Economic costs of hospitalized diarrheal disease in Bangladesh: a societal perspective

Abdur Razzaque Sarker, Marufa Sultana, Rashidul Alam Mahumud, Nausad Ali, Tanvir M Huda, M Salim Uzzaman, Sabbir Haider, Hafizur Rahman, Ziaul Islam, Jahangir A M Khan, Robert Van Der Meer, Alec Morton, Abdur Razzaque Sarker, Marufa Sultana, Rashidul Alam Mahumud, Nausad Ali, Tanvir M Huda, M Salim Uzzaman, Sabbir Haider, Hafizur Rahman, Ziaul Islam, Jahangir A M Khan, Robert Van Der Meer, Alec Morton

Abstract

Background: Diarrheal diseases are a major threat to human health and still represent a leading cause of morbidity and mortality worldwide. Although the burden of the diarrheal diseases is much lower in developed countries, it is a significant public health problem in low and middle-income countries like Bangladesh. Though diarrhea is preventable and managed with low-cost interventions, it is still the leading cause of morbidity according to the patient who sought care from public hospitals in Bangladesh indicating that significant resources are consumed in treating those patients. The aim of the study is to capture the inpatients and outpatient treatment cost of diarrheal disease and to measure the cost burden and coping mechanisms associated with diarrheal illness.

Methods: This study was conducted in six randomly selected district hospitals from six divisions (larger administrative units) in Bangladesh. The study was performed from the societal perspective which means all types of costs were identified, measured and valued no matter who incurred them. Cost analysis was estimated using the guideline proposed by the World Health Organization for estimating the economic burden of diarrheal diseases. The study adopted quantitative techniques to collect the household and hospital level data including structured and semi-structured questionnaires, observation checklists, analysis of hospital database, telephone interviews and compilation of service statistics.

Results: The average total societal cost of illness per episode was BDT 5274.02 (US $ 67.18) whereas the average inpatient and outpatient costs were BDT 8675.09 (US $ 110.51) and BDT 1853.96 (US $ 23.62) respectively. The cost burden was significantly highest for poorest households, 21.45% of household income, compared to 4.21% of the richest quintile.

Conclusions: Diarrheal diseases continue to be an overwhelming problem in Bangladesh. The economic impact of any public health interventions (either preventive or promotive) that can reduce the prevalence of diarrheal diseases can be estimated from the data generated from this study.

Keywords: Bangladesh; Catastrophic expenditure; Cost-of-illness; Diarrhea; Out-of-pocket payment; Public hospitals.

Conflict of interest statement

A written informed consent was obtained from all respondents before the data collection.Not applicable.The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Coping mechanisms during diarrheal treatment
Fig. 2
Fig. 2
Average travel and waiting time for receiving care

