Background: Worldwide, acute gastroenteritis causes substantial morbidity and mortality in children less than five years of age. In Bolivia, which has one of the lower GDPs in South America, 16% of child deaths can be attributed to diarrhea, and the costs associated with diarrhea can weigh heavily on patient families. To address this need, the study goal was to identify predictors of cost burden (diarrhea-related costs incurred as a percentage of annual income) and catastrophic cost (cost burden ≥ 1% of annual household income). Methods. From 2007 to 2009, researchers interviewed caregivers (n = 1,107) of pediatric patients (<5 years old) seeking treatment for diarrhea in six Bolivian hospitals. Caregivers were surveyed on demographics, clinical symptoms, direct (e.g. medication, consult fees), and indirect (e.g. lost wages) costs. Multivariate regression models (n = 551) were used to assess relationships of covariates to the outcomes of cost burden (linear model) and catastrophic cost (logistic model). Results: We determined that cost burden and catastrophic cost shared the same significant (p < 0.05) predictors. In the logistic model that also controlled for child sex, child age, household size, rural residence, transportations taken to the current visit, whether the child presented with complications, and whether this was the child's first episode of diarrhea, significant predictors of catastrophic cost included outpatient status (OR 0.16, 95% CI [0.07, 0.37]); seeking care at a private hospital (OR 4.12, 95% CI [2.30, 7.41]); having previously sought treatment for this diarrheal episode (OR 3.92, 95% CI [1.64, 9.35]); and the number of days the child had diarrhea prior to the current visit (OR 1.14, 95% CI [1.05, 1.24]). Conclusions: Our analysis highlights the economic impact of pediatric diarrhea from the familial perspective and provides insight into potential areas of intervention to reduce associated economic burden.
Bibliographical noteFunding 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 Laney Graduate School at Emory University; the New Aid Fellowship; the Bolivia National Rotavirus Surveillance Program (BNRSP); the Swedish Cooperation ASDI-UMSA (Diarrhea Disease Project); PHS Grant UL1 TR000454 from the Clinical and Translational Science Award Program, National Institutes of Health, National Center for Research Resource; the Emory + Children’s Pediatric Center Seed Grant Program; The National Institutes of Health/NIAID grant U19-AI057266; and the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR000454. RMB was supported in part by an NIH T32 training grant in reproductive, pediatric, and perinatal epidemiology (HD052460-01). PAR was supported by the National Institute of Allergy and Infectious Diseases (Award number T32AI074492). 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. The contents of this paper are solely the responsibility of the authors and do not necessarily represent the official views of the USDA or the National Institutes of Health. We are grateful for the support of the hospital staff and the many study participants involved in this study.
- Health economics
- Pediatric gastroenteritis
- Societal costs