Cost to households in treating maternal complications in northern Ghana: a cross sectional study.

Maxwell Ayindenaba Dalaba,Svetla Loukanova,Raymond Akawire Aborigo,Gifty Apiung Aninanya,John Williams,Happiness Pius Saronga,Rainer Sauerborn,Patricia Akweongo

doi:10.1186/s12913-014-0659-1

Abstract

BackgroundThe cost of treating maternal complications has serious economic consequences to households and can hinder the utilization of maternal health care services at the health facilities. This study estimated the cost of maternal complications to women and their households in the Kassena-Nankana district of northern Ghana.MethodsWe carried out a cross-sectional study between February and April 2014 in the Kassena-Nankana district. Out of a total of 296 women who were referred to the hospital for maternal complications from the health centre level, sixty of them were involved in the study. Socio-demographic data of respondents as well as direct and indirect costs involved in the management of the complications at the hospital were collected from the patient’s perspective. Analysis was performed using STATA 11.ResultsOut of the 60 respondents, 60% (36) of them suffered complications due to prolonged labour, 17% (10) due to severe abdominal pain, 10% (6) due to anaemia/malaria and 7% (4) due to pre-eclampsia. Most of the women who had complications were primiparous and were between 21–25 years old. Transportation cost accounted for the largest cost, representing 32% of total cost of treatment. The median direct medical cost was US$8.68 per treatment, representing 44% of the total cost of treatment. Indirect costs accounted for the largest proportion of total cost (79%). Overall, the median expenditure by households on both direct and indirect costs per complication was US$32.03. Disaggregating costs by type of complication, costs ranged from a median of US$58.33 for pre-eclampsia to US$6.84 for haemorrrhage. The median number of days spent in the hospital was 2 days - five days for pre-eclampsia. About 33% (6) of households spent more than 5% of annual household expenditure and therefore faced catastrophic payments.ConclusionAlthough maternal health services are free in Ghana, women still incur substantial costs when complications occur and face the risk of incurring catastrophic health expenditure.

Highlights

The cost of treating maternal complications has serious economic consequences to households and can hinder the utilization of maternal health care services at the health facilities
Study site The study was conducted in the Kassena-Nankana Districts (East and West) located in northern Ghana
Indirect costs accounted for the largest proportion of total cost (79%)

Summary

Introduction

The cost of treating maternal complications has serious economic consequences to households and can hinder the utilization of maternal health care services at the health facilities. Global efforts towards improving maternal health during this period have focused on increasing access to skilled care during child birth and providing emergency obstetric care where complications occur [3]. Anecdotal evidence suggests that even where maternal services are free, there may be unofficial or under-the-table payments and buying drugs outside the health facility when health facilities are out of stock. Indirect costs such as transportation, food and lodging can hinder the utilisation of maternal health care services at health facilities [11]

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