Incidence of catastrophic health expenditures for households: an example of medical attention for the treatment of severe childhood malaria in Kinshasa reference hospitals, Democratic Republic of Congo

This study aimed to estimate the incidence of catastrophic health expenditures faced by households in Kinshasa with children affected by severe malaria. A total of 1350 children below the age of 15 year who were hospitalized due to severe malaria were included in the study. We analyzed the incidence of households facing catastrophic expenditures according to two thresholds: 40% of the household's capacity to pay and 10% of the household's total consumption. Based on the [40% of the capacity to pay] threshold, the incidence of catastrophic health expenditures reached 81.1%, and this estimate reached 46.4% for the [10% above total consumption] threshold. Regarding the >/= 40% capacity to pay threshold, the incidences of catastrophic expenditures was higher among households with children who were admitted to state hospitals [adjusted odds ratio [aOR] 3.7] and private hospitals [aOR 59.1], for poor households [aOR 13], for households with medium socioeconomic statuses [aOR 3.2], for female-headed households [aOR 2.9], for households with children affected by the neurological form [aOR 4.8] and respiratory distress [aOR 3.6], and for households who opted for a pre-hospital resort [aOR 2.7]. Similar results were obtained when the 10% above the total consumption threshold was applied. Greater government financing of medical attention would lead to a reduction in the catastrophic health expenditures faced by the poorest households

Treatment-seeking Paths in the Management of Severe Malaria in Children under 15 Years of Age Treated in Reference Hospitals of Kinshasa, Democratic Republic of Congo

Background: In the Democratic Republic of Congo (DRC), few studies have focused on treatment-seeking paths selected by caretakers for the management of severe childhood malaria in an urban environment. The present study aims at describing the treatment-seeking paths according to the characteristics of households, as well as the subsequent impact on pre-hospitalisation delay and malarial fatality and on the main syndromes associated with severe childhood malaria. Methods: This descriptive study included data collected at nine hospitals in Kinshasa between January and November 2011. A total of 1,350 children, under 15 years of age and hospitalised for severe malaria, were included in the study. Results: Regarding the management of malaria, 31.5% of households went directly to the health centre or hospital while 68.5% opted for self-medication, church and/or traditional healing therapy. The most frequent first-line option was self-medication, adopted by more than 61.5% of households. Nevertheless, rational self-medication using antimalarial drugs recommended by the WHO (artemisinin-based combinations) was reported for only 5.5% of children. Only 12.5% of households combined 2 or 3 traditional options. The following criteria influenced the choice of a modern <i>vs</i>. traditional path: household socioeconomic level, residential environment, maternal education level and religious beliefs. When caretakers opted for traditional healing therapy, the pre-hospitalisation delay was longer and the occurrence of respiratory distress, severe anaemia and mortality was higher. Conclusion: The implementation of a malaria action plan in the Democratic Republic of Congo should take into account the diversity and pluralistic character of treatment-seeking behaviours in order to promote the most appropriate options (hospital and rational self-medication) and to avoid detrimental outcomes.

Treatment-seeking paths in the management of severe malaria in children under 15 years of age attended in reference hospitals of Kinshasa, Democratic Republic of Congo

Background: In the Democratic Republic of Congo (DRC), fewstudies have focused on treatment-seeking paths selected by caretakers for themanagement of severe childhood malaria in an urban environment. The presentstudy aims at describing the treatment-seeking paths according to thecharacteristics of households, and the subsequent impact on pre-hospitalisationdelay and malarial fatality, as well as on the main syndromes associated withsevere childhood malaria. Methods: This descriptive study included data collected in nine hospitals ofKinshasa between January and November 2011. A total of 1,350 children, under 15years of age and hospitalised for severe malaria, were included in the study. Results: Regarding the management of malaria, 31.5% of households directly wentto the health centre or hospital while 68.5% of them opted for self-medication,church and/or traditional healing therapy. The most frequent first-line optionwas self-medication, adopted by more than 61.5% of households. Nevertheless,rational self-medication relying on the use of antimalarial drugs recommendedby the WHO (artemisinin-based combinations), was only reported for 5.5% ofchildren. Only 12.5% of households combined 2 or 3 traditional options. Thefollowing criteria influenced the choice of a modern <i>vs.</i> a traditional path: household socioeconomic level, residentialenvironment, mother educational level and religious beliefs. When caretakersopted for traditional healing therapy, the pre-hospitalisation delay was longerwhile the occurrence of respiratory distress, severe anaemia and mortality wasmore frequent. Conclusion: The implementation of a malaria action plan  in the Democratic Republic of Congo shouldtake into account the diversity and pluralistic character of treatment-seekingbehaviours, in order to promote the most appropriate options (hospital andrational self-medication) and avoid the deadliest severe forms.