Duval Laetitia, Sicuri Elisa, Scott Susana, Traoré Maminata, Daabo Bunja, Tinto Halidou, Grietens Koen Peeters, d'Alessando Umberto, Schallig Henk, Mens Petra, Conteh Lesong
Centre d'Economie de La Sorbonne, University Paris 1 Panthéon-Sorbonne, Paris, France.
Department of Health Policy, London School of Economics and Political Science, London, UK.
Cost Eff Resour Alloc. 2022 Aug 20;20(1):42. doi: 10.1186/s12962-022-00376-x.
Malaria in pregnancy remains a major health threat in sub-Saharan Africa to both expectant mothers and their unborn children. To date, there have been very few studies focused on the out of pocket costs associated with seeking treatment for malaria during pregnancy.
A cross-sectional survey was undertaken in Burkina Faso and The Gambia to estimate the direct and indirect costs associated with outpatient consultations (OP) and inpatient admissions (IP). Direct costs were broken down into medical (admission fees, drug charges, and laboratory fees), and non-medical (transportation and food). Indirect costs reflected time lost due to illness. In total, 220 pregnant women in Burkina Faso and 263 in The Gambia were interviewed about their treatment seeking decisions, expenditure, time use and financial support associated with each malaria episode.
In Burkina Faso 6.7% sought treatment elsewhere before their OP visits, and 27.1% before their IP visits. This compares to 1.3% for OP and 25.92% for IP in The Gambia. Once at the facility, the average direct costs (out of pocket) were 3.91US$ for an OP visit and 15.38US$ of an IP visit in Burkina Faso, and 0.80US$ for an OP visit and 9.19US$ for an IP visit in The Gambia. Inpatient direct costs were driven by drug costs (9.27US$) and transportation costs (2.72US$) in Burkina Faso and drug costs (3.44 US$) and food costs (3.44 US$) in The Gambia. Indirect costs of IP visits, valued as the opportunity cost of time lost due to the illness, were estimated at 11.85US$ in Burkina Faso and 4.07US$ in The Gambia. The difference across the two countries was mainly due to the longer time of hospitalization in Burkina Faso compared to The Gambia. In The Gambia, the vast majority of pregnant women reported receiving financial support from family members living abroad, most commonly siblings (65%).
High malaria treatment costs are incurred by pregnant women in Burkina Faso and The Gambia. Beyond the medical costs of fees and drugs, costs in terms of transport, food and time are significant drivers. The role of remittances, particularly their effect on accessing health care, needs further investigation.
在撒哈拉以南非洲地区，妊娠疟疾仍然是对孕妇及其未出生子女的一大主要健康威胁。迄今为止，很少有研究关注孕期疟疾治疗的自付费用。
在布基纳法索和冈比亚开展了一项横断面调查，以估算门诊咨询（OP）和住院治疗（IP）的直接和间接费用。直接费用细分为医疗费用（入院费、药费和化验费）和非医疗费用（交通费和食品费）。间接费用反映因病造成的时间损失。总共对布基纳法索的220名孕妇和冈比亚的263名孕妇进行了访谈，了解她们每次疟疾发作时的就医决策、支出、时间利用和经济支持情况。
在布基纳法索，6.7%的孕妇在门诊就诊前曾去其他地方治疗，27.1%在住院治疗前曾去其他地方治疗。相比之下，冈比亚门诊就诊前这一比例为1.3%，住院治疗前为25.92%。在医疗机构，布基纳法索门诊就诊的平均直接自付费用为3.91美元，住院治疗为15.38美元；冈比亚门诊就诊为0.80美元，住院治疗为9.19美元。在布基纳法索，住院直接费用由药费（9.27美元）和交通费（2.72美元）驱动；在冈比亚，住院直接费用由药费（3.44美元）和食品费（3.44美元）驱动。住院治疗的间接费用，即因病造成的时间损失的机会成本，在布基纳法索估计为11.85美元，在冈比亚为4.07美元。两国之间的差异主要是由于布基纳法索的住院时间比冈比亚长。在冈比亚，绝大多数孕妇报告从国外的家庭成员那里获得了经济支持，最常见的是兄弟姐妹（65%）。
布基纳法索和冈比亚的孕妇承担着高昂的疟疾治疗费用。除了费用和药品的医疗成本外，交通、食品和时间方面的成本也是重要因素。汇款的作用，特别是其对获得医疗保健的影响，需要进一步调查。
