Economic burden of acute gastroenteritis and associated cost variability in patients attending health facilities in Busia County, Kenya

Abstract

Background: Infectious diarrhoea was the third leading cause of death in Kenya across all age groups in 2019 and a leading cause of hospitalisation in Busia County. More than 70% of acute gastroenteritis cases result from contaminated food & water. Busia County had low sanitation coverage with estimated open defecation rate of 74% in rural areas. The approximated economic burden in Kenya in 2009 due to a single cause of infectious diarrhoea was US$10.9 million. Missing paid employment due to illness in low income communities can have negative economic impacts. Objectives: The study aimed to estimate the total cost of acute gastroenteritis from a household perspective for patients attending health facilities in Busia County and assess factors influencing the cost as a pre-requisite for understanding the economic burden of acute gastroenteritis at county level. Methods: A cross sectional cost-of-illness study was conducted among gastroenteritis patients in Busia County between September & October 2020. Patients were sampled from facilities proportionate to number of diarrheal cases in the previous year. Interviews were conducted using structured questionnaires. Data on demographic, socio-economic, clinical & costs incurred were collected. We calculated median and interquartile range for direct medical costs (e.g. medications, diagnostics), non-medical direct costs (e.g. transport, food) and indirect costs (e.g. lost income). Linear regression was applied to identify factors associated with variation in cost of illness and p-value of less than 0.05 and 95% confidence interval were considered significant. Results: We enrolled 249 acute gastroenteritis patients; Median age was 8 years (IQR) 2–21), 143(57.4%) were female, 134(54%) visited public facilities, 241 (99.2%) had diarrhoea and 104 (46.2%) had medical insurance. The average duration of illness was 3.3 days (SD 1.2). The average total cost for patients visiting Public health care facilities was KES 1374.62; SD 502.21 (US$12.5), Private KES 1461.11; SD 637.35 (US$13.28) and Faith-based KES 1506.06; SD 477.45 (US$13.69). The average total cost of seeking care for acute gastroenteritis patients in Busia was KES 1,497.8; SD 578.5 (US$13.6). Self-medication significantly influenced total cost, p=0.0001. Total cost was 27% higher for those with prior treatment compared to those without. Having insurance also significantly influenced the total cost, p=0.02. Total cost was 15% higher for those paying cash compared to those with medical insurance. Conclusion: The cost of seeking health care for an episode of acute gastroenteritis was high relative to household incomes. This study observed low utilization of medical insurance especially in public health care facilities. Lost wages due to illness represented a substantial proportion of the costs due to acute gastroenteritis. Recommendation: To reduce out of pocket costs to their residents, the county government should promote enrollment in the publically available insurance coverage that is offered by the state through the national hospital insurance fund (NHIF). With high number of acute gastroenteritis cases in the country, the economic burden on citizens becomes considerable indicating the need to strengthen existing strategies for prevention & control