Routine Paediatric Sickle Cell Disease (SCD) Outpatient Care in a Rural Kenyan Hospital: Utilization and Costs

More than 70% of children with sickle cell disease (SCD) are born in sub-Saharan Africa where the prevalence at birth of this disease reaches 2% or higher in some selected areas. There is a dearth of knowledge on comprehensive care received by children with SCD in sub-Saharan Africa and its associated cost. Such knowledge is important for setting prevention and treatment priorities at national and international levels. This study focuses on routine care for children with SCD in an outpatient clinic of the Kilifi District Hospital, located in a rural area on the coast of Kenya.To estimate the per-patient costs for routine SCD outpatient care at a rural Kenyan hospital.We collected routine administrative and primary cost data from the SCD outpatient clinic and supporting departments at Kilifi District Hospital, Kenya. Costs were estimated by evaluating inputs - equipment, medication, supplies, building use, utility, and personnel - to reflect the cost of offering this service within an existing healthcare facility. Annual economic costs were similarly calculated based on input costs, prorated lifetime of equipment and appropriate discount rate. Sensitivity analyses evaluated these costs under different pay scales and different discount rate.We estimated that the annual economic cost per patient attending the SCD clinic was USD 138 in 2010 with a range of USD 94 to USD 229.This study supplies the first published estimate of the cost of routine outpatient care for children born with SCD in sub-Saharan Africa. Our study provides policy makers with an indication of the potential future costs of maintaining specialist outpatient clinics for children living with SCD in similar contexts

Porous safety net: catastrophic health expenditure and its determinants among insured households in Togo

Abstract Background In Togo, about half of health care costs are paid at the point of service, which reduces access to health care and exposes households to catastrophic health expenditure (CHE). To address this situation, the Togolese government introduced a National Health Insurance Scheme (NHIS) in 2011. This insurance currently covers only employees and retirees of the State as well as their dependents, although plans for extension exist. This study is the first attempt to examine the extent to which Togo’s NHIS protects its members financially against the consequences of ill-health. Methods Data was obtained from a cross-sectional representative households’ survey involving 1180 insured households that had reported illness in the household in the 4 weeks preceding the survey or hospitalization in the 12 months preceding the survey. The incidence and intensity of CHE were measured by the catastrophic health payment method. A logistic regression was used to analyse determinants of CHE. Results The results indicate that the proportion of insured households with CHE varies widely between 3.94% and 75.60%, depending on the method and the threshold used. At the 40% threshold, health care cost represents 60.95% of insured households’ total monthly non-food expenditure. This study showed that the socioeconomic status, the type of health facility used, hospitalization and household size were the highest predictors of CHE. Whatever the chosen threshold, care in referral and district hospitals significantly increases the likelihood of CHE. In addition, the proportion of households facing CHE is higher in the lowest income groups. The behaviour of health care providers, poor quality of care and long waiting time were the main factors leading to CHE. Conclusion A sizable proportion of insured households face CHE, suggesting gaps in the coverage. To limit the impoverishment of insured households with low income, policies for free or heavily subsidized hospital services should be considered. The results call for an equitable health insurance scheme, which is affordable for all insured households

Mean and percentage of total household monthly income and expenditures per category.

<p>Mean household income 11,274 (standard deviation 9,417) and median household income is KES 8,800 (or about USD 104.5 per month).</p><p>Mean household expenditures: KES 13,957 (standard deviation 10,009).</p><p>Number of observations  = 3431 for food and 3435 for all other items.</p

Descriptive statistics of variables included in the analysis.

<p>• The total may not add to 1 because of rounding errors.</p><p>do not have formal employment nor own a business. Household engaged in casual work, petty trade or is unemployed.</p><p>Idiosyncratic shock included : fire, mugging, burglary, eviction, property destruction, or rape.</p><p>Covariate shocks is floods.</p

Field Lessons from a Zoonotic Disease Study in the Nairobi Health Surveillance System

We aim to disseminate field lessons gained from studying zoonotic diseases among children with diarrhea in the Nairobi Urban Health and Demographic Surveillance System. Despite the numerical importance of slums in sub-Saharan Africa, little is known on the practice of health surveillance in those resource-limited areas. Challenges and lessons gained concern sustaining community participation over the years, engaging with gatekeepers, hiring and training local fieldworkers, ensuring safety of employees and material, and offering clinical care to children with diarrhea in their households

Odds-ratios and (standard deviation) for the determinants of use of coping Strategies.

<p>Note: The second column shows the determinants of use of any coping strategies, the next seven analyze the use of specific coping strategies.</p><p>*is significant at 10%, ** significant at 5%, and *** significant at 1%.</p><p>Idiosyncratic shocks includes fire, mugging, burglary, eviction, property destruction or rape.</p><p>community shocks includes floods.</p

Reproductive health voucher program and facility based delivery in informal settlements in Nairobi: A longitudinal analysis

Introduction: In Kenya, the maternal mortality rate had ranged from 328 to 501 deaths per 100,000 live births over the last three decades. To reduce these rates, the government launched in 2006 a means-tested reproductive health output-based approach (OBA) voucher program that covers costs of antenatal care, a facility-based delivery (FBD) and a postnatal visit in prequalified healthcare facilities. This paper investigated whether women who bought the voucher for their index child and had a FBD were more likely to deliver a subsequent child in a facility compared to those who did not buy vouchers. Methods and Findings: We used population-based cohort data from two Nairobi slums where the voucher program was piloted. We selected mothers of at least two children born between 2006 and 2012 and divided the mothers into two groups: Index-OBA mothers bought the voucher for the index child (N = 352), and non-OBA mothers did not buy the voucher during the study period (N = 514). The most complete model indicated that the adjusted odds-ratio of FBD of subsequent child when the index child was born in a facility was 3.89 (p \u3c 0.05) and 4.73 (p \u3c 0.01) in Group 2. Discussion and Conclusion: The study indicated that the voucher program improved poor women access to FBD. Furthermore, the FBD of an index child appeared to have a persistent effect, as a subsequent child of the same mother was more likely to be born in a facility as well. While women who purchased the voucher have higher odds of delivering their subsequent child in a facility, those odds were smaller than those of the women who did not buy the voucher. However, women who did not buy the voucher were less likely to deliver in a good healthcare facility, negating their possible benefit of facility-based deliveries. Pathways to improve access to FBD to all near poor women are needed

Percentage of households that used listed coping strategies in the last four weeks.

<p>Percentage of households that used listed coping strategies in the last four weeks.</p

Odds ratio and (Standard deviation) of facility-based delivery (FBD) of the subsequent children.

<p>Standard error in parentheses*** p<0.01, ** p<0.05, * p<0.1</p