Cost of illness for severe and non-severe diarrhea borne by households in a low-income urban community of Bangladesh: A cross-sectional study.
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ABSTRACT:
SUBMITTER: Sultana R
PROVIDER: S-EPMC8221788 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Rapid urbanisation has often meant that public infrastructure has not kept pace with growth leading to urban slums with poor access to water and sanitation and high rates of diarrhoea with greater household costs due to illness. This study sought to determine the monetary cost of diarrhoea to urban slum households in Kaula Bandar slum in Mumbai, India. The study also tested the hypotheses that the cost of water and sanitation infrastructure may be surpassed by the cumulative costs of diarrhoea for households in an urban slum community.A cohort study using a baseline survey of a random sample followed by a systematic longitudinal household survey. The baseline survey was administered to a random sample of households. The systematic longitudinal survey was administered to every available household in the community with a case of diarrhoea for a period of 5 weeks.Every household in Kaula Bandar was approached for the longitudinal survey and all available and consenting adults were included.The direct cost of medical care for having at least one person in the household with diarrhoea was 205 rupees. Other direct costs brought total expenses to 291 rupees. Adding an average loss of 55 rupees per household from lost wages and monetising lost productivity from homemakers gave a total loss of 409 rupees per household. During the 5-week study period, this community lost an estimated 163 600 rupees or 3635 US dollars due to diarrhoeal illness.The lack of basic water and sanitation infrastructure is expensive for urban slum households in this community. Financing approaches that transfer that cost to infrastructure development to prevent illness may be feasible. These findings along with the myriad of unmeasured benefits of preventing diarrhoeal illness add to pressing arguments for investment in basic water and sanitation infrastructure.
| S-EPMC3641490 | biostudies-other
Project description:BACKGROUND:Cholera poses a substantial health burden to developing countries such as Bangladesh. In this study, the objective is to estimate the economic burden of cholera treatments incurred by households. The study was carried out in the context of a large vaccine trial in an urban area of Bangladesh. METHODS:The study used a combination of prospective and retrospective incidence-based cost analyses of cholera illness per episode per household. A total of 394 confirmed cholera hospitalized cases were identified and treated in the study area during June-October 2011. Households with cholera patients were interviewed within 15 days after discharge from hospitals or clinics. To estimate the total cost of cholera illness a structured questionnaire was used, which included questions on direct medical costs, non-medical costs, and the indirect costs of patients and caregivers. RESULTS:The average total household cost of treatment for an episode of cholera was US$30.40. Total direct and indirect costs constituted 24.6% (US$7.40) and 75.4% (US$23.00) of the average total cost, respectively. The cost for children under 5 years of age (US$21.50) was higher than that of children aged 5-14 years (US$17.50). The direct cost of treatment was similar for male and female patients, but the indirect cost was higher for males. CONCLUSION:Our study suggests that by preventing one cholera episode (3 days on an average), we can avert a total cost of 2,278.50 BDT (US$30.40) per household. Among medical components, medicines are the largest cost driver. No clear socioeconomic gradient emerged from our study, but limited demographic patterns were observed in the cost of illness. By preventing cholera cases, large production losses can be reduced.
