Preterm birth incidence has risen globally and remains a major cause of neonatal mortality despite improved survival. Demand and cost of initial hospitalization has also increased. This study assessed the cost of preterm birth during initial hospitalization from care provider perspective in neonatal intensive care units (NICU) of two hospitals in the state of Kedah, Malaysia. It utilized universal sampling and prospectively followed up preterm infants till discharge. Care provider cost was assessed using mixed method of top down approach and activity based costing. A total of 112 preterm infants were recruited from intensive care (93 infants) and minimal care (19 infants) units. Majority were from the moderate (23%) and late (36%) preterm groups followed by very preterm (32%) and extreme preterm (9%). Median cost per infant increased with level of care and degree of prematurity. Cost was dominated by overhead (fixed) costs for general (hospital), intermediate (clinical support services) and final (NICU) cost centers where it constituted at least three quarters of admission cost per infant while the remainder was consumables (variable) cost. Breakdown of overhead cost showed NICU specific overhead contributing at least two thirds of admission cost per infant. Personnel salary made up three quarters of NICU specific overhead. Laboratory investigation was the cost driver for consumables. Gender, birth weight and length of stay were significant factors and cost prediction was developed with these variables. This study demonstrated the inverse relation between resource utilization, cost and prematurity and identified personnel salary as the cost driver. Cost estimates and prediction provide in-depth understanding of provider cost and are applicable for further economic evaluations. Since gender is non-modifiable and reducing LOS alone is not effective, birth weight as a cost predictive factor in this study can be addressed through measures to prevent or delay preterm birth.
14Preterm birth incidence has risen globally and remains a major cause of neonatal mortality despite 15 improved survival. The demand and cost of initial hospitalization has also increased. This study 16 assessed care provider cost in neonatal intensive care units of two hospitals in the state of Kedah, 17 Malaysia. It utilized universal sampling and prospectively followed up preterm infants till discharge. 18 Care provider cost was assessed using mixed method of top down approach and activity based 19 costing. A total of 112 preterm infants were recruited from intensive care (93 infants) and minimal 20 care (19 infants). Majority were from the moderate (23%) and late (36%) preterm groups followed 21 by very preterm (32%) and extreme preterm (9%). Mean total cost per infant increased with level of 22 care and degree of prematurity from MYR 2,751 (MYR 374 -MYR 10,103) for preterm minimal care, 23 MYR 8,478 (MYR 817 -MYR 47,354) for late preterm intensive care to MYR 41,598 (MYR 25,351-24 MYR 58,828) for extreme preterm intensive care. Mean cost per infant per day increased from MYR 25 401 (MYR 363-MYR 534), MYR 444 (MYR 354 -MYR 916) to MYR 532 (MYR 443-MYR 939) 26 respectively. Cost was dominated by overhead (fixed) costs for general (hospital), intermediate 27 (clinical support services) and final (NICU) cost centers where it constituted at least three quarters of 157 MYR 2,518 (MYR 362-MYR 9,406) in minimal care to MYR 31,527 (MYR 12,710-MYR 47,268) in 158 extreme preterm intensive care. Breakdown of overhead cost revealed NICU specific overhead as 159 the overwhelming contributor in all categories (69% -89%). Mean total consumables cost per infant 160 ranged from MYR 232 (MYR 12-MYR 697) in minimal care to MYR 10,071 (MYR 7,428-MYR 13,441) 161 in extreme preterm intensive care.
Introduction Outreach program is one of the strategies to reach the underserved population besides investigating the barriers to the first dose of the COVID-19 vaccine. There is scarce information on the outcome of the COVID-19 outreach program and the reasons for missing the first dose COVID-19 vaccine among adult residents stayed in the rural Sik district. The study aimed to describe the Sik District outreach program's outcome in terms of the proportion of residents being successfully vaccinated and the reasons for missing the first dose COVID-19 vaccine at the public vaccination center. This study also determined the factor associated with structural barriers among residents who missed the first dose of the COVID-19 vaccine in the Sik District. Material and Methods This was a retrospective study on the secondary data and the data analysis was conducted between June to August 2022. The Sik District outreach program was held between October 2021 to January 2022 after a line listing of residents who missed the first dose COVID-19 vaccine was compiled. Descriptive, bivariate and logistic regression were utilized in analyzing the data. Ethical approval was obtained from the relevant authorities before conducting the study. Results A total of 486 out of 553 residents were vaccinated through this outreach program, yielding 87.6% of success rate. Most of the residents were noted to have transportation problems (52.6%), followed by vaccine hesitancy (19.8%), vaccine refusal (13.2%), and afraid of needles (8.5%). Only ten residents were successfully vaccinated out of the total 73 residents who were categorized as vaccine refusal following on-site counseling. The proportion of attitude-related barriers was 45.4%, while structural-related was 54.6%. The associated factors for structural barriers in this outreach program were being bed-bound residents, being non-citizen residents, staying away from the health care facilities, and being older age. Conclusion This outreach program increases the vaccination coverage rate despite the barriers to the underserved population. The outreach team may have no problem handling the residents with structural barriers, however, dedicated and trained staff are needed for the residents with attitudinal barriers.
13Preterm birth incidence has risen globally and the high cost of initial hospitalization poses financial 14 burden to the family. This study assessed family cost at neonatal intensive care units of two hospitals 15 in the state of Kedah, Malaysia. Family's expenditure was obtained using a structured questionnaire. 16 126 families who were government employed spent a mean total cost of MYR 549 (MYR 0 -MYR 17 4,700) compared to MYR 650 (MYR 40 -MYR 9,300) for 244 families who were not government 18 employed. Mean income loss was MYR 310 (MYR 0 -MYR 15,000) and MYR 348 (MYR 0 -MYR 19 5,500) respectively. Travel expenses was the cost driver for all families. 15% of families in this study 20 were already living below the income poverty line and majority were not government employed. For 21 the rest of the families, 21% became impoverished when one month household income was used for 22 hospitalization cost but this lowered to 9% with cumulative household income by length of hospital 23 stay. Overall incidence of catastrophic health expenditure among families was 38%. Using 24 multivariable logistic regression household income and residential location were predictive factors 25 for catastrophic health expenditure. Despite universal health coverage through subsidy of direct 26 medical (hospital) cost, the high incidence of catastrophic health expenditure and impoverishment 27 among families of preterm infants was attributable to out of pocket payment for direct non-medical 2 28 cost (such as travel and food) and indirect cost from income loss. Government employed families 29 with an array of employment benefits appear better protected against financial hardship compared 30 to those in private sector or self-employed. Remedial measures include improving neonatal intensive 31 care unit rooming-in service for mothers, complementary financial assistance for families and 32 enhancing universal health coverage through affordable social health insurance for infant 33 healthcare. 34
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