Health seeking behaviour and the related household out-of-pocket expenditure for chronic non-communicable diseases in rural Malawi

Abstract

Malawi is facing a rising chronic non-communicable disease (CNCD) epidemic. This study explored health seeking behaviour and related expenditure on CNCDs in rural Malawi, with specific focus on detecting potential differences across population groups. We used data from the first round of a panel household health survey conducted in rural Malawi between August and October 2012 on a sample of 1199 households. Multinomial logistic regression was used to analyse factors associated with health seeking choices for CNCDs, distinguishing between no care, informal care and formal care. Descriptive statistics (mean, standard deviation and median) were used to describe related household out-of-pocket expenditure. There were 475 individuals (equivalent to 8.4% of all respondents) reporting at least one CNCD. Among them, 37.3% did not seek any care, 42.5% sought formal care (facility-based care), and 20.2% opted for informal care (traditional or home treatment). Regression analysis showed that illness severity and duration, socio-economic status, being a household head, and the proportion of household members living with a CNCD were significantly associated with health care utilization. Among those seeking care, 65.8% incurred out-of-pocket expenditure with an average of USD 1.49 spent on medical treatment and an additional USD 0.50 spent on transport. Further qualitative inquiry is needed to understand the reasons for low service utilization and to explore the potential role of supply-side factors. To increase access to care for people suffering from CNCDs, the provision of a free Essential Health Package in Malawi ought to be strengthened through the integration of system-wide screening, risk factor modification and continuity of care options for people suffering from CNCDs. This would ensure affordable services to modulate health seeking behaviour of patients at risk of major chronic illnesses.

Poverty-related diseases (PRDs): unravelling complexities in disease responses in Cameroon

“…Even when the costs of hospital consultation, laboratory examination and buying medication from hospitals can be covered, the decision to do so can be postponed, depending on other factors, most prominently the perceived severity of the disease. Other studies have reported a similar strategic use of available resources [47–51]. Perceived severity is an obvious incentive for hospital-based action [22].…”

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“…Since healthcare expenditures were non‐normally distributed, 5% trimmed means (arithmetic mean after eliminating 5% each of the smallest and largest cases) were used. This leads to an inevitable but negligible reduction in the sample size (Osborn, ; Wang et al, ). Mann–Whitney test was used as a test of significance.…”

The economic burden of chronic non-communicable diseases in rural Malawi: an observational study

“…In 2010, the government expanded the EHP to also include health interventions targeting the most common CNCDs, such as screening, prevention, and treatment of cardiovascular diseases, diabetes, and certain cancers (breast cancer, cervical cancer) [21]. As shown in our previous work, however, health service utilization by people suffering from any of these CNCDs remains rather poor [23]. …”

“…In addition, there are 6 private for-profit facilities. Details of the sampling procedures for the panel household survey have been described elsewhere [23]. In brief, given that the ultimate purpose of the panel was to evaluate the impact of a micro-health insurance scheme to be launched by the local Savings and Credit Cooperative (SACCO), the panel included both households where at least one person was a SACCO member ( n = 691) and households where no person was a SACCO member ( n = 525).…”