Household burden of malaria in South Africa and Mozambique: is there a catastrophic impact?

Trop Med Int Health. 2008 Jan;13(1):108-22. doi: 10.1111/j.1365-3156.2007.01979.x.

Abstract

Objectives: To evaluate treatment-seeking behaviour, financial impact and time lost due to malaria events, in southern Mozambique and eastern South Africa.

Methods: In-depth household surveys (828 in Mozambique and 827 in South Africa) were analysed. An asset index was calculated using principal component analysis to allow comparison across socio-economic groups. Direct costs of seeking care and the time lost due to malaria were determined. The extent of catastrophic payments was assessed using as thresholds the traditional 10% of household income and 40% of non-food income, as recently recommended by WHO.

Results: Poverty was highly prevalent: 70% of the South African and 95% of Mozambican households studied lived on less than $1 per capita per day. Around 97% of those with recent malaria sought healthcare, mainly in public facilities. Out-of-pocket household expenditure per malaria episode averaged $2.30 in South Africa and $6.50 in Mozambique. Analysis at the individual household level found that 32-34% of households in Mozambique, compared with 9-13% of households in South Africa, incurred catastrophic payments for malaria episodes. Results based on mean values underestimated the prevalence of catastrophic payments. Days off work/school were higher in Mozambique.

Conclusions: The high rate of health seeking in public health facilities seems unusual in the African context, which bodes well for high coverage with artemisinin-based combinations, even if only deployed within the public sector. However, despite no or modest charges for public sector primary healthcare, households frequently incur catastrophic expenditure on a single malaria episode.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Antimalarials* / economics
  • Antimalarials* / therapeutic use
  • Catastrophic Illness / economics
  • Catastrophic Illness / mortality
  • Child
  • Child, Preschool
  • Cost of Illness
  • Episode of Care
  • Family Characteristics*
  • Female
  • Health Care Surveys*
  • Health Expenditures
  • Humans
  • Malaria* / drug therapy
  • Malaria* / economics
  • Malaria* / mortality
  • Male
  • Middle Aged
  • Mozambique / epidemiology
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Poverty
  • Public Sector
  • Rural Population
  • Socioeconomic Factors
  • South Africa / epidemiology

Substances

  • Antimalarials