Out of Pocket Expenditure among Animal Bite Patients Attending a Tertiary Care Hospital for Treatment in Rajasthan

Abstract

Introduction: Rabies is an infectious viral disease that is almost always fatal. It is present on all continents, except Antarctica, with over 95% of human deaths occurring in the Asia and Africa regions. Treating a rabies exposure, where the average cost of rabies post-exposure prophylaxis (PEP) is US$ 40 in Africa, and US$ 49 in Asia, can be a catastrophic financial burden on affected families whose average daily income is around US$ 1-2 per person. Study was conducted with the objectives to analyse the direct and indirect out of pocket expenditure of the post exposure prophylaxis of animal bites in spite of free supply of anti-rabies vaccine and immunoglobulin. Material and methods: A cross sectional observational study was carried out at Anti Rabies Clinic, SMS Hospital Jaipur, Rajasthan from October 2018 to March 2019 to know out of pocket expenditure of animal bite patients and its determinants. Prior approval from institutional ethics committee and informed consent were taken and a pre-designed, pre-tested proforma was filled from the persons attending anti rabies clinic on last visit of post-exposure prophylaxis (PEP). Apart from socio-demographic details, information about direct or indirect out of pocket expenditure due to animal bite was recorded and analysis was done using chi square test, ANOVA test, 't'-test and univariate and multivariate regression. Results: Total out of pocket expenditure by 81 studied patients was Rs. 53201.00, out of which 91.69% i.e. Rs. 48780.00 were indirect expenses and 5.04% i.e. Rs. 2681.00 was expenditure on medical and surgical management including registration and consumables. Only 3.27% i.e. Rs. 1740.00 was on post exposure anti-rabies prophylaxis of 81 patients. Mean out of pocket expenditure was Rs. 656.80±1387.76 ranging from Rs. 0.00 to Rs. 8550.00 per patient with median of Rs. 290.00. Conclusion: Despite free supply of anti-rabies vaccine and anti-rabies serum under Mukhyamantri Nishulk Dava Yojna (MNDY) the indirect out of pocket expenditure in animal bite treatment is still high, which should draw attention for policy makers.