Cost of illness for severe and non-severe diarrhea borne by households in a low-income urban community of Bangladesh: A cross-sectional study.

Rebeca Sultana,Emily S Gurley,Jahangir A M Khan,Peter Kjær Mackie Jensen,Shifat Khan,Humayun Kabir,Nadia Ali Rimi,Sayeda Tasnuva Swarna,Stephen P Luby,Nazmun Nahar,Sushil Ranjan Howlader,Probir Kumar Ghosh,Deborah Mcfarland

doi:10.1371/journal.pntd.0009439

Abstract

The illness cost borne by households, known as out-of-pocket expenditure, was 74% of the total health expenditure in Bangladesh in 2017. Calculating economic burden of diarrhea of low-income urban community is important to identify potential cost savings strategies and prioritize policy decision to improve the quality of life of this population. This study aimed to estimate cost of illness and monthly percent expenditure borne by households due diarrhea in a low-income urban settlement of Dhaka, Bangladesh. We conducted this study in East Arichpur area of Tongi township in Dhaka, Bangladesh from September 17, 2015 to July 26, 2016. We used the World Health Organization (WHO) definition of three or more loose stool in 24 hours to enroll patients and enrolled 106 severe patients and 158 non-severe patients from Tongi General Hospital, local pharmacy and study community. The team enrolled patients between the first to third day of the illness (≤ 72 hours) and continued daily follow-up by phone until recovery. We considered direct and indirect costs to calculate cost-per-episode. We applied the published incidence rate to estimate the annual cost of diarrhea. The estimated average cost of illness for patient with severe diarrhea was US$ 27.39 [95% CI: 24.55, 30.23] (2,147 BDT), 17% of the average monthly income of the households. The average cost of illness for patient with non-severe diarrhea was US$ 6.36 [95% CI: 5.19, 7.55] (499 BDT), 4% of the average monthly income of households. A single diarrheal episode substantially affects financial condition of low-income urban community residents: a severe episode can cost almost equivalent to 4.35 days (17%) and a non-severe episode can cost almost equivalent to 1 day (4%) of household’s income. Preventing diarrhea preserves health and supports financial livelihoods.

Highlights

Diarrhea presents a substantial health burden globally
Most of the studies in Bangladesh that estimated the cost of diarrheal illness collected data from hospital patients and mostly targeted under-five children
Information on economic burden of diarrhea borne by households of low-income urban communities who commonly had 2 US$ dollar income per capita per day still remained unknown

Summary

Introduction

In Bangladesh in 2016 the estimated DALY due to diarrhea was 1.4 million (1,391,000) [3] and the mortality attributed to exposure to unsafe water and sanitation service was 12 deaths per 100,000 population [4]. Sixty-five to ninety-five percent of all diarrhea episodes in low-income areas are mild and moderate cases [9]. These mild and moderate cases are missed in the prevalence and cost estimates due to scarcity of community based diarrheal disease burden studies, as diarrhea prevalence studies are mainly focused on child diarrhea [10,11]. The low-income urban communities endure a high burden of diarrhea, which has an important economic impact on the household’s economy and on the community

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Discussion

Conclusion