PDF(Pubmed)
Abstract：
Severe acute malnutrition (SAM) is a high-fatality condition that affected 13.7 million children under five years of age worldwide in 2022, with complicated cases requiring extensive inpatient stay with an accompanying caregiver. Our objective was to assess the costs of inpatient treatment for complicated SAM in children aged 6 to 59 months in Northern Senegal and identify cost predictors. We performed a retrospective cost analysis, including 140 children hospitalized from January to December 2020 in five SAM inpatient treatment facilities. We adopted a societal perspective, including direct medical and non-medical costs and indirect costs. We extracted patients\' sociodemographic and clinical data from medical records and conducted semi-structured interviews with healthcare staff to capture information on time allocation and care management. A multivariable generalized linear model with gamma family and a log link was used to investigate the factors associated with direct costs. Costs are expressed in 2020 international USD using purchasing power parity. Mean length of stay was 5.3 (SD = 3.2) days and diarrhoea was the cause of the admission in 55.7% of cases. Mean total cost was USD 431.9 (SD = 203.9), with personnel being the largest cost item (33% of the total). Households\' out-of-pocket expenses represented 45.3% of total costs and amounted to USD 195.6 (SD = 103.6). Costs were significantly associated with gender (20.3% lower in boys), diarrhoea (27% increase), anaemia (49.4% increase), inpatient death (44.9% decrease), and type of facility (26% higher in hospitals vs. health centre). Our study highlights the financial burden of complicated SAM in Senegal in particular for families. This underscores the need for tailored prevention and social policies to protect families from the disease\'s financial burden and improve treatment adherence, both in Senegal and similar contexts.
摘要：
严重急性营养不良（SAM）是一种高致死率疾病，在2022年影响了全球1370万5岁以下儿童，复杂的病例需要在陪同护理人员的陪同下大量住院。我们的目标是评估塞内加尔北部6至59个月儿童的复杂SAM住院治疗费用，并确定费用预测因素。我们进行了回顾性成本分析，包括2020年1月至12月在5个SAM住院治疗设施住院的140名儿童。我们采用了社会观点，包括直接医疗和非医疗费用以及间接成本。我们从医疗记录中提取患者的社会人口统计学和临床数据，并与医护人员进行半结构化访谈，以获取有关时间分配和护理管理的信息。使用具有伽马族和对数链接的多变量广义线性模型来研究与直接成本相关的因素。成本以2020年国际美元使用购买力平价表示。平均住院时间为5.3（SD=3.2）天，腹泻是55.7％病例的入院原因。平均总成本为431.9美元(标准差=203.9)，人员是最大的成本项目(占总数的33%)。家庭自付费用占总成本的45.3%，达195.6美元(标准差=103.6)。费用与性别显著相关(男孩低20.3%)，腹泻(增加27%)，贫血（增加49.4%），住院死亡（下降44.9%），和设施类型(医院比医院高出26%健康中心)。我们的研究强调了塞内加尔复杂的SAM的经济负担，特别是家庭。这强调需要有针对性的预防和社会政策，以保护家庭免受疾病的经济负担，并提高治疗依从性，在塞内加尔和类似的情况下。