| S-EPMC4228304 | biostudies-literature
Project description:BACKGROUND:Numerous studies have reported the economic burden of childhood diarrhea in low- and middle-income countries (LMICs). Yet, empirical data on the cost of diarrheal illness is sparse, particularly in LMICs. In this study we review the existing literature on the cost of childhood diarrhea in LMICs and generate comparable estimates of cost of diarrhea across 137 LMICs. METHODS:The systematic literature review included all articles reporting cost estimates of diarrhea illness and treatment from LMICs published between January 2006 and July 2018. To generate country-specific costs, we used service delivery unit costs from the World Health Organization's Choosing Interventions that are Cost-Effective (WHO-CHOICE database). Non-medical costs were calculated using the ratio between direct medical and direct non-medical costs, derived from the literature review. Indirect costs (lost wages to caregivers) were calculated by multiplying the average GDP per capita per day by the average number of days lost to illness identified from the literature. All cost estimates are reported in 2015 USD. We also generated estimates using the IHME's service delivery unit costs to explore input sensitivity on modelled cost estimates. RESULTS:We identified 25 articles with 64 data points on either direct or indirect cost of diarrhoeal illness in children aged < 5 years in 20 LMICs. Of the 64 data points, 17 were on the cost of outpatient care, 28 were on the cost of inpatient care, and 19 were unspecified. The average cost of illness was US$36.56 (median $15.73; range $4.30 - $145.47) per outpatient episode and $159.90 (median $85.85; range $41.01 - $538.33) per inpatient episode. Direct medical costs accounted for 79% (83% for inpatient and 74% for outpatient) of the total direct costs. Our modelled estimates, across all 137 countries, averaged (weighted) $52.16 (median $47.56; range $8.81 - $201.91) per outpatient episode and $216.36 (median $177.20; range $23.77 -$1225.36) per inpatient episode. In the 12 countries with primary data, there was reasonable agreement between our modelled estimates and the reported data (Pearson's correlation coefficient = .75). CONCLUSION:Our modelled estimates generally correspond to estimates observed in the literature, with a few exceptions. These estimates can serve as useful inputs for planning and prioritizing appropriate health interventions for childhood diarrheal diseases in LMICs in the absence of empirical data.
| S-EPMC7201538 | biostudies-literature
Project description:Background Animal source foods, especially fish is the most commonly consumed and an important source of macro and micronutrients in the diet of the urban low-income residents. The COVID-19 pandemic has disrupted the food environment in Bangladesh but little is known about how food access and food prices (affordability) have affected the purchase and consumption of fish. The objective of the study was to understand the impact of the first wave of the COVID-19 pandemic on urban food environment with a specific focus on fish consumption. Methods A cross-sectional survey was conducted among 586 homogeneous adults (288 females and 298 males) from separate households from five informal settlements in Dhaka city, Bangladesh during October-November 2020. Data were collected on: (1) food access and affordably; and (2) food purchase and fish consumption. The associations between food access, price, food purchase, and fish consumption were evaluated using path analysis. Results The majority of respondents reported that food access was more difficult, food prices increased, and food purchase decreased during the COVID-19 pandemic compared to pre-COVID (84–89% of respondents). Fish and meat were more difficult to access, more expensive and purchased less compared to other foods (74–91% of respondents). Compared to pre-COVID period, households consumed less fish during the COVID-19 pandemic, and reported compromised the variety and quality of fish. In the path analysis, food access was associated with food purchase (b = 0.33, p < 0.001). Food purchase was associated with quantity, variety, and quality of fish consumed. Food price was inversely associated with the quality of fish consumed (b = −0.27, p < 0.001). Conclusions The COVID-19 pandemic negatively affected the food environment, particularly food access, price (affordability), purchase, and consumption, especially of fish. Limited food access negatively affected the quantity, variety and quality of fish consumed. An increase in food prices directly affected the quality of fish consumed. Policy actions are essential to ensure equal access to nutritious foods, such as fish. These policies need to focus on diversity and quality along with preventing increases in food prices during emergencies to mitigate future threats to the nutrition and health of the urban low-income residents.
| S-EPMC9521681 | biostudies-literature
Project description:Studies on clean energy transition amongst low-income urban households in the Global South use an array of qualitative and quantitative methods. However, attempts to combine qualitative and quantitative methods are rare and there are a lack of systematic approaches to this. This paper demonstrates a two stage approach using clustering methods to analyse a mixed dataset containing quantitative household survey data and qualitative interview data. By clustering the quantitative and qualitative data separately, latent groups with common characteristics and narratives arising from each of the two analyses are identified. A second stage of clustering identifies links between these qualitative and quantitative clusters and enables inference of energy transition pathways followed by low-income urban households defined by both quantitative characteristics and qualitative narratives. This approach can support interdisciplinary collaboration in energy research, providing a systematic approach to comparing and identifying links between quantitative and qualitative findings.•A mixed dataset comprising of quantitative survey data and qualitative interview data on low-income household energy use is analysed using hierarchical clustering to detect communities within each dataset.•Interviewees are matched to quantitative survey clusters and a second stage of clustering is performed using cluster membership as variables.•Second stage clusters identify common pairs of survey and interview clusters which define energy transition pathways based on socio-economic characteristics, energy use patterns, and narratives for decision making and practices.
