Abstract
BackgroundIn 2016, diarrhea killed around 7 children aged under 5 years per 1000 live births in Burundi. The objective of this study was to estimate the economic burden associated with diarrhea in Burundi and to examine factors affecting the cost to provide economic evidence useful for the policymaking about clinical management of diarrhea.MethodsThe study was designed as a prospective cost-of-illness study using an incidence-based approach from the societal perspective. The study included patients aged under 5 years with acute non-bloody diarrhea who visited Buyenzi health center and Prince Regent Charles hospital from November to December 2019. Data were collected through interviews with patients’ caregivers and review of patients’ medical and financial records. Multiple linear regression was performed to identify factors affecting cost, and a cost model was used to generate predictions of various clinical and care management costs. All costs were converted into international dollars for the year 2019.ResultsOne hundred thirty-eight patients with an average age of 14.45 months were included in this study. Twenty-one percent of the total patients included were admitted. The average total cost per episode of diarrhea was Int$109.01. Outpatient visit and hospitalization costs per episode of diarrhea were Int$59.87 and Int$292, respectively. The costs were significantly affected by the health facility type, patient type, health insurance scheme, complications with dehydration, and duration of the episode before consultation. Our model indicates that the prevention of one case of dehydration results in savings of Int$16.81, accounting for approximately 11 times of the primary treatment cost of one case of diarrhea in the community-based management program for diarrhea in Burundi.ConclusionDiarrhea is associated with a substantial economic burden to society. Evidence from this study provides useful information to support health interventions aimed at prevention of diarrhea and dehydration related to diarrhea in Burundi. Appropriate and timely care provided to patients with diarrhea in their communities and primary health centers can significantly reduce the economic burden of diarrhea. Implementing a health policy to provide inexpensive treatment to prevent dehydration can save significant amount of health expenditure.
Highlights
Despite the remarkable achievements globally in the fight against diarrheal diseases in the last two decades, diarrhea remains as one of the major public health problems in the world [1, 2]
We found that the average cost per episode of diarrhea was international dollar (Int$)109.01, which accounts for 14.5% of the gross national income (GNI) per capita [20]
Contrary to some previous studies, which found that direct non-medical costs, including informal care cost, were the largest cost component [30, 31], we found that direct medical costs were the largest component of the total cost of diarrhea
Summary
Despite the remarkable achievements globally in the fight against diarrheal diseases in the last two decades, diarrhea remains as one of the major public health problems in the world [1, 2]. In 2016, it was estimated that diarrhea was responsible for approximately 446,000 deaths globally among children aged under 5 years [2]. Despite the prevalence of diarrhea in all regions of the world, it has been reported that more deaths attributed to diarrhea occur in developing countries, especially in sub-Saharan Africa and south Asia [3]. In sub-Saharan Africa, diarrhea killed 290,724 children aged under 5 years or more than 65% of total global deaths [2]. In 2016, diarrhea killed around 7 children aged under 5 years per 1000 live births in Burundi. The objective of this study was to estimate the economic burden associated with diarrhea in Burundi and to examine factors affecting the cost to provide economic evidence useful for the policymaking about clinical management of diarrhea
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