References

    1. Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the global burden of disease study 2015. Lancet. 2016;388:1545–1602. doi: 10.1016/S0140-6736(16)31678-6.
    1. Liu L, Oza S, Hogan D, Chu Y, Perin J, Zhu J, et al. Global, regional, and national causes of under-5 mortality in 2000-15: an updated systematic analysis with implications for the sustainable development goals. Lancet. 2016;388:3027–3035. doi: 10.1016/S0140-6736(16)31593-8.
    1. Mashoto KO, Malebo HM, Msisiri E, Peter E. Prevalence, one week incidence and knowledge on causes of diarrhea: household survey of under-fives and adults in Mkuranga district, Tanzania. BMC Public Health. 2014;14:985. doi: 10.1186/1471-2458-14-985.
    1. National Institute of Population Research and Training, Mitra and Associates and II. Bangladesh Demographic and Health Survey 2014: Key Indicators. Dhaka, Bangladesh; 2015.
    1. Montgomery M, Elimelech M. Water and sanitation in developing countries: including health in the equation. Env. Sci Technol. 2007;41:17–24. doi: 10.1021/es072435t.
    1. Schwartz BS, Harris JB, Khan AI, LaRocque RC, Sack DA, Malek MA, et al. Diarrheal epidemics in Dhaka, Bangladesh, during three consecutive floods: 1988, 1998, and 2004. Am J Trop Med Hyg. 2006;74:1067–1073.
    1. Rahman KM, Duggal P, Harris JB, Saha SK, Streatfield PK, Ryan ET, et al. Familial aggregation of vibrio cholerae-associated infection in Matlab, Bangladesh. J Health Popul Nutr. 2009;27:733–738.
    1. Colombara DV, Faruque ASG, Cowgill KD, Mayer JD. Risk factors for diarrhea hospitalization in Bangladesh, 2000-2008: a case-case study of cholera and shigellosis. BMC Infect Dis. 2014;14:440. doi: 10.1186/1471-2334-14-440.
    1. Ali M, Emch M, Donnay JP, Yunus M, Sack RB. Identifying environmental risk factors for endemic cholera: a raster GIS approach. Heal Place. 2002;8:201–210. doi: 10.1016/S1353-8292(01)00043-0.
    1. Biswas DK, Bhunia R, Maji D, Das P. Contaminated pond water favors cholera outbreak at Haibatpur Village, Purba Medinipur District, West Bengal, India. J Trop Med Hindawi Publishing Corporation; 2014;2014.
    1. You YA, Ali M, Kanungo S, Sah B, Manna B, Puri M, et al. Risk map of cholera infection for vaccine deployment: the eastern Kolkata case. PLoS One. 2013;8
    1. Drasar BS, Tomkins AM, Feacham RG. Seasonal aspects of diarrhoeal disease. Seas. Dimens. to Rural poverty. (Report to UK Overseas Dev. Assoc. London Sch. Hyg. Trop. Med. London. London, UK; 1978.
    1. Black RE, Lanata CF. Epidemiology of diarrhoeal diseases in developing countries. Infect. Gastrointest. tract. Blaser MJ, Smith PD, Ravdin JI, Greenb. HP, Guerr. RI, eds. Ra. New York: Raven Press, New York; 1995.
    1. Ozguler M. Febril Neutropenia: an approach as an infectious disease specialist. USA: Scientific Research Publishing, Inc; 2015. Available from: .
    1. Rabbani GH, Larson CP, Islam R, Saha UR, Kabir A. Green banana-supplemented diet in the home management of acute and prolonged diarrhoea in children: a community-based trial in rural Bangladesh. Tropical Med Int Health. 2010;15:1132–1139. doi: 10.1111/j.1365-3156.2010.02608.x.
    1. Isanaka S. Systematic review of diarrhea duration and severity in children and adults in low- and middle-income countries. BMC Public Health [Internet]. BioMed Central Ltd; 2012;12:832.
    1. Sultana M, Mahumud RA, Sarker AR. Emerging patterns of mortality and morbidity in district level hospitals in Bangladesh. Ann Public Heal Res. 2015;2:2–4.
    1. Shillcutt SD, Lefevre AE, Walker CLF, Taneja S, Black RE, Mazumder S. Economic costs to caregivers of diarrhoea treatment among children below 5 in rural Gujarat India : findings from an external evaluation of the DAZT programme. Health Policy Plan. 2016;31:1411–1422. doi: 10.1093/heapol/czw083.
    1. Burke R, Rebolledo P, Embrey S, Wagner L, Cowden C. The burden of pediatric diarrhea: a cross-sectional study of incurred costs and perceptions of cost among Bolivian families. BMC Public Health. 2013;13
    1. Kosek M, Bern C, Guerrant RL. The global burden of diarrhoeal disease, as estimated from studies published between 1992 and 2000. Bull World Health Organ. 2003;81:197–204.
    1. Bartsch SM, Lee BY. Economics and financing of vaccines for diarrheal diseases. Hum Vaccin Immunother. 2014;10:1568–1581. doi: 10.4161/hv.28885.