| S-EPMC8563469 | biostudies-literature
Project description:INTRODUCTION:Accompanying rapid urbanization in Bangladesh are inequities in health and healthcare which are most visibly manifested in slums or low-income settlements. This study examines socioeconomic, demographic and geographic patterns of self-reported chronic illness and healthcare seeking among adult slum dwellers in Bangladesh. Understanding these patterns is critical in designing more equitable urban health systems and in enabling the country's goal of Universal Health Coverage by 2030. METHODS:This descriptive cross-sectional study compares survey data from slum settlements located in two urban sites in Bangladesh, Tongi and Sylhet. Reported chronic illness symptoms and associated healthcare-seeking strategies are compared, and the catastrophic impact of household healthcare expenditures are assessed. RESULTS:Significant differences in healthcare-seeking for chronic illness were apparent both within and between slum settlements related to sex, wealth score (PPI), and location. Women were more likely to use private clinics than men. Compared to poorer residents, those from wealthier households sought care to a greater extent in private clinics, while poorer households relied more on drug shops and public hospitals. Chronic symptoms also differed. A greater prevalence of musculoskeletal, respiratory, digestive and neurological symptoms was reported among those with lower PPIs. In both slum sites, reliance on the private healthcare market was widespread, but greater in industrialized Tongi. Tongi also experienced a higher probability of catastrophic expenditure than Sylhet. CONCLUSIONS:Study results point to the value of understanding context-specific health-seeking patterns for chronic illness when designing delivery strategies to address the growing burden of NCDs in slum environments. Slums are complex social and geographic entities and cannot be generalized. Priority attention should be focused on developing chronic care services that meet the needs of the working poor in terms of proximity, opening hours, quality, and cost.
| S-EPMC7295220 | biostudies-literature
Project description:Cholera remains an important public health problem in many low- and middle-income countries. Vaccination has been recommended as a possible intervention for the prevention and control of cholera. Evidence, especially data on disease burden, cost-of-illness, delivery costs and cost-effectiveness to support a wider use of vaccine is still weak. This study aims at estimating the cost-of-illness of cholera to households and health facilities in Machinga and Zomba Districts, Malawi. A cross-sectional study using retrospectively collected cost data was undertaken in this investigation. One hundred patients were purposefully selected for the assessment of the household cost-of-illness and four cholera treatment centres and one health facility were selected for the assessment conducted in health facilities. Data collected for the assessment in households included direct and indirect costs borne by cholera patients and their families while only direct costs were considered for the assessment conducted in health facilities. Whenever possible, descriptive and regression analysis were used to assess difference in mean costs between groups of patients. The average costs to patients' households and health facilities for treating an episode of cholera amounted to US$65.6 and US$59.7 in 2016 for households and health facilities, respectively equivalent to international dollars (I$) 249.9 and 227.5 the same year. Costs incurred in treating a cholera episode were proportional to duration of hospital stay. Moreover, 52% of households used coping strategies to compensate for direct and indirect costs imposed by the disease. Both households and health facilities could avert significant treatment expenditures through a broader use of pre-emptive cholera vaccination. These findings have direct policy implications regarding priority investments for the prevention and control of cholera.
