Department of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Observatory 7925, Cape Town, South Africa
Castillo-Riquelme, M., Department of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Observatory 7925, Cape Town, South Africa; McIntyre, D., Department of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Barnes, K., Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
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. © 2008 Blackwell Publishing Ltd.
comparative study; health care; health expenditure; household expenditure; household income; household survey; malaria; poverty; article; child; disease surveillance; health care cost; health care facility; help seeking behavior; human; income; malaria; Mozambique; poverty; principal component analysis; socioeconomics; South Africa; Adolescent; Adult; Antimalarials; Catastrophic Illness; Child; Child, Preschool; Cost of Illness; Episode of Care; Family Characteristics; Female; Health Care Surveys; Health Expenditures; Humans; Malaria; Male; Middle Aged; Mozambique; Patient Acceptance of Health Care; Poverty; Public Sector; Rural Population; Socioeconomic Factors; South Africa; Africa; Mozambique; Southern Africa; Sub-Saharan Africa