The financial burden of sickle cell disease on households in Ekiti, Southwest Nigeria

Oladele Simeon Olatunya,1,3 Ezra Olatunde Ogundare,1,3 Joseph Olusesan Fadare,2 Isaac Oludare Oluwayemi,1,3 Oyinkansola Tolulope Agaja,3 Babajide Samson Adeyefa,3 Odunayo Aderiye3 1Department of Paediatrics, Ekiti State University, Ado Ekiti, Nigeria; 2Department of Clinical Pharmacology, Ekiti State University, Ado Ekiti, Nigeria; 3Department of Paediatrics, Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria Background: Studies on economic impact of sickle cell disease (SCD) are scanty despite its being common among children in developing countries who are mostly Africans.Objective: To determine the financial burden of SCD on households in Ado Ekiti, Southwest Nigeria.Methods: A longitudinal and descriptive study of household expenditures on care of 111 children with SCD managed at the pediatric hematology unit of the Ekiti State University Teaching Hospital was conducted between January and December 2014.Results: There were 64 male and 47 female children involved, aged between 15 and 180 months. They were from 111 households, out of which only eight (7.2%) were enrolled under the National Health Insurance Scheme. The number of admissions and outpatients' consultations ranged from 1 to 5 and 1 to 10 per child, respectively. Malaria, vaso-occlusive crisis, and severe anemia were the leading comorbidities. The monthly household income ranged between ₦12,500 and ₦330,000 (US$76 and US$2,000) with a median of ₦55,000 (US$333), and health expenditure ranged between ₦2,500 and ₦215,000 (US$15 and US$1,303) with a mean of ₦39,554±35,479 (US$240±215). Parents of 63 children lost between 1 and 48 working days due to their children's ill health. Parents of 23 children took loans ranging between ₦6,500 and ₦150,000 (US$39 and US$909) to offset hospital bills. The percentage of family income spent as health expenditure on each child ranged from 0.38 to 34.4. Catastrophic health expenditure (when the health expenditure >10% of family income) occurred in 23 (20.7%) households. Parents who took loan to offset hospital bills, low social class, and patients who took ill during the study period significantly had higher odds for catastrophic health expenditure (95% confidence interval [CI] 5.399–87.176, P=0.000; 95% CI 2.322–47.310, P=0.002; and 95% CI 1.128–29.694, P=0.035, respectively).Conclusion: SCD poses enormous financial burden on parents and households.Keywords: sickle cell disease, family income, health expenditure, financial catastrophe, Nigeria