Department of Research, Kenya Medical Research Institute, Kisumu, Kenya.
Department of Public Health and Community Development, University of Kabianga, Kericho, Kenya.
PLoS One. 2019 Nov 19;14(11):e0225194. doi: 10.1371/journal.pone.0225194. eCollection 2019.
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.
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.
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.
在全球范围内，肺炎占五岁以下儿童死亡人数的 16%，是 2018 年总体死亡的主要原因之一。肯尼亚在肺炎发病率方面排名前 15 位，在 2018 年，肯尼亚约占全球年度肺炎病例的 74%。不幸的是，只有不到 50%的肺炎患儿接受了适当的抗生素治疗。2014 年，肯尼亚霍马贝县按照世界卫生组织（WHO）的建议，利用社区卫生工作者实施肺炎社区病例管理。然而，自该方案实施以来，基于患者的家庭治疗和医疗机构治疗肺炎的相对费用，以及苏巴县的这些费用的主要驱动因素仍不确定。因此，本研究的主要目的是比较社区卫生工作者家庭治疗肺炎的患者水平成本与医疗机构治疗的成本。
本研究采用横断面研究设计，使用结构化问卷从 208 名照顾者那里收集了有关肺炎治疗的直接费用（咨询、药物、交通）和间接费用（机会成本）的定量数据。与在医疗机构接受治疗的患者相比，接受社区管理的患者的家庭治疗费用平均为 122.65 肯尼亚先令（1.29 美元），而在医疗机构接受治疗的患者的费用为 447.46 肯尼亚先令（4.71 美元），相差 4 倍。家庭治疗和医疗机构治疗的最大成本驱动因素分别是机会成本（88.25 肯尼亚先令（0.93 美元））和药物成本（126.16 肯尼亚先令（1.33 美元））。
本研究表明，与医疗机构管理相比，家庭管理肺炎的费用要低得多。机会成本（照顾者时间和放弃的工资）和药物费用是医疗机构和家庭管理肺炎的主要成本驱动因素。这些发现强调需要加强和扩大社区病例管理，以克服 5 岁以下患病儿童获得正确治疗的障碍和延误。
