Household costs and time to treatment for children with severe febrile illness in rural Burkina Faso: the role of rectal ... View Full Text


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Article Info

DATE

2018-10-22

AUTHORS

Joëlle Castellani, Borislava Mihaylova, Mohamadou Siribié, Zakaria Gansane, Amidou Z. Ouedraogo, Florence Fouque, Sodiomon B. Sirima, Silvia M. A. A. Evers, Aggie T. G. Paulus, Melba Gomes

ABSTRACT

BackgroundCommunity health workers (CHWs) were trained to identify children with malaria who could not take oral medication, treat them with rectal artesunate (RA) and refer them to the closest healthcare facility to complete management. However, many children with such symptoms did not seek CHWs’ care. The hypothesis was that the cost of referral to a health facility was a deterrent. The goal of this study was to compare the out-of-pocket costs and time to seek treatment for children who sought CHW care (and received RA) versus those who did not.MethodsChildren with symptoms of severe malaria receiving RA at CHWs and children with comparable disease symptoms who did not go to a CHW were identified and their parents were interviewed. Household out-of-pocket costs per illness episode and speed of treatment were evaluated and compared between RA-treated children vs. non-RA treated children and by central nervous symptoms (CNS: repeated convulsions, altered consciousness or coma).ResultsAmong children with CNS symptoms, costs of RA-treated children were similar to those of non-RA treated children ($5.83 vs. $4.65; p = 0.52), despite higher transport costs ($2.74 vs. $0.91; p < 0.0001). However, among children without CNS symptoms, costs of RA-treated children were higher than the costs of non-RA treated children with similar symptoms ($5.62 vs. $2.59; p = 0.0001), and the main driver of the cost difference was transport. After illness onset, CNS children reached CHWs for RA an average of 9.0 h vs. 16.1 h for non-RA treated children reaching first treatment [difference 7.1 h (95% CI − 1.8 to 16.1), p = 0.11]. For non-CNS patients the average time to CHW-delivered RA treatment was 12.2 h vs. 20.1 h for those reaching first treatment [difference 7.9 h (95% CI 0.2–15.6), p = 0.04]. More non-RA treated children developed CNS symptoms before arrival at the health centre but the difference was not statistically significant (6% vs. 4%; p = 0.58).ConclusionsCommunity health worker-delivered RA does not affect the total out-of-pocket costs when used in children with CNS symptoms, but is associated with higher total out-of-pocket costs when used in children with less severe symptoms. RA-treated children sought treatment more quickly. More... »

PAGES

380

References to SciGraph publications

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  • Identifiers

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    http://scigraph.springernature.com/pub.10.1186/s12936-018-2526-8

    DOI

    http://dx.doi.org/10.1186/s12936-018-2526-8

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    32 schema:description BackgroundCommunity health workers (CHWs) were trained to identify children with malaria who could not take oral medication, treat them with rectal artesunate (RA) and refer them to the closest healthcare facility to complete management. However, many children with such symptoms did not seek CHWs’ care. The hypothesis was that the cost of referral to a health facility was a deterrent. The goal of this study was to compare the out-of-pocket costs and time to seek treatment for children who sought CHW care (and received RA) versus those who did not.MethodsChildren with symptoms of severe malaria receiving RA at CHWs and children with comparable disease symptoms who did not go to a CHW were identified and their parents were interviewed. Household out-of-pocket costs per illness episode and speed of treatment were evaluated and compared between RA-treated children vs. non-RA treated children and by central nervous symptoms (CNS: repeated convulsions, altered consciousness or coma).ResultsAmong children with CNS symptoms, costs of RA-treated children were similar to those of non-RA treated children ($5.83 vs. $4.65; p = 0.52), despite higher transport costs ($2.74 vs. $0.91; p < 0.0001). However, among children without CNS symptoms, costs of RA-treated children were higher than the costs of non-RA treated children with similar symptoms ($5.62 vs. $2.59; p = 0.0001), and the main driver of the cost difference was transport. After illness onset, CNS children reached CHWs for RA an average of 9.0 h vs. 16.1 h for non-RA treated children reaching first treatment [difference 7.1 h (95% CI − 1.8 to 16.1), p = 0.11]. For non-CNS patients the average time to CHW-delivered RA treatment was 12.2 h vs. 20.1 h for those reaching first treatment [difference 7.9 h (95% CI 0.2–15.6), p = 0.04]. More non-RA treated children developed CNS symptoms before arrival at the health centre but the difference was not statistically significant (6% vs. 4%; p = 0.58).ConclusionsCommunity health worker-delivered RA does not affect the total out-of-pocket costs when used in children with CNS symptoms, but is associated with higher total out-of-pocket costs when used in children with less severe symptoms. RA-treated children sought treatment more quickly.
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    40 CHW care
    41 CHWs
    42 CNS symptoms
    43 Faso
    44 MethodsChildren
    45 RA treatment
    46 ResultsAmong children
    47 arrival
    48 artesunate
    49 average
    50 average time
    51 care
    52 center
    53 central nervous symptoms
    54 children
    55 cost
    56 cost differences
    57 cost of referrals
    58 deterrent
    59 differences
    60 disease symptoms
    61 drivers
    62 episodes
    63 facilities
    64 febrile illness
    65 first treatment
    66 goal
    67 health centers
    68 health facilities
    69 health workers
    70 healthcare facilities
    71 high transport costs
    72 higher total
    73 household costs
    74 hypothesis
    75 illness
    76 illness episodes
    77 illness onset
    78 main drivers
    79 malaria
    80 management
    81 medications
    82 nervous symptoms
    83 onset
    84 oral medications
    85 out
    86 parents
    87 patients
    88 pocket costs
    89 rectal artesunate
    90 referral
    91 role
    92 rural Burkina Faso
    93 severe febrile illness
    94 severe malaria
    95 severe symptoms
    96 similar symptoms
    97 speed
    98 speed of treatment
    99 study
    100 such symptoms
    101 symptoms
    102 time
    103 total
    104 transport
    105 transport costs
    106 treatment
    107 workers
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