Illness burden, care seeking, and treatment cost among less than 2-year-olds in rural Haryana.

Abstract

To estimate illness burden, treatment sources, and out-of-pocket (OOP) expenditures among <2-y-olds as mortality is higher in this age group. This prospective study was conducted in rural area of Haryana from January through June 2007. At baseline, 6828 children (<2-y-olds) were enrolled from 169 villages of Khizrabad block in Haryana. Thirty trained volunteers interviewed their mothers/caretakers at fortnightly interval to record symptoms and signs of illnesses occurring in past two weeks and the treatment sought. Five supervisors obtained data on Out-of-Pocket (OOP) expenditures from 20% randomly selected households who had reported illness. The main outcome measures were illness burden, treatment sources and OOP expenditures. Overall, 8% (4,893/60,910) of the <2-y-olds suffered from illness during 12 fortnightly surveys. Incidence was estimated to be 2.1 episodes per child per year. Acute respiratory infections (ARI) and diarrhea were the leading illnesses (66.3% and 19.4% respectively). Most (98%) had consulted a health care provider. Village practitioners were the major (71%) healthcare providers. About 12% of the children were hospitalized. Consultations were mostly (98%) with private medical practitioners. Average OOP expenditure was Rs. 444 (95% CI 299 to 589) per episode; Rs. 203 (95% CI 188 to 232) and Rs. 5,734 (95%CI 3,336 to 8,131) in the out-patient and in-patient department respectively. ARI and diarrhea continue to be the commonest illness among <2-y-olds. Most patients seek care in private sector and pay for the treatment from out-of-pocket source. Access to healthcare needs to be enhanced in public sector to reduce the financial burden.