Assessing the economic burden of urinary Schistosomiasis among household members in Wassa Amenfi District

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Schistosomiasis is a communicable disease caused by the adult form of a long fluke that belong to the genus schistosoma. Infection with any of the 5 species of schistosorna worm is rarely fatal but the resulting organ damage is progressive, leading to chronic illness and complications in adult life. It ranks second to malaria in terms of socio-economic and public health importance in the tropical and subtropical areas. It is estimated to affect between 200 and 300 million people in 79 countries. In Ghana, urinary and intestinal forms of the disease are common. It is a frequent cause of absenteeism from school by pupils and from work by carers. The study objectives were assessing trend of urinary schistosomiasis reported at Asankragwa Catholic Hospital from 2001 to 2003, estimating the total cost of disease among households and describing the actions by households to manage costs. Evaluation of direct medical and non-medical and indirect costs was carried out retrospectively among hundred households with a member who has suffered urinary schistosomiasis and had received treatment at the Catholic Hospital at the district capital These households were selected using simple random and purposive sampling. Direct medical cost obtained at the District Hospital included cost due to registration, consultation, laboratory test and drugs. The direct non-medical cost which was prospectively obtained using an interview guide were cost of travel to the health facility, food bought by the accompanied person and the sick whilst seeking care and cost of labour hired by the households in the absence of the member. The indirect costs, foregone earnings by the sick and accompanied person were calculated using the wage rate approach. Urinary schistosomiasis is perceived as the commonest water related disease in the study area and affects mainly 10 to 14 year age group. The reported cases at the out-patient seem to be decreasing, though insignificantly, from 3.38%, 3.35% and 3.32% for the year 2001, 2002 and 2003 respectively. Average direct medical cost was ¢45,700.00. The component of drug in this cost was ¢30,800.00 per episode. Average costs of transport per household were ¢13,424.52, 16% of the total directs cost Average costs of hired labour was ¢20,200.00 per household. This is about 11 % of average village daily wage. Food purchased was on the average ¢4,567, 53% of total non- medical cost. Average total direct costs were ¢83,791.00 per episode per household. On the average each household lost 1.15 days per episode which translates to an amount of ¢20,642.00 per day per episode, 13% higher than the average village daily wage. As a coping strategy, savings were used to meet the cost involved. Urinary schistosomiasis imposes a high economic burden on households in Wassa Arnenfi District and is likely to result in delay in seeking help from appropriate sources.
thesis submitted to the Department of Community Health, School of Medical Sciences, College of Health Sciences Kwame Nkrumah University of Science and Technology in partial fulfilment of the requirements for the award of in Health Services Planning and Management, 2004