Kamya Carol, Idro Richard, Kalibbala Dennis, Phiri Kamija S, Nkosi-Gondwe Thandile, Akun Pamela, Kirikumwino Joanita, Kaarboe Oddvar, Bjarne Robberstad
Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda.
BMC Public Health. 2025 Jun 4;25(1):2070. doi: 10.1186/s12889-025-23209-x.
Chronic diseases such as sickle cell anaemia (SCA) often lead to catastrophic health expenditures, especially in malaria-endemic regions. There is limited evidence on the economic burden faced by households with children suffering from SCA. This study aimed to assess the household economic burden of SCA and the incidence of catastrophic health expenditures in Uganda and Malawi.
This prospective cohort study was nested in a clinical trial comparing malaria chemoprevention regimes: weekly dihydroartemisinin-piperaquine versus monthly sulfadoxine-pyrimethamine for children aged 6 months to 15 years in Uganda and Malawi. The economic burden was evaluated using the cost of illness approach by measuring and valuing direct and indirect costs. Quantile regression models were employed to identify factors associated with these costs.
The study included 723 children with an SCA (437 in Uganda and 286 in Malawi) with mean ages of 7.3 years (SD 3.9) and 8.0 years (SD 4.1), respectively. The annual median costs per household were $638.8 (IQR: $227-$2,693) in Uganda and $387.3 (IQR: $203-$694) in Malawi. The main contributors to the economic burden were direct costs in Uganda and indirect costs in Malawi. Factors such as malaria episodes, hospitalisation, hydroxyurea use, household wealth, children's age, and gender significantly influenced direct and indirect costs. The concentration indices (CI) revealed a pro-rich distribution with poorer households incurring higher direct costs in both Malawi, CI=-0.12 (SE = 0.00, P < 0.00), and Uganda, CI= -0.23 (SE = 0.02, P < 0.000). Most households in both countries experienced catastrophic health expenditures, with the highest incidence in the poorest quartile.
Households with children with SCA incur high expenditures, which are catastrophic for a substantial proportion of them. Malaria episodes, hospitalisation and wealth status significantly increase the economic burden on households. Targeted interventions are needed to alleviate this financial strain, reduce disparities and improve outcomes for vulnerable households. Enhancing access to improved treatment strategies, such as effective malaria prevention measures and the consistent availability of hydroxyurea, could help reduce the number of sick episodes and, consequently, the economic burden on households and patients.
镰状细胞贫血（SCA）等慢性病往往导致灾难性的医疗支出，尤其是在疟疾流行地区。关于患有SCA的儿童家庭所面临的经济负担的证据有限。本研究旨在评估乌干达和马拉维SCA的家庭经济负担以及灾难性医疗支出的发生率。
这项前瞻性队列研究嵌套在一项比较疟疾化学预防方案的临床试验中：在乌干达和马拉维，对6个月至15岁的儿童采用每周双氢青蒿素-哌喹与每月磺胺多辛-乙胺嘧啶进行比较。通过测量和评估直接和间接成本，使用疾病成本法评估经济负担。采用分位数回归模型确定与这些成本相关的因素。
该研究纳入了723名患有SCA的儿童（乌干达437名，马拉维286名），平均年龄分别为7.3岁（标准差3.9）和8.0岁（标准差4.1）。乌干达每户每年的中位数成本为638.8美元（四分位距：227美元至2693美元），马拉维为387.3美元（四分位距：203美元至694美元）。经济负担的主要贡献因素在乌干达是直接成本，在马拉维是间接成本。疟疾发作、住院、羟基脲使用、家庭财富、儿童年龄和性别等因素对直接和间接成本有显著影响。浓度指数（CI）显示贫富分布不均，在马拉维（CI=-0.12，标准误=0.00，P<0.00）和乌干达（CI=-0.23，标准误=0.02，P<0.000），较贫困家庭的直接成本更高。两国大多数家庭都经历了灾难性医疗支出，最贫困四分位数家庭的发生率最高。
患有SCA儿童的家庭支出高昂，其中很大一部分家庭面临灾难性支出。疟疾发作、住院和财富状况显著增加了家庭的经济负担。需要有针对性的干预措施来缓解这种经济压力，减少差距并改善弱势群体家庭的结局。增加获得改进治疗策略的机会，如有效的疟疾预防措施和持续供应羟基脲，有助于减少发病次数，从而减轻家庭和患者的经济负担。
