NDLI: The societal cost and economic impact of surgical care on patients’ households in rural Uganda; a mixed method study

Content Provider	Springer Nature : BioMed Central
Author	Nwanna–Nzewunwa, Obieze Oke, Rasheedat Agwang, Esther Ajiko, Mary-Margaret Yoon, Christopher Carvalho, Melissa Kirya, Fred Marseille, Elliot Dicker, Rochelle A.
Abstract	Background The epidemiology and cost of surgical care delivery in low-and middle-income countries (LMICs) is poorly understood. This study characterizes the cost of surgical care, rate of catastrophic medical expenditure and medical impoverishment, and impact of surgical hospitalization on patients’ households at Soroti Regional Referral Hospital (SRRH), Uganda. Methods We prospectively collected demographic, clinical, and cost data from all surgical inpatients and caregivers at SRRH between February 2018 and January 2019. We conducted and thematically analyzed qualitative interviews to discern the impact of hospitalization on patients’ households. We employed the chi-square, t-test, ANOVA, and Bonferroni tests and built regression models to identify predictors of societal cost of surgical care. Out of pocket spending (OOPS) and catastrophic expenses were determined. Results We encountered 546 patients, mostly male (62%) peasant farmers (42%), at a median age of 22 years; and 615 caregivers, typically married (87%), female (69%), at a median age of 35 years. Femur fractures (20.4%), soft tissue infections (12.3%), and non-femur fractures (11.9%) were commonest. The total societal cost of surgical care was USD 147,378 with femur fractures (USD 47,879), intestinal obstruction (USD 18,737) and non-femur fractures (USD 10,212) as the leading contributors. Procedures (40%) and supplies (12%) were the largest components of societal cost. About 29% of patients suffered catastrophic expenses and 31% were medically impoverished. Conclusion Despite free care, surgical conditions cause catastrophic expenses and impoverishment in Uganda. Femur fracture is the most expensive surgical condition due to prolonged hospitalization associated with traction immobilization and lack of treatment modalities with shorter hospitalization.
Related Links	https://bmchealthservres.biomedcentral.com/counter/pdf/10.1186/s12913-021-06579-x.pdf
Ending Page	10
Page Count	10
Starting Page	1
File Format	HTM / HTML
ISSN	14726963
DOI	10.1186/s12913-021-06579-x
Journal	BMC Health Services Research
Issue Number	1
Volume Number	21
Language	English
Publisher	BioMed Central
Publisher Date	2021-06-09
Access Restriction	Open
Subject Keyword	Public Health Health Administration Health Informatics Nursing Research Surgical care cost Societal cost Catastrophic medical expenditure Uganda Africa Epidemiology Global surgery
Content Type	Text
Resource Type	Article
Subject	Health Policy

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1	Ministry of Education (GoI), Department of Higher Education	Sanctioning Authority	https://www.education.gov.in/ict-initiatives
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4	Project PI / Joint PI	Principal Investigator and Joint Principal Investigators of the project	Dr. B. Sutradhar bsutra@ndl.gov.in Prof. Saswat Chakrabarti will be added soon
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