Cost of care for preterm babies to Clients and influence of costs on care in resource limited settings - Societal perspective: A case of Jinja Regional Referral Hospital in East central Uganda

Introduction: The costs of care for preterm birth to clients and the influence of costs on preterm care remain a significant issue to the health system and families globally especially in the low-middle income countries particularly, in Asia and sub-Saharan Africa with already constrained economies. However, this has not received worthwhile attention. We estimated the costs of care for preterm babies to families (clients) and the influence of costs on the care for preterm babies from a societal perspective in Jinja Regional Referral Hospital. Methods: This was a one-month survey from August 2016 — September 2016 through which we had exit interviews with 100 mothers to determine the costs on admission and followed up 82 mothers to determine follow up costs of all babies that were born preterm and weighed less than 2.5 kg either at discharge or follow up. A micro costing approach was used to compute client costs for preterm care. Mothers were asked to identify absolute costs incurred. We also reviewed medical records of patients and receipts that were available from clients. A likert scale was used to assess influence of costs on preterm care to mothers. This ranged from -5 to 5, where (+5 to +1) was high influence, (0) was neutral, (-5 to -1) was low influence. Respondents were also asked to give reasons for their answers. From the provider perspective, we conducted key informant interviews with health care workers to ascertain the influence of costs on preterm care from the provider perspective. Analysis of findings was done using the Microsoft excel sheet. Statistical analysis was done using Stata Version 13 to determine the influence of costs on the care of preterm babies from the client's perspective. Thematic analysis was used to analyze the influence of costs on care from the provider perspective. Costs were converted to US$for the annual exchange average rate of 2016. One-way sensitivity analysis was done to establish the impact of cost drivers on the total cost. Results: The total annual cost of preterm care from the client perspective was US$ 10,520.36 and the unit cost of care per preterm baby was US$ 105.2 at Jinja Regional Referral Hospital. Cost drivers included opportunity costs (i.e., potential benefits foregone by clients to take care of preterm babies), drug costs on follow up, supplies and feeding costs to the mothers/caregivers during admission. Drugs, supplies thermal care and feeding costs during admission were found to have a high influence on preterm care from a societal perspective. Conclusion: The cost of preterm care is high from the client perspective and is characterized by longer stay in hospital because of missed treatment due to stock outs and affordability constraints to clients, but also discharge against medical advice leading to poor survival of preterm babies. Improving funding for preterm care and welfare for caregivers during hospitalization may lead to better outcomes for preterm babies

Cost of care for preterm babies in Jinja Regional Referral Hospital, East-central Uganda: A provider perspective

Introduction: Preterm birth and its complications are a major global health burden and significantly contribute to the under-five mortality in Uganda. This study aimed at identifying the morbidities suffered by preterm babies and the cost of preterm care to the provider in Jinja Referral Hospital. Methods: This was a one-year cost analysis of preterm care from August 2015 – July 2016. The study took on a micro-costing approach, through which medical and accounting records, were reviewed for 507 preterm babies that were seen over the year to determine morbidities of preterm infants and costs from the provider perspective. Analysis of findings was done using a Microsoft excel sheet. Costs were converted to US$for the annual exchange average rate of 2016. One-way sensitivity analysis was done to establish the impact of cost drivers on the total cost. Results: We found that the most prevalent morbidities among preterm babies were; neonatal hyperbilirubinemia, respiratory distress and neonatal septicaemia. The total annual cost of preterm care from the provider perspective was US$ 54,108 and the unit cost of care per preterm baby was US$ 107 at Jinja Regional Referral Hospital. Cost drivers included; equipment, personnel and utility costs (water and electricity). Conclusion: The cost of preterm care is high and sub-optimal from a provider perspective. It is characterized by stockouts of drugs and supplies which are critical in the care that is required to boost the survival of preterm babies. Improving funding for preterm care may be helpful in enhancing preterm survival

Consequences of school closures due to COVID-19 in DRC, Nigeria, Senegal, and Uganda.

In 2020 and 2021, Governments across the globe instituted school closures to reduce social interaction and interrupt COVID-19 transmission. We examined the consequences of school closures due to COVID-19 across four sub-Saharan African countries: the Democratic Republic of Congo (DRC), Nigeria, Senegal, and Uganda. We conducted a qualitative study among key informants including policymakers, school heads, students, parents, civil society representatives, and local leaders. The assessment of the consequences of school closures was informed by the Diffusion of Innovations theory which informed the interview guide and analysis. Interview transcripts were thematically analysed. Across the four countries, schools were totally closed for 120 weeks and partially closed for 48 weeks. School closures led to: i) Desirable and anticipated consequences: enhanced adoption of online platforms and mass media for learning and increased involvement of parents in their children's education. ii) Desirable and unanticipated consequences: improvement in information, communication, and technology (ICT) infrastructure in schools, development and improvement of computer skills, and created an opportunity to take leave from hectic schedules. iii) Undesirable anticipated consequences: inadequate education continuity among students, an adjustment in academic schedules and programmes, and disrupted student progress and grades. iv) Undesirable unanticipated: increase in sexual violence including engaging in transactional sex, a rise in teenage pregnancy, and school dropouts, demotivation of teachers due to reduced incomes, and reduced school revenues. v) Neutral consequences: engagement in revenue-generating activities, increased access to phones and computers among learners, and promoted less structured learning. The consequences of school closures for COVID-19 control were largely negative with the potential for both short-term and far-reaching longer-term consequences. In future pandemics, careful consideration of the type and duration of education closure measures and examination of their potential consequences in the short and long term is important before deploying them