Household burden of malaria in South Africa and Mozambique: is there a catastrophic impact?
Household burden of malaria in South Africa and Mozambique: is there a catastrophic impact?
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DOI：
10.1111/j.1365-3156.2007.01979.x
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发表时间：
2008-01-01
影响因子：
3.3
通讯作者：
Barnes, Karen
中科院分区：
文献类型：
--
作者：
Castillo-Riquelme, Marianela;McIntyre, Diane;Barnes, Karen
目标 评估莫桑比克南部和南非东部因疟疾事件而寻求治疗的行为、财务影响和时间损失。方法 对深入的家庭调查（莫桑比克 828 项和南非 827 项）进行了分析。使用主成分分析计算资产指数，以便跨社会经济群体进行比较。确定了寻求治疗的直接费用和因疟疾损失的时间。根据世界卫生组织最近的建议，灾难性支付的程度是使用传统的家庭收入的 10% 和非食品收入的 40% 作为阈值进行评估的。 结果 贫困现象非常普遍：研究中 70% 的南非家庭和 95% 的莫桑比克家庭的人均每日生活费不足 1 美元。大约 97% 近期患有疟疾的人寻求医疗保健，主要是在公共设施中。南非每次疟疾发作的家庭自付费用平均为 2.30 美元，莫桑比克为 6.50 美元。对个体家庭层面的分析发现，莫桑比克有 32-34% 的家庭因疟疾发作而支付了灾难性费用，而南非这一比例为 9-13%。基于平均值的结果低估了灾难性付款的发生率。莫桑比克的上班/上学休息时间更长。 结论 在非洲，前往公共卫生机构就诊的高比例似乎不寻常，这预示着基于青蒿素的组合药物的高覆盖率，即使仅在公共部门内部署。然而，尽管公共部门初级医疗保健不收费或收费很少，但家庭经常因单次疟疾发作而产生灾难性支出。
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.