    1. MacIntyre U, Villiers F. Economic burden of diarrheal disease in a tertiary level hospital, Gauteng, South Africa. J Infect Dis. 2010;202:116–125. doi: 10.1086/653560.
    1. Burke R, Rebolledo P, Embrey S, Wagner L, Cowden CL, Kelly FM, et al. The burden of pediatric diarrhea: a cross-sectional study of incurred costs and perceptions of cost among Bolivian families. BMC Public Health. 2013;13
    1. Bhuiyan MU, Luby SP, Zaman RU, Rahman MW, Sharker MA, Hossain MJ, et al. Incidence of and risk factors for hospital-acquired diarrhea in three tertiary care public hospitals in Bangladesh. Am J Trop Med Hyg. 2014;91:165–172. doi: 10.4269/ajtmh.13-0484.
    1. Pham-Duc P, Nguyen-Viet H, Hattendorf J, Cam PD, Zurbrügg C, Zinsstag J, et al. Diarrhoeal diseases among adult population in an agricultural community Hanam province, Vietnam, with high wastewater and excreta re-use. BMC Public Health. 2014;14:978. doi: 10.1186/1471-2458-14-978.
    1. Konstantyner T, Cláudia T, De Oliveira R, Mais L, Warkentin S. Prevalence and hospitalization rates due to diarrhoea in infants : the 2006 Brazilian National Demographic Health Survey. J Epidemiol Res. 2016;2:29–38. doi: 10.5430/jer.v2n1p29.
    1. Parashar UD, Bresee JS, Glass RI. The global burden of diarrhoeal disease in children. Bull World Health Organ. 2003;81:236.
    1. Ali Q. Calculation of total unit cost for diarrhoeal management at district and Thana health complex. 2001.
    1. Das J, Das SK, Ahmed S, Ferdous F, Farzana FD, Sarker MHR, et al. Determinants of percent expenditure of household income due to childhood diarrhoea in rural Bangladesh. Epidemiol Infect. 2015:1–7.
    1. Rheingans R, Kukla M, Faruque ASG, Sur D, Zaidi AKM, Nasrin D, et al. Determinants of household costs associated with childhood diarrhea in 3 south Asian settings. Clin Infect Dis. 2012;55:327–335. doi: 10.1093/cid/cis764.
    1. Jahangir A. Prevalence and Costs of Childhood Diarrhoea in the Slums of Dhaka. Kathmandu, Nepal; 2009. Report No.: 46–09.
    1. Siegel JE, Weinstein MC, Russell LB, Gold MR. Recommendations for reporting cost-effectiveness analyses. JAMA. J Am Med Assoc. 1996;276:1339–1341. doi: 10.1001/jama.1996.03540160061034.
    1. Gold MR, Siegel JE, Russell LB, Weinstein MC. Cost- effectiveness in health and medicine. New York: Oxford University Press; 1996.
    1. WHO . Guidelines for estimating the economic burden of diarrhoeal disease with focus on assessing the costs of rotavirus diarrhoea. Geneva, Switzerland: Department of Immunization, Vaccines and Biologicals; 2005.
    1. Drummond MF, Sculpher MJ, Torrance GG, O’Brien BJ, Stoddart G. Methods for the economic evaluation of health care Programmes. Third. Oxford Univ. press. York. New York: Oxford University Press; 2005.
    1. Rice DP. Estimating cost of illness. US Dep. Heal. Educ. Welfare, Public Heal. Serv. 1966;
    1. van Roijen L, Essink-Bot ML, Koopmanschap MA, Bonsel G, Rutten FF. Labor and health status in economic evaluation of health care. The health and labor questionnaire. Int J Technol Assess Health Care. 1996;12:405–415. doi: 10.1017/S0266462300009764.
    1. Sarker AR, Islam Z, Khan IA, Saha A, Chowdhury F, Khan AI, et al. Cost of illness for cholera in a high risk urban area in Bangladesh: an analysis from household perspective. BMC Infect Dis. 2013;13:518. doi: 10.1186/1471-2334-13-518.
    1. Poulos C, Riewpaiboon A, Stewart JF, Clemens J, Guh S, Agtini M, et al. Costs of illness due to endemic cholera. Epidemiol Infect. 2012;140:500–509. doi: 10.1017/S0950268811000513.
    1. Chima RI, Goodman CA, Mills A. The economic impact of malaria in Africa: a critical review of the evidence. Health Policy (New York) 2003;63:17–36. doi: 10.1016/S0168-8510(02)00036-2.
    1. Grietens KP, Boock AU, Peeters H, Hausmann-Muela S, Toomer E, Ribera JM. “It is me who endures but my family that suffers”: social isolation as a consequence of the household cost burden of buruli ulcer free of charge hospital treatment. PLoS Negl Trop Dis. 2008;2:1–7.
    1. GOB. MONTHLY REPORT ON FISCAL- MACRO POSITION [Internet]. Dhaka, Bangladesh; 2016. Available from: .
    1. Javanbakht M, Mashayekhi A, Haghdoost A, Khamesh M, Kharazmi E, Sadeghi A, et al. Cost of illness analysis of type 2 diabetes mellitus in Iran. PLoS One. 2011;6
