Patient-level cost of home- and facility-based child pneumonia treatment in Suba Sub County, Kenya

English version

Autoři: Joel Amenya Machuki ^aff001; Dickens S. Omondi Aduda ^aff002; Abong’o B. Omondi ^aff003; Maricianah Atieno Onono ^aff001
Působiště autorů: Department of Research, Kenya Medical Research Institute, Kisumu, Kenya ^aff001; Department of Public Health and Community Development, University of Kabianga, Kericho, Kenya ^aff002; Department of Biomedical Sciences and Technology, The National University of Lesotho, Maseru, Lesotho ^aff003; Department of Biology, National University of Lesotho, Lesotho, South Africa ^aff004
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0225194

Souhrn

Background

Globally, pneumonia accounted for 16% of deaths among children under 5 years of age and was one of the major causes of death overall in 2018. Kenya is ranked among the top 15 countries with regard to pneumonia prevalence and contributed approximately 74% of the world's annual pneumonia cases in 2018. Unfortunately, less than 50% of children with pneumonia receive appropriate antibiotics for treatment. Homa-Bay County implemented pneumonia community case management utilizing community health workers, as recommended by the World Health Organization (WHO), in 2014. However, since implementation of the program, the relative patient-level cost of home-based and facility-based treatment of pneumonia, as well as the main drivers of these costs in Suba Subcounty, remain uncertain. Therefore, the main objective of this study was to compare the patient-level costs of home based treatment of pneumonia by a community health worker with those of health facility-based treatment.

Methods and findings

Using a cross-sectional study design, a structured questionnaire was used to collect quantitative data from 208 caregivers on the direct costs (consultation, medicine, transportation) and indirect costs (opportunity cost) of pneumonia treatment. The average household cost for the community managed patients was KSH 122.65 ($1.29) compared with KSh 447.46 ($4.71), a 4-fold difference, for those treated at the health facility. The largest cost drivers for home treatment and health facility treatment were opportunity costs (KSH 88.25 ($ 0.93)) and medicine costs (KSH 126.16 ($ 1.33)), respectively.

Conclusion

This study demonstrates that the costs incurred for home-based pneumonia management are considerably lower compared to those incurred for facility-based management. Opportunity costs (caregiver time and forgone wages) and the cost of medication were the key cost-drivers in the management of pneumonia at the health facility and at home, respectively. These findings emphasize the need to strengthen and scale community case management to overcome barriers and delays in accessing the correct treatment for pneumonia for sick children under 5 years of age.

Klíčová slova:

Health economics – Socioeconomic aspects of health – Kenya – Transportation – Child health – Mothers – Pneumonia – Indirect costs

Zdroje

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