Cost of Illness Due to Typhoid Fever in Pemba, Zanzibar, East Africa - Journal of Health, Population and Nutrition Vol.32 No.3

Today we are featuring "Cost of Illness Due to Typhoid Fever in Pemba, Zanzibar, East Africa" by Riewpaiboon et al in Journal of Health, Population and Nutrition vol.32 no.3.

Typhoid fever is still an ongoing economic burden within Pemba, Zanzibar, East Africa and the purpose of this study was to estimate said cost associated with this illness. The method used was an incidence-based cost-of-illness analysis from a societal perspective, paying close attention to new episodes of confirmed cases of typhoid fever in patients from inpatient and outpatient hospitals between May 2010 and December 2010. 

The overall cost associated with this illness was both the sum of direct costs and the costs of productivity, or in more fluid economic terms, the opportunity cost of the time lost. The sum of these costs, when broken down more specifically, looks like this: 

direct costs covered treatment, travel, and meals, whereas productivity costs were the loss of income of patients and caregivers. The analysis itself consisted of 17 episodes of confirmed cases with the mean age of the patients was 23 years (range= 5-65, median= 22). Thirty-five percent were inpatients, with a mean timespan of 4.75 days of hospital stay (range=3-7, median= 4.50). 

The results of the study may be surprising: the mean cost for treatment of typhoid fever was care was US$ 21.97 at 2010 prices (US$ 1=1,430.50 Tanzanian Shilling─TSH), with the average societal cost being that of $154.47 per episode. However, the most dramatic expenditure is the overall cost of lost wages of $128.02 (83%). These results help contribute to the economic evaluation of vaccination of typhoid fever in Zanzibar, as well as other sub-Saharan African regions.

For this article and others from this issue, click here.

Esha Homenauth: A Student Perspective: Pre-eclampsia/Eclampsia in the Developing World

Pre-eclampsia is a condition that occurs as a result of elevated blood pressure during pregnancy. It can cause several health complications including eclampsia (seizures), kidney and liver damage, and, ultimately, death. Pre-eclampsia accounted for 63,000 deaths worldwide in 2002, and is characterized as the second direct cause of maternal mortality. According to the World Health Organization, living in a developing country increases the risk of dying due to complications of pre-eclampsia by 300 fold, compared to that of a developed country.(EngenderHealth, 2007. 15 p.)Multiple randomized controlled trials show that magnesium sulphate (MgSO₄) is the essential, most effective, safe and affordable drug available to treat pre-eclampsia and eclampsia. However, only about half the countries in the world adhere to the WHO's recommendation to use MgSO4. In 2009, the maternal mortality ratio (MMR) for India was documented as 212/100,000 livebirths. MgSO₄ is on the list of essential medicines in India, however many women succumb to eclampsia and this accounts for 26% maternal deaths In Maharashtra state, India.

A study by Chaturvedi et al, published in,vol. 31 no. 3 of the Journal of Health, Population and Nutrition is the first study of its kind that reports on the availability of treatment for eclampsia in public facilities throughout rural India. The researchers focused on the public sector with the knowledge that impoverished women are more likely to forgo treatment when accessing health care from private facilities due to financial limitations. MgSO₄ was used exclusively in private facilities for eclampsia treatment; however, health professionals in the public industries were conflicted about the use of MgSO₄ due to risky outcomes. The availability of MgSO₄ injections was unevenly distributed among hospitals with some hospitals having more or less of the recommended number of 50 MgSO₄ injections. Gaps in policy practice for the use of MgSO₄, poor inventory management and poor monitoring processes are reasons suggested for the profound occurrences of eclampsia among pregnant woman in rural India.

As a Health Studies student, I find that this study provides important information regarding medical care provisions for women living in poverty in India to be a great inequality. Studies have been done that highlight the effect of the two-tiered health system in India on the health of local population and knowledge of the influence of the private sector stifling the minimal resources in India is well documented. However, this article focuses solely on the public sector. Though multiple studies address how inequality exists between developed and developing nations, this article focuses on how the effects of inequality trickles down to local populations through limited access to resources, in this case, the availability of MgSO₄ treatment. As such, discrepancies in health outcomes exists between the public and private sector due to poorer pregnant women being unable to afford the drugs to treat the onset or pre-eclampsia or eclampsia.

In developed countries, pre-eclampsia or eclampsia may be a condition often unheard of, but in the developing world, half a million women are affected. With Bioline International providing open access to this journal, fundamental information targeted to these marginalized societies can be brought to attention and strategies can be implemented in order to prevent poorer women from being victimized.

Chaturvedi, S., Randive, B., Mistry, M. (2013) Availability of Treatment for Eclampsia in Public Health Institutions in Maharashtra, India. Journal of Health, Population and Nutrition, 31(1), 78-85