Economic Burden of Malaria and Associated Factors among Rural Households in Chewaka District, Bunno Bedele Zone, Oromia Region, west Ethiopia

Abstract

Background: Malaria is the most serious public health problem in the world, especially in the tropical and sub-tropical regions. It imposes a heavy economic burden on individuals, households and the entire economy. It has also remained as major impediment to both health and economic development, where 75% of the land area is malarious in Ethiopia. However, evidence on the economic burden of malaria in the study area was scanty. Objective: The study aimed to estimate economic burden of malaria and identify associated factors among rural households in Chewaka District, Bunno Bedele Zone, Oromia Region, west Ethiopia, 2017/2018. Methods: Community based cross-sectional study design was employed to estimate the economic burden of malaria at the household level. The study included malaria expenditure during one-year period prior to the study period (July 09, 2017 to July 09, 2018) on households using retrospective costing approaches from the households’ perspective. The data was collected from 765 selected households computed by using single population proportion formula. It was collected using semi-structured interviewer administered pre-tested questionnaire by face to face interviewing of heads of the households from August 13 to September 02, 2018. Data entry and analysis was made using EpiData version 3.1 and SPSS version 20 statistical software respectively. Descriptive statistics, binary and multiple variable logistic regression analysis were performed. Finally, variables with a P-values <0.05 were considered as statistically significant at 95% CI. Results: This study finding showed that, an overall average total cost of malaria per households per year was 28.59US$ (+SD=21.70). An average total direct cost to the household was 13.89US$ (+SD=15.65US$) which accounted 48.58 % and an average total indirect cost was 14.71(+SD=8.71US$) which accounted for 51.42 % of the total cost. Also, an average direct medical cost was 6.73US$ (+SD =8.75) which accounted for 48.46% and an average direct non-medical cost was 7.16US$ (+SD=6.93) which accounted for 51.54% of the total direct cost. Household lost an average of 6.83 productive working days with an average wage loss of 10.32 US$. An estimated 50.2% of the household spent more than 5% of their annual income to pay for the treatment of malaria. The most important significant variables that brought influence on the economic burden of malaria were educational status, ill days, fever days, onset of fever and treatment initiation, perceived severity of illness, completion of prescribed drugs and number of patients received prescription only, level of facility visited on second formal treatment, means of transportation and hospitalizations required in the household. Conclusion: This study found that malaria has been posing a significant economic burden on the households in terms of direct and indirect costs. Although, malaria treatment is supposed to be free in the public health facilities, households in the study area incurred high direct and indirect costs for malaria illness episodes. Also, both individual/patient and availability/accessibility factors influenced the amount of direct and indirect costs. As a result, national malaria program needs to recognize this economic burden and identify mechanisms for ensuring that the community to have uninterrupted easy access for malaria treatment services by engaging the community in to community based health insurance system in addition to preventive services.