred catastrophic payments for malaria episodes. Results based on mean values underestimated the prevalence of catastrophic payments. Days off work/school were higher in Mozambique. CONCLUSIONS: The high rate of health seeking in public health facilities seems unusual in the African context, which bodes well for high coverage with artemisinin-based combinations, even if only deployed within the public sector. However, despite no or modest charges for public sector primary healthcare, households frequently incur catastrophic expenditure on a single malaria episode.
Authors: Breanna Barger; Hamma Maiga; Oumar Bila Traore; Mamadou Tekete; Intimbeye Tembine; Antoine Dara; Zoumana Isaac Traore; Soren Gantt; Ogobara K Doumbo; Abdoulaye A Djimde Journal: Trop Med Int Health Date: 2009-05-26 Impact factor: 2.622
Authors: Christopher Au-Yeung; Steve Kanters; Erin Ding; Philippe Glaziou; Aranka Anema; Curtis L Cooper; Julio Sg Montaner; Robert S Hogg; Edward J Mills Journal: Clin Epidemiol Date: 2011-01-19 Impact factor: 4.790