| S-EPMC5608291 | biostudies-literature
Project description:BackgroundPsychosocial factors are important determinants of health behaviors and diet-related outcomes, yet relatively little work has explored their relation to food-purchasing and preparation behaviors in low-income populations.AimTo evaluate the psychosocial factors associated with food-related behaviors.MethodsCross-sectional data collected from 465 low-income African American adult caregivers in the baseline evaluation of the B'more Healthy Communities for Kids obesity prevention trial. Questionnaires were used to assess household sociodemographic characteristics, food sources frequently used, and food preparation and food acquisition behaviors. Multiple linear regression models explored the associations between caregiver psychosocial variables and food-related behaviors, controlling for caregivers' age, sex, household income, household size, and food assistance participation.ResultsCaregivers purchased prepared food at carry-outs on average 3.8 times (standard deviation [ SD] = 4.6) within 30 days. Less healthy foods were acquired 2 times more frequently than healthier foods ( p < .001). Higher food-related behavioral intention and self-efficacy scores were positively associated with healthier food acquisition (β = 0.7; 95% confidence interval [CI] [0.09, 1.4]; β = 0.04; 95% CI [0.02, 0.06]) and negatively associated with frequency of purchasing at prepared food sources (β = -0.4; 95% CI [-0.6, -0.2]; β = -0.5; 95% CI [-0.7, -0.3]), respectively. Higher nutrition knowledge was associated with lower frequency of purchasing food at prepared food venues (β = -0.7; 95% CI: [-1.2, -0.2]).DiscussionOur findings indicate a positive association between psychosocial determinants and healthier food acquisition and food preparation behaviors.ConclusionInterventions that affect psychosocial factors (i.e., food-related behavioral intentions and self-efficacy) may have the potential to increase healthier food preparation and food-purchasing practices among low-income African American families.
| S-EPMC6119507 | biostudies-literature
Project description:Rising temperatures are causing distress across the world, and for those most vulnerable, it is a silent killer. Information about indoor air temperature in residential dwellings is of interest for a range of reasons, such as health, thermal comfort and coping practices. However, there have been only few studies that measure indoor heat exposure, and contrast these to outdoor temperatures in rural-urban areas, of which none are in South Asia. We aim to close this knowledge gap with our indoor and outdoor heat measurement dataset, covering five low-income sites in South Asia. Two sites are in rural areas (Maharashtra, India), while three sites focus on urban areas (Dhaka, Delhi and Faisalabad). Data are based on 206 indoor temperature data loggers and complemented by data from five outdoor automated weather stations. The data-set can be used to examine temperature and humidity variation in low-socioeconomic status households in rural and urban areas and to better understand factors aggravating heat stress. This is important to plan and implement actions for combating heat stress.
| S-EPMC9184534 | biostudies-literature
Project description:BackgroundThe economic burden of type 2 diabetes has not been adequately investigated in many low- and lower middle-income countries, including Bangladesh. The aim of this study was to estimate the cost-of-illness of type 2 diabetes and to find its determinants in Bangladesh.MethodsA cross-sectional study was conducted in 2017 to recruit 1253 participants with type 2 diabetes from six diabetes hospitals, providing primary to tertiary health care services, located in the northern and central regions of Bangladesh. A structured questionnaire was used for face-to-face interviewing to collect non-clinical data. Patients' medical records were reviewed for clinical data and hospital records were reviewed for hospitalisation data. Cost was calculated from the patient's perspective using a bottom-up methodology. The direct costs for each patient and indirect costs for each patient and their attendants were calculated. The micro-costing approach was used to calculate direct cost and the human capital approach was used to calculate indirect cost. Median regression analysis was performed to identify the determinants of average annual cost.ResultsAmong the participants, 54% were male. The mean (±SD) age was 55.1?±?12.5?years and duration of diabetes was 10.7?±?7.7?years. The average annual cost was US$864.7 per patient. Medicine cost accounted for 60.7% of the direct cost followed by a hospitalisation cost of 27.7%. The average annual cost for patients with hospitalisation was 4.2 times higher compared to those without hospitalisation. Being females, use of insulin, longer duration of diabetes, and presence of diabetes complications were significantly related to the average annual cost per patient.ConclusionsThe cost of diabetes care is considerably high in Bangladesh, and it is primarily driven by the medicine and hospitalisation costs. Optimisation of diabetes management by positive lifestyle changes is urgently required for prevention of comorbidities and complications, which in turn will reduce the cost.
| S-EPMC6712789 | biostudies-literature