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Catastrophic health expenditures associated with single admission for paediatric surgery in a low-resource setting: a
Tunde Talib Sholadoye1,2, Omolara M Williams3, Olumide Abiodun Elebute4
1Surgery, Ahmadu Bello University, Zaria, Kaduna, Nigeria hamedtalib2000@yahoo.co.uk.
Insights
Catastrophic healthcare expenditure (CHE) is prevalent in Nigerian families with pediatric surgical patients. Factors like major surgery and longer hospital stays increase CHE risk, while health insurance helps prevent it.
Area of Science:
- Public Health
- Health Economics
- Paediatric Surgery
Background:
- Catastrophic healthcare expenditure (CHE) presents a substantial financial burden globally, especially in low- and middle-income countries.
- This study addresses the significant financial strain faced by families of children undergoing surgery.
Purpose of the Study:
- To determine the prevalence of CHE among families of paediatric surgical patients in Nigeria.
- To identify factors associated with CHE in this population.
Main Methods:
- A prospective, multicentre, cross-sectional study was conducted in 25 Nigerian paediatric surgery hospitals.
- Data from 1665 paediatric patients (age ≤16 years) and their households were analyzed.
- CHE was defined as healthcare costs exceeding 10% of annual household income.
Main Results:
- Over 58% of households experienced CHE, with a median annual income of $1097.78.
- Major surgery and prolonged hospital stays significantly increased CHE risk.
- Male patients, higher parental education, and health insurance access were associated with reduced CHE.
Conclusions:
- CHE is highly prevalent in families of paediatric surgical patients in Nigeria.
- Major and emergency surgeries, along with extended hospital stays, are key drivers of CHE.
- Health insurance access is a critical protective factor against CHE.
Background:
Catastrophic healthcare expenditure (CHE) poses significant financial burdens on households globally, particularly in low- and middle-income countries. This study was designed to determine the prevalence of CHE among families of paediatric surgical patients admitted for surgery and to explore factors associated with it.
Methods:
The study was a prospective, multicentre, cross-sectional study carried out in 25 hospitals with paediatric surgery in Nigeria from July to November 2024. Consecutive patients below 16 years of age who underwent surgery were included. CHE was defined as health expenditure above 10% of the head of household annual household income. Data on demographic data, educational and employment status of parents and other related factors were collected and analysed using Stata.
Results:
A total of 1665 patients were recruited with ages ranging from 5 days to ≤16 years (median=4.74 years). Overall median annual income for the heads of household was US$1097.78. The median (IQR) cost of care was US$129.81 per patient and 56.3% of households spent out of pocket and only 11.7% of households had access to health insurance.A total of 981 households (58.9%; 95% CI 56.5% to 61.3%) experienced CHE. The CHE incidence rate ratio (IRR) decreased among households where the patients were male (IRR 0.92 (95% CI 0.86 to 0.98); p=0.011), the head-of-households had a graduate/postgraduate education (IRR 0.64 (95% CI 0.53 to 0.78); p<0.001), but increased when major surgery was performed (IRR 1.25 (95% CI 1.08 to 1.44); p=0.002) and with prolonged hospital stay (1.008 (95% CI 1.005 to 1.011); p<0.001).The main sources of funds for healthcare were out-of-pocket (n=936, 56.3%) and availability of health insurance was significant in preventing CHE, as three of every four households accessing health insurance did not experience it.
Conclusion:
Catastrophic health expenditure was highly prevalent among families of children who underwent surgery in Nigeria, particularly among those who had major and emergency surgeries.
