Out-of-Pocket Costs and Other Determinants of Access to Healthcare for Children with Febrile Illnesses: A Case-Control Study in Rural Tanzania.

To study private costs and other determinants of access to healthcare for childhood fevers in rural Tanzania. A case-control study was conducted in Tanzania to establish factors that determine access to a health facility in acute febrile illnesses in children less than 5 years of age. Carers of eligible children were interviewed in the community; cases were represented by patients who went to a facility and controls by those who did not. A Household Wealth Index was estimated using principal components analysis. A multivariable logistic regression analysis was performed to understand the factors which influenced attendance of healthcare facility including severity of the illness and household wealth/socio-demographic indicators. To complement the data on costs from community interviews, a hospital-based study obtained details of private expenditures for hospitalised children under the age of 5. Severe febrile illness is strongly associated with health facility attendance (OR: 35.76, 95%CI: 3.68-347.43, p = 0.002 compared with less severe febrile illness). Overall, the private costs of an illness for patients who went to a hospital were six times larger than private costs of controls ($5.68 vs.$0.90, p<0.0001). Household wealth was not significantly correlated with total costs incurred. The separate hospital based cost study indicated that private costs were three times greater for admissions at the mission versus public hospital: $13.68 mission vs.$4.47 public hospital (difference $ 9.21 (95% CI: 7.89 -10.52), p<0.0001). In both locations, approximately 50% of the cost was determined by the duration of admission, with each day in hospital increasing private costs by about 12% (95% CI: 5% - 21%). The more severely ill a child, the higher the probability of attending hospital. We did not find association between household wealth and attending a health facility; nor was there an association between household wealth and private cost

Out-of-pocket costs and other determinants of access to healthcare for children with febrile illnesses : a case-control study in rural Tanzania

Objectives To study private costs and other determinants of access to healthcare for childhood fevers in rural Tanzania. Methods A case-control study was conducted in Tanzania to establish factors that determine access to a health facility in acute febrile illnesses in children less than 5 years of age. Carers of eligible children were interviewed in the community; cases were represented by patients who went to a facility and controls by those who did not. A Household Wealth Index was estimated using principal components analysis. A multivariable logistic regression analysis was performed to understand the factors which influenced attendance of healthcare facility including severity of the illness and household wealth/socio-demographic indicators. To complement the data on costs from community interviews, a hospital-based study obtained details of private expenditures for hospitalised children under the age of 5. Results Severe febrile illness is strongly associated with health facility attendance (OR: 35.76, 95%CI: 3.68-347.43, p = 0.002 compared with less severe febrile illness). Overall, the private costs of an illness for patients who went to a hospital were six times larger than private costs of controls ($5.68 vs.$0.90, p&lt;0.0001). Household wealth was not significantly correlated with total costs incurred. The separate hospital based cost study indicated that private costs were three times greater for admissions at the mission versus public hospital: $13.68 mission vs.$4.47 public hospital (difference $ 9.21 (95% CI: 7.89 -10.52), p&lt;0.0001). In both locations, approximately 50% of the cost was determined by the duration of admission, with each day in hospital increasing private costs by about 12% (95% CI: 5% - 21%). Conclusion The more severely ill a child, the higher the probability of attending hospital. We did not find association between household wealth and attending a health facility; nor was there an association between household wealth and private cost

Community interviews—Cases and Controls (A); Hospital interviews (B).

<p>Community interviews—Cases and Controls (A); Hospital interviews (B).</p

Household Wealth Index for the community participants.

<p>*Estimated using information on household possessions (table, radio, lantern, bicycle and iron) and food problems.</p><p>Household Wealth Index for the community participants.</p

Mean private hospital costs (US Dollar) and duration of admission by location and illness severity for participants interviewed at hospital.

<p>* Includes registration and consultation costs, bed costs, food costs and other costs such as soap, toilet paper, etc.</p><p>† Transport cost included only for the guardian.</p><p>≠ Missing for 1 participant</p><p>Trend p-value for total private costs by episode severity in Kilosa: p = 0.93.</p><p>Trend p-value for total private costs by episode severity in Turiani: p = 0.79.</p><p>Mean private hospital costs (US Dollar) and duration of admission by location and illness severity for participants interviewed at hospital.</p

Mean private costs (US Dollar) for a whole episode of an acute febrile illness by case-control status and location.

<p>* Includes registration and consultation costs, bed costs, food costs and other costs such as soap, toilet paper, etc.</p><p>† Transport cost included only for the guardian.</p><p>ǂ Excludes 17 participants (16 Cases and 1 Control in Turiani) unable to provide detailed costs by cost category; their costs are included in Total costs.</p><p>Cases Turiani vs. Cases Kilosa: p<0.0001 for difference in private cost.</p><p>Controls Turiani vs. Controls Kilosa: p = 0.0352 for difference in private cost.</p><p>Mean private costs (US Dollar) for a whole episode of an acute febrile illness by case-control status and location.</p