Out-of-pocket cost of managing sick newborns in Enugu, southeast Nigeria

Abstract

BackgroundNeonatal illnesses usually require long hospital stays and specialized care and/or facilities, which usually results in huge medical bills. With more than 70% of people in Nigeria living on less than US$2 per day, these bills are not affordable to many families’ livelihoods.AimThis study aims to determine the average cost of managing neonatal illnesses in Enugu in southeast Nigeria and the proportion of family income spent on these illnesses. It further seeks to ascertain the cost of various components in the management of neonatal diseases.MethodsThis is a longitudinal and descriptive study involving 106 newborns admitted to the sick baby unit of the Enugu State University Teaching Hospital and the out-of-pocket medical expenditure in the management of their illnesses.ResultsA hundred and six newborns participated in the study. All (100%) medical bills were out-of-pocket payments, and 103 (97.2%) of these were catastrophic health expenditure (more than 10% of total family monthly income). The average duration of hospital stay and cost of managing a neonatal illness was 12.86±8.81 days and ₦36,382±19,389.72 (US$223±119), respectively. This expenditure amounted to 157%, 71%, and 25% of total monthly family income for the low, middle, and upper socioeconomic class families, respectively, with a mean percentage of 85%. Families with a total monthly income of less than ₦10,000 (US$61), ₦10,000–49,999 (US$61–306), and ₦50,000–100,000 (US$306–612) and more than ₦100,000 (US$612) on average spent 683%, 108%, 54%, and 20% of their monthly income on their newborn’s illness. Hospital and utility bills compared with bills accruing from drug and laboratory investigations account for a significantly larger proportion of total cost incurred in neonatal sepsis (₦23,499±14,987 [US$144±92], P=0.001), low birth weight (₦39,863±24,003 [US$224±147], P=0.001), severe anemia (₦40,504±13,923 [US$248±85], P=0.001), transient tachypnea of the newborn (₦10,083±1,078 [US$62±7], P=0.001), birth asphyxia (₦24,398±14,096 [US$149±86], P=0.001), and meningitis (₦26,731±7,675 [US$164±47], P=0.001), whereas cost for laboratory investigations was significantly higher for neonatal jaundice (₦11,690±3,169 [US$72±19], P=0.001). There was a strong positive correlation between duration of hospital stay and total medical cost incurred (r=0.897, P=0.001).ConclusionHealth expenditure on neonatal illness is high and leads to catastrophic expenditure for the majority of households in the state. There is a need for effective health insurance schemes to help subsidize and cushion this disastrous and impoverishing health expenditure on families for improved neonatal survival in Nigeria.

The financial burden of sickle cell disease on households in Ekiti, Southwest Nigeria

“…Catastrophic expenditure estimation requires measuring the extent to which health expenditure exceeds different thresholds of household income or consumption expenditure. 7 , 8 , 16 Studies have put the threshold for CHE at values exceeding 10% of the total household income or 40% of the household nonfood income. 7 , 8 , 16 In this study, we used the former (health expenditure >10% of total household income) to adjudge whether or not a household was involved in CHE while caring for their wards with SCD.…”

“… 7 , 8 , 16 Studies have put the threshold for CHE at values exceeding 10% of the total household income or 40% of the household nonfood income. 7 , 8 , 16 In this study, we used the former (health expenditure >10% of total household income) to adjudge whether or not a household was involved in CHE while caring for their wards with SCD. Thus, percentage of the total household income spent as health expenditure on each child ( T HE/FI ) was calculated using the following equation.…”

“… 8 In Nigeria, OOPS for health care is the commonest form of health care financing, and it accounts for between 70% and 95% of the total monies spent on health care. 6 , 7 , 10 – 13 This method of health care financing does not offer any financial risk protection and may lead to financial catastrophe for households. 8 , 14 , 15 Catastrophic health expenditure (CHE) represents the situation in which an individual or household spending on maintaining health compromises other basic needs, and/or incurs debts, sells assets, and becomes impoverished.…”

“… 8 , 14 – 17 The widely held consensus regarding the cut-off to describe CHE is spending >10% of total household income or >40% of nonfood income to maintain health. 7 , 16 …”

“…Although some studies on household health expenditures exist in Nigeria, 6 , 7 , 10 – 12 only a few were on SCD 6 despite its chronic nature and high prevalence in the country. 3 Examining the financial burden of SCD on households will help to guide policy makers define appropriate strategies to offset the burden and guide health care providers in their choice of cost-effective measures in taking care of children with the disease condition.…”