Reducing the constraints to school access and progress: Assessing the effects of a school scholarship program in Malawi

This study utilizes a non-equivalent groups research design to compare the educational experiences and outcomes of two student groups – those who did and those who did not receive a needs-based scholarship to attend secondary school and college in the Dowa, Kasungu, and Lilongwe Districts of Malawi. We assess impacts across a range of short and medium-term outcomes, including: school attendance, withdrawal, attainment, graduation, employment status, employment quality, and post-schooling income. The scholarship substantially reduces the household cost of participation in school, and reduces the distance travelled to school. As a result, we find that scholarship recipients attain between 1 and 1.5 years of additional school and graduate at higher rates. In terms of post-schooling outcomes, we find that recipients are in higher wage-earning occupations after leaving school. Overall, results suggest that scholarships are an effective demand-side strategy for improving schooling attainment, progression, and potentially longer-term labor market outcomes.

Associated factors, post infection child growth, and household cost of invasive enteritis among under 5 children in Bangladesh

Both Campylobacter- and Shigella-induced invasive enteritis are common in under-5 Bangladeshi children. Our study aimed to determine the factors associated with Campylobacter and Shigella enteritis among under-5 children, the post-infection worsening growth, and the household cost of invasive enteritis. Data of children having Shigella (591/803) and Campylobacter (246/1148) isolated from the fecal specimen in Bangladesh were extracted from the Global Enteric Multicenter Study (GEMS) for the period December 2007 to March 2011. In multiple logistic regression analysis, fever was observed more frequently among shigellosis cases [adjusted OR 2.21; (95% CI 1.58, 3.09)]. Breastfeeding [aOR 0.55; (95% CI 0.37, 0.81)] was found to be protective against Shigella. The generalized estimating equations multivariable model identified a negative association between Shigella and weight-for-height z score [aOR − 0.11; (95% CI − 0.21, − 0.001)]; a positive association between symptomatic Campylobacter and weight-for-age z score [aOR 0.22; (95% CI 0.06, 0.37)] and weight-for-height z score [aOR 0.22; (95% CI 0.08, 0.37)]. Total costs incurred by households were more in shigellosis children than Campylobacter-induced enteritis ($4.27 vs. $3.49). Households with low-level maternal education tended to incur less cost in case of their shigellosis children. Our findings underscore the need for preventive strategies targeting Shigella infection, which could potentially reduce the disease burden, associated household costs, and child growth faltering.

Household economic burden of childhood severe pneumonia in Bangladesh: a cost-of-illness study

ObjectiveTo estimate household cost of illness (COI) for children with severe pneumonia in Bangladesh.DesignAn incidence-based COI study was performed for one episode of childhood severe pneumonia from a household perspective. Face-to-face interviews collected data on socioeconomic, resource use and cost from caregivers. A micro-costing bottom-up approach was applied to calculate medical, non-medical and time costs. Multiple regression analysis was applied to explore the factors associated with COI. Sensitivity analysis explored the robustness of cost parameters.SettingFour urban and rural study sites from two districts in Bangladesh.PatientsChildren aged 2–59 months with severe pneumonia.Results1472 children with severe pneumonia were enrolled between November 2015 and March 2019. The mean age of children was 12 months (SD ±10.2) and 64% were male. The mean household cost per episode was US$147 (95% CI 141.1 to 152.7). Indirect costs were the main cost drivers (65%, US$96). Household costs for the poorest income quintile were lower in absolute terms, but formed a higher proportion of monthly income. COI was significantly higher if treatment was received from urban health facilities compared with rural health facilities (difference US$84.9, 95% CI 73.3 to 96.3). Child age, household income, healthcare facility and hospital length of stay (LoS) were significant predictors of household COI. Costs were most sensitive to hospital LoS and productivity loss.ConclusionsSevere pneumonia in young children is associated with high household economic burden and cost varies significantly across socioeconomic parameters. Management strategies with improved accessibility are needed particularly for the poor to make treatment affordable in order to reduce household economic burden.

Estimating the Economic Impact of Respiratory Syncytial Virus and Other Acute Respiratory Infections Among Infants Receiving Care at a Referral Hospital in Malawi

Background Respiratory syncytial virus (RSV) is a leading cause of respiratory illness among infants globally, yet economic burden data are scant, especially in low-income countries. Methods We collected data from 426 infants enrolled in the Queen Elizabeth Central Hospital respiratory disease surveillance platform to estimate the household and health system costs of managing RSV and other respiratory pathogens in Malawian infants. Total household cost per illness episode, including direct and indirect costs and lost income, was reported by parents/guardians at the initial visit and 6 weeks post discharge. The total cost to the health system was based on patient charts and hospital expenditures. All-cause acute respiratory infections (ARIs) and RSV costs for inpatient and outpatients are presented separately. All costs are in the 2018 US Dollar. Results The mean costs per RSV episode were $62.26 (95% confidence interval [CI]: $50.87-$73.66) and $12.51 (95% CI: $8.24-$16.79) for inpatient and outpatient cases, respectively. The mean cost per episode for all-cause ARIs was slightly higher among inpatients at $69.93 (95% CI: $63.06-$76.81) but slightly lower for outpatients at $10.17 (95% CI: $8.78-$11.57). Household costs accounted for roughly 20% of the total cost per episode. For the lowest-income families, household cost per inpatient RSV episode was about 32% of total monthly household income. Conclusions Among infants receiving care at a referral hospital in Malawi, the cost per episode in which RSV was detected is comparable to that of other episodes of respiratory illnesses where RSV was not detected. Estimates generated in this study can be used to evaluate the economic and financial impact of RSV and acute respiratory illness preventive interventions in Malawi.

