Journal Article

Care-seeking behaviour and socio-economic burden associated with uncomplicated malaria in the Democratic Republic of Congo

Kabututu, Pius Zakayi, Speybroeck, Niko, Mvumbi, Georges Lelo, DeMol, Patrick, Devleesschauwer, Brecht, Lusamba, Paul Dikassa, Rosas-Aguirre, Angel, Beutels, Philippe, Kayiba, Nadine Kalenda, Hayette, Marie-Pierre, Mvumbi, Dieudonné Makaba, Kalindula, Lydie Azama, Likwela, Joris Losimba, Yobi, Doudou Malekita

2021

Overview

Background This study aimed to estimate the socio-economic costs of uncomplicated malaria and to explore health care-seeking behaviours that are likely to influence these costs in the Democratic Republic of Congo (DRC), a country ranked worldwide as the second most affected by malaria. Methods In 2017, a cross-sectional survey included patients with uncomplicated malaria in 64 healthcare facilities from 10 sentinel sites of the National Malaria Control Programme (NMCP) in the DRC. A standard questionnaire was used to assess health care-seeking behaviours of patients. Health-related quality of life (HRQL) and disutility weights (DW) of illness were evaluated by using the EuroQol Group’s descriptive system (EQ-5D-3L) and its visual analogue scale (EQ VAS). Malaria costs were estimated from a patient’s perspective. Probabilistic sensitivity analyses (PSA) evaluated the uncertainty around the cost estimates. Generalized regression models were fitted to assess the effect of potential predictive factors on the time lost and the DW during illness. Results In total, 1080 patients (age: 13.1 ± 14 years; M/F ratio: 1.1) were included. The average total costs amounted to US$ 36.3 [95% CI 35.5–37.2] per malaria episode, including US$ 16.7 [95% CI 16.3–17.1] as direct costs and US$ 19.6 [95% CI 18.9–20.3] indirect costs. During care seeking, economically active patients and their relatives lost respectively 3.3 ± 1.8 and 3.4 ± 2.1 working days. This time loss occurred mostly at the pre-hospital stage and was the parameter associated the most with the uncertainty around malaria cost estimates. Patients self-rated an average 0.36 ± 0.2 DW and an average 0.62 ± 0.3 EQ-5D index score per episode. A lack of health insurance coverage (896 out of 1080; 82.9%) incurred substantially higher costs, lower quality of life, and heavier DW while leading to longer time lost during illness. Residing in rural areas incurred a disproportionally higher socioeconomic burden of uncomplicated malaria with longer time lost due to illness and limited access to health insurance mechanisms. Conclusion Uncomplicated malaria is associated with high economic costs of care in the DRC. Efforts to reduce the cost-of-illness should target time lost at the pre-hospital stage and social disparities in the population, while reinforcing measures for malaria control in the country.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adolescent / Adult / Aged / Aged, 80 and over / Biomedical and Life Sciences / Biomedicine / body weight / Care and treatment / Child / Child, Preschool / controlled study / Cost of Illness / Costs / Cross-Sectional Studies / cross-sectional study / Data collection / Democratic Republic Congo / Democratic Republic of Congo / Democratic Republic of the Congo / Diagnosis / Distribution / Economics / Entomology / European Quality of Life 5 Dimensions 3 Level questionnaire / Female / Forecasts and trends / GDP / Gross Domestic Product / Health behavior / Health care / Health care expenditures / Health care policy / Health facilities / health insurance / Health services / Health-related quality of life / Households / human / Human diseases / Human health sciences / Humans / Illnesses / Infant / Infant, Newborn / Infectious Diseases / Insurance / Laboratory medicine & medical technology / major clinical study / Malaria / Malaria - economics / Malaria - parasitology / Malaria - psychology / malaria control / Male / Microbiology / Middle Aged / Médecine de laboratoire & technologie médicale / National Malaria Control Programme / newborn / Parasitology / Patient Acceptance of Health Care / Patient Acceptance of Health Care - statistics & numerical data / patient attitude / Patients / Population / preschool child / psychology / Public Health / Quality of life / Questionnaires / Regression analysis / relative / rural area / Rural areas / Sciences de la santé humaine / Sensitivity analysis / Socioeconomic aspects / Socioeconomic Factors / Socioeconomics / Surveying / Teams / Tropical Medicine / Uncertainty / Vector-borne diseases / very elderly / visual analog scale / Young Adult