Exploring Household Economic Impacts of Childhood Diarrheal Illnesses in 3 African Settings

Department of Environmental and Global Health, University of Florida, Gainesville.
Clinical Infectious Diseases (Impact Factor: 8.89). 12/2012; 55 Suppl 4(Suppl 4):S317-26. DOI: 10.1093/cid/cis763
Source: PubMed


Beyond the morbidity and mortality burden of childhood diarrhea in sub-Saharan African are significant economic costs to affected households. Using survey data from 3 of the 4 sites in sub-Saharan Africa (Gambia, Kenya, Mali) participating in the Global Enteric Multicenter Study (GEMS), we estimated the direct medical, direct nonmedical, and indirect (productivity losses) costs borne by households due to diarrhea in young children. Mean cost per episode was $2.63 in Gambia, $6.24 in Kenya, and $4.11 in Mali. Direct medical costs accounted for less than half of these costs. Mean costs understate the distribution of costs, with 10% of cases exceeding $6.50, $11.05, and $13.84 in Gambia, Kenya, and Mali. In all countries there was a trend toward lower costs among poorer households and in 2 of the countries for diarrheal illness affecting girls. For poor children and girls, this may reflect reduced household investment in care, which may result in increased risks of mortality.

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Available from: Richard D Rheingans, Oct 07, 2015
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    • "These high levels of disease burden can also be translated into economic costs, which affect healthcare systems and also represent a relevant household economic burden, which is of special relevance in developing areas in which access to inexpensive treatments is difficult (Patil et al., 2002; Rheingans et al., 2012). These costs are also reflected in social inequities, with a trend towards lower expenditure related to diarrhoea in poorer households, which in some countries may often more frequently affect girls, and subsequently result in an increased risk of death (Rheingans et al., 2012). "
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    ABSTRACT: The objective of the study was to describe the etiology, epidemiology, and clinical characteristics of the principal causes of acute infectious diarrhea requiring hospitalization among children under 5 years of age in Rabat, Morocco. A prospective study was conducted from March 2011 to March 2012, designed to describe the main pathogens causing diarrhea in hospitalized children >2 months and less than 5 years of age. Among the 122 children included in the study, Enteroaggregative E. coli (EAEC) and rotavirus were the main etiologic causes of diarrhea detected. Twelve (9.8%) children were referred to the intensive care unit, while 2, presenting infection by EAEC and EAEC plus a Shigella sonnei respectively, developed a hemolytic uremic syndrome. Additionally, 6 (4.9%) deaths occurred with EAEC being isolated in four of these cases. Diarrheogenic E. coli and rotavirus play a significant role as the two main causes of severe diarrhea while other pathogens such as norovirus or parasites seem to have a minimal contribution. Surveillance and prevention programs to facilitate early recognition and improved management of potentially life-threatening diarrhea-episodes are needed. Copyright © 2014, the Society for General Microbiology.
    Journal of Medical Microbiology 01/2015; 64(Pt1):84-92. DOI:10.1099/jmm.0.079830-0 · 2.25 Impact Factor
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    • "The present study in combination with our related study on household costs for diarrhea treatment in African settings provides helps identify similarities and differences among countries and regions [26]. Across the 6 countries, mean total household costs fell within a fairly wide range, from $1.82 in Bangladesh to $6.47 in Pakistan. "
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    ABSTRACT: In addition to being a major cause of mortality in South Asia, childhood diarrhea creates economic burden for affected households. We used survey data from sites in Bangladesh, India, and Pakistan to estimate the costs borne by households due to childhood diarrhea, including direct medical costs, direct nonmedical costs, and productivity losses. Mean cost per episode was $1.82 in Bangladesh, $3.33 in India, and $6.47 in Pakistan. The majority of costs for households were associated with direct medical costs from treatment. Mean costs understate the distribution of costs, with 10% of cases exceeding $6.61, $8.07, and $10.11 in Bangladesh, India, and Pakistan, respectively. In all countries there was a trend toward lower costs among poorer households and in India and Pakistan there were lower costs for episodes among girls. For both poor children and girls this may reflect rationing of care, which may result in increased risks of mortality.
    Clinical Infectious Diseases 12/2012; 55 Suppl 4(Suppl 4):S327-35. DOI:10.1093/cid/cis764 · 8.89 Impact Factor
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    ABSTRACT: We performed serial healthcare use surveys among caretakers of children ages 0-59 months randomly selected from demographically defined populations participating in the Global Enteric Multicenter Study (GEMS), a case control study of moderate-to-severe diarrhea (MSD) in seven developing countries. The surveys aimed to estimate the proportion of children with MSD who would present to sentinel health centers (SHCs) where GEMS case recruitment would occur and provide a basis for adjusting disease incidence rates to include cases not seen at the SHCs. The proportion of children at each site reported to have had an incident episode of MSD during the 7 days preceding the survey ranged from 0.7% to 4.4% for infants (0-11 months of age), from 0.4% to 4.7% for toddlers (12-23 months of age), and from 0.3% to 2.4% for preschoolers (24-59 months of age). The proportion of MSD episodes at each site taken to an SHC within 7 days of diarrhea onset was 15-56%, 17-64%, and 7-33% in the three age strata, respectively. High cost of care and insufficient knowledge about danger signs were associated with lack of any care-seeking behavior outside the home. Most children were not offered recommended fluids and continuing feeds at home. We have shown the utility of serial healthcare use surveys as an invaluable tool for optimizing operational and methodological issues related to the performance of a large case control study and deriving population-based incidence rates of MSD. Moreover, the surveys suggest key targets for educational interventions that might improve the outcome of diarrheal diseases in low-resource settings.
    The American journal of tropical medicine and hygiene 04/2013; 89((Suppl 1)). DOI:10.4269/ajtmh.12-0749 · 2.70 Impact Factor
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