Healthcare Costs and Catastrophic Health Expenditure among Children with and without Sickle Cell Anaemia in Yenagoa, Bayelsa State Nigeria: A Cross Sectional Study

Abstract

Background and Aims: Sickle cell anaemia (SCA) is one of the commonest genetic and chronic diseases in Nigeria. The chronicity of this disease, hospitalisations and interventions, incurs a high financial cost on families when out-of-pocket expenditure is made for healthcare. The aim is to evaluate the prevalence and intensity of catastrophic health expenditure among children with and without sickle cell anaemia in Yenagoa, Bayelsa state, Nigeria. Study Design:  A hospital-based comparative cross-sectional study was done. Place and Duration of Study: The study was conducted at the Paediatrics Haematology and Out-patient Clinics of Federal Medical Centre Yenagoa between April and September 2024 Methodology:  Caregivers of 60 sickle cell anaemia and another 60 caregivers of children without sickle cell anaemia were recruited for the study. Data were collected using pretested questionnaires. Data analysis was by Student T-test, Mann-Whitney U test, Chi-Square test and Fishers-exact test with significance set at P <.05. Results: Females constituted 56.7% and males 43.3% of the children with mean age of 8.0 ± 4.3 years. The annual median total direct healthcare cost on children with SCA was ₦165,190 (IQR= ₦108,895 – ₦211,395) which was not significantly different from that on children without SCA: ₦127,720  (IQR= ₦97,565 – 162,560) P=.010. The prevalence of CHE was 58.3% among the SCA group and 45% among the non-SCA group using the 10% threshold for CHE. There was no significant   difference in catastrophic overshoot: 5.9% ± 19.2% versus 5.1% ± 19.5% (P=.83) and the mean positive overshoot: 14.0% ± 21.6% versus 16.2% ± 24.9% among the SCA group and non-SCA group respectively (P=.071). Conclusion: The healthcare costs, prevalence and intensity of CHE in this study were high among both groups which could affect child survival and wellbeing. There is need for robust efforts towards attainment of universal health coverage.