Economic burden of malaria and predictors of cost variability to rural households in south-central Ethiopia

<div><p>Background</p><p>While recognizing the recent remarkable achievement in the global malaria reduction, the disease remains a challenge to the malaria endemic countries in Africa. Beyond the huge health consequence of malaria, policymakers need to be informed about the economic burden of the disease to the households. However, evidence on the economic burden of malaria in Ethiopia is scanty. The aims of this study were to estimate the economic burden of malaria episode and to identify predictors of cost variability to the rural households.</p><p>Methods</p><p>A prospective costing approach from a household perspective was employed. A total of 190 malaria patients were enrolled to the study from three health centers and nine health posts in Adami Tullu district in south-central Ethiopia, in 2015. Primary data were collected on expenditures due to malaria, forgone working days because of illness, socioeconomic and demographic situation, and households’ assets. Quantile regression was applied to predict factors associated with the cost variation. Socioeconomic related inequality was measured using concentration index and concentration curve.</p><p>Results</p><p>The median cost of malaria per episode to the household was USD 5.06 (IQR: 2.98–8.10). The direct cost accounted for 39%, while the indirect counterpart accounted for 61%. The history of malaria in the last six months and the level of the facility visited in the health system predominantly influenced the direct cost. The indirect cost was mainly influenced by the availability of antimalarial drugs in the health facility. The concentration curve and the concentration index for direct cost indicate significant pro-rich inequality. <i>Plasmodium falciparum</i> is significantly more costly for households compared to <i>Plasmodium vivax</i>.</p><p>Conclusion</p><p>The economic burden of malaria to the rural households in Ethiopia was substantial—mainly to the poor—indicating that reducing malaria burden could contribute to the poverty reduction as well.</p></div

Concentrations curves for direct (A), and indirect (B) cost of malaria.

<p>Concentrations curves for direct (A), and indirect (B) cost of malaria.</p

Direct, indirect and total malaria costs to the household (2015 USD) at health centers, health posts, and overall for both level of care, Adami Tullu district south-central Ethiopia.

<p>Direct, indirect and total malaria costs to the household (2015 USD) at health centers, health posts, and overall for both level of care, Adami Tullu district south-central Ethiopia.</p

Quantile (median) regression of factors associated with variability of direct, indirect and total cost of malaria, Adami Tullu district south-central Ethiopia, 2015.

<p>Quantile (median) regression of factors associated with variability of direct, indirect and total cost of malaria, Adami Tullu district south-central Ethiopia, 2015.</p

Analysis of the difference in median and mean cost of P. falciparum and P. vivax malaria, Adami Tullu district in south-central Ethiopia, 2015.

<p>Analysis of the difference in median and mean cost of P. falciparum and P. vivax malaria, Adami Tullu district in south-central Ethiopia, 2015.</p

Mean malaria costs and concentration indices across different socio economic status, Adami Tullu district in south-central Ethiopia, 2015.

<p>Mean malaria costs and concentration indices across different socio economic status, Adami Tullu district in south-central Ethiopia, 2015.</p

Socio-demographic characteristics and the situation of the malaria illness, Adami Tullu district south-central Ethiopia, 2015.

<p>Socio-demographic characteristics and the situation of the malaria illness, Adami Tullu district south-central Ethiopia, 2015.</p

Incidence rate and hazard ratio of anaemia among dynamic cohort of children in Adami Tullu district in south-central Ethiopia, 2014 to 2015.

<p>Incidence rate and hazard ratio of anaemia among dynamic cohort of children in Adami Tullu district in south-central Ethiopia, 2014 to 2015.</p

Multilevel logistic regression for predictors of anaemia among children in Adami Tullu district in south-central Ethiopia, 2014 and 2015.

<p>Multilevel logistic regression for predictors of anaemia among children in Adami Tullu district in south-central Ethiopia, 2014 and 2015.</p

Demographic and anthropometric measurements of children, and household characteristics in Adami Tullu district in south-central Ethiopia, 2014 and 2015.

<p>Demographic and anthropometric measurements of children, and household characteristics in Adami Tullu district in south-central Ethiopia, 2014 and 2015.</p