Out-of-Pocket expenditures associated with Congenital Zika Syndrome in Brazil: an analysis of household health spending

Abstract

Introduction: The study aims to estimate out-of-pocket household expenditures associated with the diagnosis and follow-up treatment of Congenital Zika Syndrome (CZS) in children affected during the 2015-2016 epidemic in Brazil. Methods: Ninety-six interviews were held in the cities of Fortaleza and Rio de Janeiro in a convenience sample, using a questionnaire on sociodemographic characteristics and private household expenditures associated with the syndrome, which also allowed estimating catastrophic expenditures resulting from care for CZS. Results: Most of the mothers interviewed in the study were brown, under 34 years of age, unemployed, and reported a monthly family income of two minimum wages or less. Spending on medicines accounted for 77.6% of the out-of-pocket medical expenditures, while transportation and food were the main components of nonmedical expenditures, accounting for 79% of this total. The mean annual out-of-pocket expenditures by households was equivalent to almost a quarter of the annual minimum wage. Conclusions: The affected households were largely low-income and suffered catastrophic expenditures due to the disease. Public policies should consider the financial and healthcare needs of these families to ensure adequate support for individuals affected by CZS.

Democratizing Public Health: Participatory Policymaking Institutions, Mosquito Control, and Zika in the Americas

“…Further, collaboration across government and civil society may also help to increase local capacity to combat disease and deliver health services through community-based human capital [ 23 , 24 , 25 ]. Implementing multifaceted strategies to combat complex diseases, such as Zika, requires attention to social, economic, and political issues that go far beyond laboratory-based, purely medical conceptualizations of public health [ 21 , 22 , 29 ]. Empowering citizens and civil society through local participatory institutions can use robust local democracy to combat disease and promote better public health performance.…”

“…Specifically, municipal environmental sanitation councils and mosquito control teams are both associated with low rates of municipal Zika transmission. Our models of Zika transmission control for local healthcare spending and economic conditions, among other factors, that also likely influenced Zika contraction rates [ 21 , 22 ]. The result is stronger models of Aedes aegypti mosquito abatement and public health programs that can inform government responses to Zika across Brazil and throughout the Global South.…”