Cost of diarrhoea: a household perspective from seven countries in the Global Enteric Multicentre Study (GEMS)

The burden of diarrhoeal diseases is considerable in South Asia, as well as in sub-Saharan Africa. Its economic impact is more profound in resource-limited settings like low-income and middle-income countries (LMICs). In this study, we aimed to estimate the direct and indirect costs reported by the caregivers of participants from seven LMICs.

The current study is a secondary analysis using data from the multicentre, Global Enteric Multicentre Study, which enrolled under-5 children. This prospective case-control study was conducted in seven sites, all of which were in LMICs. After adjustment for inflation, cost data were collected from the caregivers and converted into international dollar (I$). Quantile regression models were developed after adjusting for age, sex and country.

This study analysed data from 4592 participants. The median (IQR) total direct cost (TDC) and total indirect cost (TIC) were I$8.4 (I$11.0) and I$10.2 (I$14.3), respectively. Statistically significant differences were found across continents for multiple variables. The highest median TDC and TIC were in Bangladesh (I$13.6 and I$23.2, respectively), while mozambique reported the lowest (I$0.4 and I$4.9, respectively), with medication accounting for 60.9% of TDC. Quantile regression analysis showed TDC was positively associated with factors like family size, urban residence, moderate-to-severe disease, caregiver education and use of rehydration methods, while treated drinking water and overweight status were negatively associated. TIC was significantly associated with seeking prior care.

The indirect cost of diarrhoea was higher, which indicates the impact of lost productivity due to the disease. Bolstering the healthcare financing systems, ensuring affordable medication using pricing regulation, subsidising treatment packages, promoting the water, sanitation and hygiene (WASH) initiative, promoting and practising standard case management, and timely healthcare-seeking can reduce the economic burden.