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Out of pocket costs and time/productivity losses for pediatric sepsis in Uganda: a mixed-methods study
A Krepiakevich1, A R Khowaja2, O Kabajaasi3
1First Nations Health Authority, Vancouver, British Columbia, Canada.
Insights
Families face significant financial hardship due to childhood sepsis care costs in Uganda. Out-of-pocket expenses for hospitalization and post-discharge treatment, including lost income and asset sales, are substantial, particularly at private facilities.
Area of Science:
- Global Health
- Pediatric Infectious Diseases
- Health Economics
Background:
- Sepsis disproportionately impacts children in low-resource settings, exacerbating socioeconomic disparities.
- Financial strain from seeking care can lead to delayed treatment and increased mortality.
- Post-discharge care represents a vulnerable period with significant associated costs.
Purpose of the Study:
- To investigate the out-of-pocket expenditures for pediatric sepsis hospitalizations.
- To determine the financial burden of post-discharge care for children with sepsis.
- To explore the economic impact on families in Uganda.
Main Methods:
- A mixed-methods approach combining focus group discussions (FGDs) with caregivers.
- Focus group discussions informed a quantitative cross-sectional household survey.
- Survey assessed out-of-pocket costs during initial admission and post-discharge.
Main Results:
- FGDs revealed themes of financial losses, time/productivity losses, and cost-coping strategies.
- High out-of-pocket costs were reported at both public and private facilities, with higher costs at private facilities.
- Mean costs were $124.50 (private) and $62.10 (public) for hospitalization, and $44.60 (private) and $14.60 (public) for post-discharge care.
Conclusions:
- Families incur substantial economic burdens for pediatric sepsis care.
- Financial hardships associated with sepsis treatment require targeted interventions.
- Understanding these costs is crucial for improving access to care and reducing mortality.
Background:
Sepsis disproportionately affects children from socioeconomically disadvantaged families in low-resource settings, where care seeking may consume scarce family resources and lead to financial hardships. Those financial hardships may, in turn, contribute to late presentation or failure to seek care and result in high mortality during hospitalization and during the post discharge period, a period of increasingly recognized vulnerability. The purpose of this study is to explore the out-of-pocket costs related to sepsis hospitalizations and post-discharge care among children admitted with sepsis in Uganda.
Methods:
This mixed-methods study was comprised of focus group discussions (FGD) with caregivers of children admitted for sepsis, which then informed a quantitative cross-sectional household survey to measure out-of-pocket costs of sepsis care both during initial admission and during the post-discharge period. All participants were families of children enrolled in a concurrent sepsis study.
Results:
Three FGD with mothers (n = 20) and one FGD with fathers (n = 7) were conducted. Three primary themes that emerged included (1) financial losses, (2) time and productivity losses and (3) coping with costs. A subsequently developed cross-sectional survey was completed for 153 households of children discharged following admission for sepsis. The survey revealed a high cost of care for families attending both private and public facilities, although out-of-pocket cost were higher at private facilities. Half of those surveyed reported loss of income during hospitalization and a third sold household assets, most often livestock, to cover costs. Total mean out-of-pocket costs of hospital care and post-discharge care were 124.50 USD and 44.60 USD respectively for those seeking initial care at private facilities and 62.10 USD and 14.60 USD at public facilities, a high sum in a country with widespread poverty.
Conclusions:
This study reveals that families incur a substantial economic burden in accessing care for children with sepsis.
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