Are we Contented in Achieving Universal Health Coverage in Treating Dengue Patients in Sri Lanka?

BackgroundAmong infectious diseases, Dengue illness causes a major public health threat in Sri Lanka. The preventive and the curative services place a financial burden on the state health sector and household cost and out of pocket expenditure also are important cost components embedded with Dengue infection. ObjectiveTo estimate the household costs and out of pocket expenditure incurred due to Dengue infection among adults who received institutional care.MethodsA longitudinal study was conducted from July to December 2018. Fifty patients each from DF and DHF categories were recruited with systematic sampling admitted to an institution in Colombo District, Sri Lanka. Adults residing in Colombo District of Sri Lanka for more than six months prior to Dengue/DHF episode, were recruited based on a systematic sampling method. Details were obtained via an interviewer administered questionnaire. They were interviewed on day of discharge from the hospital and were followed up for two weeks. Unit cost per patient was calculated. The household costs were calculated for three phases; ambulatory cost, costs incurred during hospitalization and post hospitalization costs. These components were described using mean, median, standard deviation and inter-quartile range and out of pocket expenditure were calculatedResultsThe median age in DF group was 38.5 years and in DHF group was 28.5 years. Average household cost was US$127.69(SD=93.32) and US$134.71(SD=94.31) for DF and DHF patients respectively. Among DF patients 98.03% was borne using OOPE and among DHF patients it was 95.57%. In 2016, the average monthly income of a household in Colombo was US$571.82. Therefore nearly 25% of the monthly income had been spent on a single adult with Dengue.ConclusionsIf an adult member is hospitalized with Dengue infection the Out of pocket expenditure is high, which is nearly 25% of a family’s monthly income. Strengthening the Dengue control programme is the key towards Universal Health Coverage.

Are We Contented in Achieving Universal Health Coverage in Treating Dengue Patients in Sri Lanka?

BackgroundAmong infectious diseases, Dengue illness causes a major public health threat in Sri Lanka. The preventive and the curative services place a financial burden on the state health sectorand household cost and out of pocket expenditure also are important cost components embedded with Dengue infection. ObjectiveTo estimate the household costs andout of pocket expenditure incurred due to Dengue infection among adults who received institutional care.MethodsA longitudinal study was conducted from July to December 2018. Fifty patients each from DF and DHF categories were recruited with systematic sampling admitted to an institution in Colombo District, Sri Lanka.Adults residing in Colombo District of Sri Lanka for more than six months prior to Dengue/DHF episode, were recruited based on a systematic sampling method. Details were obtained via an interviewer administered questionnaire. They were interviewed on day of discharge from the hospital and were followed up for two weeks. Unit cost per patient was calculated. The household costs were calculated for three phases; ambulatory cost, costs incurred during hospitalization and post hospitalization costs. These components were described using mean, median, standard deviation and inter-quartile range and out of pocket expenditure were calculatedResultsThe median age in DF group was 38.5 years and in DHF group was 28.5 years.Average household cost was US$127.69(SD=93.32) and US$134.71(SD=94.31) for DF and DHF patients respectively. Among DF patients 98.03% was borne using OOPE and among DHF patients it was 95.57%. In 2016, the average monthly income of a household in Colombo was US$571.82. Thereforenearly 25% of the monthly income had been spent on a single adult with Dengue.Conclusions and RecommendationsIf an adult member is hospitalized with Dengueinfection the Out of pocket expenditure is high, which is nearly 25% of a family’s monthly income.Strengthening the Dengue control programme is the key towards Universal Health Coverage.

Modelling the household cost of paediatric malaria treatment in a rural county in Kenya: do non-user fee payments matter? A partial cost of illness analysis

ObjectiveThe objective of this study was to develop an econometric model for the cost of treatment of paediatric malaria from a patient perspective in a resource scarce rural setting of Homa Bay County, Kenya. We sought to investigate the main contributors as well as the contribution of non-user fee payments to the total household cost of care. Costs were measured from a patient perspective.DesignThe study was conducted as a health facility based cross sectional survey targeting paediatric patients.SettingThe study was conducted in 13 health facilities ranging from level II to level V in Homa Bay County which is in the Eastern shores of Lake Victoria, Kenya. This is a malaria endemic area.ParticipantsWe enrolled 254 inpatient children (139 males and 115 females) all of whom participated up to the end of this study.Primary outcome measureThe primary outcome measure was the cost of pediatric malaria care borne by the patient. This was measured by asking exiting caregivers to estimate the cost of various items contributing to their total expenditure on care seeking.ResultsA total of 254 respondents who consented from 13 public government health facilities were interviewed. Age, number of days spent at the health facility, being treated at a level V facility, medical officer prescribing and seeking initial treatment from a retail shop were found significant predictors of cost.ConclusionHigher level health facilities in Homa Bay County, where the more specialised medical workers are stationed, are more costly hence barring the poorest from obtaining quality paediatric malaria care from here. Waiving user fees alone may not be sufficient to guarantee access to care by patients due to unofficial fees and non-user fees expenditures.