The burden of pediatric diarrhea: A cross-sectional study of incurred costs and perceptions of cost among Bolivian families

Rachel M. Burke, Paulina A. Rebolledo, Sally R. Embrey, Laura Danielle Wagner, Carter L. Cowden, Fiona M. Kelly, Emily R. Smith, Volga Iñiguez, Juan S. Leon

Research output: Contribution to journalArticlepeer-review

21 Scopus citations

Abstract

Background: Worldwide, acute gastroenteritis represents an enormous public health threat to children under five years of age, causing one billion episodes and 1.9 to 3.2 million deaths per year. In Bolivia, which has one of the lower GDPs in South America, an estimated 15% of under-five deaths are caused by diarrhea. Bolivian caregiver expenses related to diarrhea are believed to be minimal, as citizens benefit from universal health insurance for children under five. The goals of this report were to describe total incurred costs and cost burden associated with caregivers seeking treatment for pediatric gastroenteritis, and to quantify relationships among costs, cost burden, treatment setting, and perceptions of costs. Methods. From 2007 to 2009, researchers interviewed caregivers (n=1,107) of pediatric patients (<5 years of age) seeking treatment for diarrhea in sentinel hospitals participating in Bolivia's diarrheal surveillance program across three main geographic regions. Data collected included demographics, clinical symptoms, direct costs (e.g. medication, consult fees) and indirect costs (e.g. lost wages). Results: Patient populations were similar across cities in terms of gender, duration of illness, and age, but familial income varied significantly (p<0.05) when stratified on appointment type. Direct, indirect, and total costs to families were significantly higher for inpatients as compared to outpatients of urban (p<0.001) and rural (p<0.05) residence. Consult fees and indirect costs made up a large proportion of total costs. Forty-five percent of patients' families paid ≥1% of their annual household income for this single diarrheal episode. The perception that cost was affecting family finances was more frequent among those with higher actual cost burden. Conclusions: This study demonstrated that indirect costs due to acute pediatric diarrhea were a large component of total incurred familial costs. Additionally, familial costs associated with a single diarrheal episode affected the actual and perceived financial situation of a large number of caregivers. These data serve as a baseline for societal diarrheal costs before and immediately following the implementation of the rotavirus vaccine and highlight the serious economic importance of a diarrheal episode to Bolivian caregivers.

Original languageEnglish
Article number708
JournalBMC Public Health
Volume13
Issue number1
DOIs
StatePublished - 2013

Bibliographical note

Funding Information:
This work was supported in part by The Eugene J. Gangarosa Fund, the Anne E. and William A. Foege Global Health Fund, the O.C. Hubert Charitable Trust, the RSPH Student Initiative Fund, the NIH Global Frameworks Grant (2007–2010), the Emory University Global Health Institute, the New Aid Fellowship, the Bolivia National Rotavirus Surveillance Program (BNRSP), and the Swedish Cooperation ASDI-UMSA (Diarrhea Disease Project). JSL was supported in part by funds from the Emory University Global Health Institute, NIH-NIAID (1K01AI087724-01) and USDA-NIFA (2010-85212-20608) grants. PAR was supported by the National Institute of Allergy and Infectious (Award number T32AI074492). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the USDA or the National Institutes of Health (NIAID). We are grateful for the support of the hospital staff and the many study participants participating in this study.

Keywords

  • Diarrhea
  • Economic burden
  • Health economics
  • Pediatrics
  • Societal costs

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