Patient level cost of home and facility based child Pneumonia case treatment in Suba sub county Kenya

Abstract

Globally Pneumonia is one of the major causes of death in children under 5 years old in 2018. Kenya is ranked among top 15 countries which contribute about 74% of the world's annual pneumonia cases in 2018. Unfortunately, less than fifty percent of children with pneumonia receive appropriate antibiotics for treatment. Homa Bay County implemented pneumonia community case management as recommended by WHO utilizing community health workers. Health care seeking behaviour studies have found that the treatment cost in care seeking influence choice of place to seek care. The patient level cost of home based and facility based treatment of pneumonia in Suba Sub County and its influence on choice of subsequent place to seek care remained uncertain. As such the main objective of this study was to compare the patient level costs of home treatment of pneumonia by community health worker with health facility based treatment and its influences on the choice of subsequent place to seek care. Specifically the objectives of study were: to estimate the patient level costs associated with pneumonia home based treatment by community health worker for children aged 2-59months diagnosed with pneumonia in Suba sub county, Kenya; to estimate the patient level costs associated with facility based treatment of pneumonia for children aged 2-59months diagnosed with pneumonia in Suba sub county, Kenya; to determine how household treatment cost for children aged 2-59 months diagnosed with pneumonia, determines the caregiver’s choice of subsequent place to seek care in Suba sub county, Kenya. Using a cross section study design participants were surveyed. This study was nested within the larger iCCM implementation study. A structured questionnaire was used to collect quantitative data from caregivers on direct cost (consultation, medicine, transport) and indirect costs (Opportunity cost) of pneumonia treatment. Based on the Yamane formula 1967 for sample size calculation a total of 208 participants were recruited into the study. The average household cost for the community managed cases was Ksh 122.65($1.29) compared with Ksh 447.46($4.71) for those treated at the health facility, a 4-fold difference. The largest cost drivers for home and health facility treatment were opportunity cost (Ksh 88.25 ($ 0.93)) and Medicine (Ksh 126.16 ($ 1.33)) respectively. A logistic regression conducted found that cost of treatment of pneumonia had a highly significant effect on subsequent place of seeking carep<0.001. Consultation fee and medicine increased the odds of choosing a CHW over Health facility by 34% and 11% respectively. This study recommends strengthening of the community case management of pneumonia.