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Title The societal cost and economic impact of surgical care on patients' households in rural Uganda; a mixed method study.
Full text https://escholarship.org/uc/item/55z5s152
Date 2021
Author(s) Nwanna-Nzewunwa, Obieze; Oke, Rasheedat; Agwang, Esther; Ajiko, Mary-Margaret; Yoon, Christopher; Carvalho, Melissa; Kirya, Fred; Marseille, Elliot; Dicker, Rochelle A
Abstract BackgroundThe epidemiology and cost of surgical care delivery in low-and middle-income countries (LMICs) is poorly understood. This study characterizes the cost of surgical care, rate of catastrophic medical expenditure and medical impoverishment, and impact of surgical hospitalization on patients' households at Soroti Regional Referral Hospital (SRRH), Uganda.MethodsWe prospectively collected demographic, clinical, and cost data from all surgical inpatients and caregivers at SRRH between February 2018 and January 2019. We conducted and thematically analyzed qualitative interviews to discern the impact of hospitalization on patients' households. We employed the chi-square, t-test, ANOVA, and Bonferroni tests and built regression models to identify predictors of societal cost of surgical care. Out of pocket spending (OOPS) and catastrophic expenses were determined.ResultsWe encountered 546 patients, mostly male (62%) peasant farmers (42%), at a median age of 22 years; and 615 caregivers, typically married (87%), female (69%), at a median age of 35 years. Femur fractures (20.4%), soft tissue infections (12.3%), and non-femur fractures (11.9%) were commonest. The total societal cost of surgical care was USD 147,378 with femur fractures (USD 47,879), intestinal obstruction (USD 18,737) and non-femur fractures (USD 10,212) as the leading contributors. Procedures (40%) and supplies (12%) were the largest components of societal cost. About 29% of patients suffered catastrophic expenses and 31% were medically impoverished.ConclusionDespite free care, surgical conditions cause catastrophic expenses and impoverishment in Uganda. Femur fracture is the most expensive surgical condition due to prolonged hospitalization associated with traction immobilization and lack of treatment modalities with shorter hospitalization.
Subject(s) Humans; Family Characteristics; Poverty; Adult; Health Services; Health Expenditures; Uganda; Female; Male; Young Adult; Africa; Catastrophic medical expenditure; Epidemiology; Global surgery; Societal cost; Surgical care cost; Library and Information Studies; Nursing; Public Health and Health Services; Health Policy & Services
Coverage 568
Publisher eScholarship, University of California
Type of publication article
Format application/pdf
Source BMC health services research, vol 21, iss 1
Rights public
Identifier qt55z5s152
Repository Berkeley - University of California
Added to C-A: 2021-07-29;08:58:26