    1. Coduras A, Rabasa I, Frank A, Bermejo-Pareja F, López-Pousa S, López-Arrieta JM, et al. Prospective one-year cost-of-illness study in a cohort of patients with dementia of Alzheimer’s disease type in Spain: the ECO study. J Alzheimers Dis. 2010;19:601–615. doi: 10.3233/JAD-2010-1258.
    1. Coduras A, Rabasa I, Frank A, Bermejo-Pareja F, López-Pousa S, López-Arrieta JM, et al. Prospective one year cost of illness study in a cohort of patients with dementia of Alzheimer’s disease type in Spain: the eco study. J Alzheimers Dis. 2010;19:601–615. doi: 10.3233/JAD-2010-1258.
    1. Carl FB. Diarrhoea case management in low- and middle-income countries. An unfinished agenda. Bull World Health Organ. 2007;85:42–48. doi: 10.2471/BLT.06.030866.
    1. MOHFW . Health bulletin 2016. Dhaka: Bangladesh; 2016.
    1. Alamgir NI, Naheed A, Luby SP, Brooks W, Breiman R, Goswami D, et al. Coping strategies for financial burdens in families with childhood pneumonia in Bangladesh. BMC Public Health. 2010;10:622. doi: 10.1186/1471-2458-10-622.
    1. Andaleeb SS. Public and private hospitals in Bangladesh: service quality and predictors of hospital choice. Health Policy Plan. 2000;15:95–102. doi: 10.1093/heapol/15.1.95.
    1. Aikins M, Armah G, Akazili J, Hodgson A. Hospital health care cost of diarrheal disease in northern Ghana. J Infect Dis. 2010;202 Suppl:S126-30.
    1. Ngabo F, Mvundura M, Gazley L, Gatera M, Rugambwa C, Kayonga E, et al. The economic burden attributable to a child’s inpatient admission for diarrheal disease in Rwanda. PLoS One. 2016;11:1–16. doi: 10.1371/journal.pone.0149805.
    1. Hoang VM, Tran TA, Ha AD, Nguyen VH. Cost of hospitalization for foodborne diarrhea: a case study from Vietnam. J Korean Med Sci. 2015;30:S178–S182. doi: 10.3346/jkms.2015.30.S2.S178.
    1. Fischer Walker CL, Sack D, Black RE. Etiology of diarrhea in older children, adolescents and adults: a systematic review. PLoS Negl Trop Dis. 2010;4
    1. Baqui A, Yunus M, Zaman K, Mitra A, Hossain K. Surveillance of patients attending a rural diarrhoea treatment centre in Bangladesh. Trop Geogr Med. 1991;43:17–22.
    1. Hossain MA, Albert MJ, Hasan KZ. Epidemiology of shigellosis in Teknaf, a coastal area of Bangladesh: a 10-year survey. Epidemiol Infect. 1990;105:41–49. doi: 10.1017/S0950268800047622.
    1. Oberle M, Merson M, Islam M, Rahman A. Diarrhoeal Disease in Bangladesh Epidemiology, Mortality Averted and Costs at a Rural Treatment Centre. Int J [Internet]. 1980;9.
    1. Sarker AR, Mahumud RA, Sultana M, Ahmed S, Ahmed W, Khan JA. The impact of age and sex on healthcare expenditure of households in Bangladesh. Springerplus [Internet]. 2014 [cited 2014 Oct 21];3:435.
    1. Ministry of Health and Family Welfare. Bangladesh National Health Accounts 1997-2012 [Internet]. Dhaka, Bangladesh; 2015. Available from: .
    1. Kawai K, O’Brien MA, Goveia MG, Mast TC, El Khoury AC. Burden of rotavirus gastroenteritis and distribution of rotavirus strains in Asia: a systematic review. Vaccine. Elsevier Ltd; 2012;30:1244–1254.
    1. Tate JE, Chitambar S, Esposito DH, Sarkar R, Gladstone B, Ramani S, et al. Disease and economic burden of rotavirus diarrhoea in India. Vaccine. 2009;27
    1. Sarker AR, Sultana M, Mahumud RA, Meer R Van Der, Morton A, Sarker AR. Cost-effectiveness analysis of introducing universal childhood rotavirus vaccination in Bangladesh Cost-effectiveness analysis of introducing universal childhood rotavirus vaccination in Bangladesh. Hum. Vaccin. Immunother. [Internet]. Taylor & Francis; 2017;Accepted:1–10. Available from: 10.1080/21645515.2017.1356962.
    1. Independent Online Desk. GDP growth 7.05% in current fiscal year. Indep. [Internet]. Dhaka, Bangladesh; 2016 Apr 5; Available from: .
    1. Das SK, Begum D, Ahmed S, Ferdous F, Farzana FD, Chisti MJ, et al. Geographical diversity in seasonality of major diarrhoeal pathogens in Bangladesh observed between 2010 and 2012. Epidemiol Infect. 2014;142:2530–2541. doi: 10.1017/S095026881400017X.
    1. Das SK, Nasrin D, Ahmed S, Wu Y, Ferdous F, Farzana FD, et al. Health care-seeking behavior for childhood diarrhea in Mirzapur, rural Bangladesh. Am J Trop Med Hyg. 2013;89:62–68. doi: 10.4269/ajtmh.13-0107.

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