The Cost of Access to Health Care for Children Under-Five Years With Severe Anemia in Referral Hospitals in Malawi, Kenya, and Uganda

OBJECTIVES: Severe anaemia is a major cause of hospital admissions in African children under-five years of age. This study aims to estimate the household costs of accessing care for severe anaemia at Zomba and Kamuzu Central Hospitals in Malawi, Kisumu and Busia Referral Hospitals in Kenya and Jinja and Kitgum Referral Hospitals in Uganda.

METHODS: We prospectively collected data on the costs incurred when accessing services for severe anaemia alongside the randomized controlled trial, titled: Dihydroartemisinin-piperaquine and azithromycin for the post-discharge management of children with severe anaemia in Malawi, Kenya and Uganda. After enrolling children under-five with severe anaemia, their guardians reported direct and indirect costs encountered during their hospital admission.

RESULTS: Among 192 participants enrolled since August 2023, subsistence farming 79/192 and informal trading 50/192 were main sources of income for their households. About 67% (129/192) paid for a service or item during admission at a public referral hospital. To pay for services, 88/192 aquired a loan and 29/192 sold their assets. Motorcycle taxi, 104/192 and ambulance, 25/192 were the main modes of transport used to reach referral hospitals. The major costs incurred were for transportation $2.9 and food $3.8. In Uganda, 58/64 of participants also paid an average of $6.31 for medications. Productivity losses were high as primary guardians were unable to work for 6 days (inter-quartile range: 3-7 days) and a secondary guardian did not work for 4 (3-5) days during a childs illness with severe anaemia. This amounts to a mean productivity loss of $21 in Malawi, $38 in Kenya and $11 in Uganda during an illness with severe anaemia. The mean total cost for access to care were $30 in Malawi, $45 in Kenya and $36 in Uganda.

CONCLUSIONS: Investing in transportation, medications and nursing care for could curb catastrophic health expenditure in African health systems.