Commentary: The economic burden of pneumonia, diarrhea, and measles is significant for households in Uganda

Policy makers call for action to fight disease

By Dagna Constenla, Elizabeth Ekirapa Kiracho, and Gatien de Broucker

The Decade of Vaccine Economics (DOVE) study has revealed significant household costs associated with childhood diseases and policy makers are taking notice.

“Clearly, pneumonia, diarrhea, and measles present a real health and economic burden in Uganda,” said Dr. Charles Olaro, Director Clinical and Community Services at the Ministry of Health.

“Too many children are debilitated or die from these serious diseases, yet they are preventable by vaccines,” said Dr. Olaro. “Our new research proves that we need to improve our strategies to fight these childhood diseases,” he said about the findings from the fourth part of the study, DOVE IV.

Dr. Olaro spoke at a seminar in Kampala earlier this month that brought together 50 local stakeholders, experts, and decision makers. The seminar and the three others that followed in Jinja, Gula, and Mbarara districts provided forums for discussing opportunities to prevent childhood diseases such as allocating more resources.

To make a case for resource allocation in countries like Uganda, it’s imperative to understand the economic impact of pneumonia, diarrhea and measles, three common and severe illnesses among infants and young children. DOVE IV, which is wrapping up in Bangladesh and Uganda, was the first-ever cost-of-illness study to estimate the economic burden of pneumonia, diarrhea and measles from the household and societal perspectives in Uganda.

Healthcare facility managers and practitioners at the DOVE dissemination seminar in Mbarara district, Uganda 

What are the costs of common childhood diseases in Uganda?

What is clear from our research is that pneumonia, diarrhea, and measles have significant costs for households, who were estimated to spend out-of-pocket over 65,000 Ugandan shillings (about US$20) on average to treat one inpatient case in a private for-profit facility and 12,000 shillings (US$4) in a private not-for-profit facility.

These estimates include direct medical costs, out-of-pocket expenses, and indirect costs such as productivity losses, based on observed practice. Hospital care costs made up the biggest proportion of the total costs of pneumonia, diarrhea, and measles but loss of productivity contributed substantially to the total cost for pneumonia, diarrhea, and measles. We determined the amount of out-of-pocket spending, such as on transportation and over-the counter medication, based on caregiver interviews. A final analysis that includes the societal perspective is forthcoming.

Public health costs associated with the management of childhood diseases often go under-reported and underestimated in the literature, but they provide critical evidence for decision makers. Cost-of-illness studies aid in the policy making process in several ways:

  • These studies help estimate the true economic burden of common childhood diseases.
  • Since some illness can be prevented by vaccines, cost-of-illness results provide inputs into future health economic studies that evaluate the economic value of vaccination programs.
  • These results help stimulate greater interest in the economic implications of using vaccines.
  • They also help determine the funding required for new vaccine introduction and aid in overall strategic planning for vaccine introduction.

Findings of this study underscore the importance of pneumonia, diarrhea, and measles in Uganda. Future research should focus on a more detailed investigation of long-term costs of these childhood diseases.

Feedback from health workers: #COI studies give important insights into planning for health care at both household level and health facility level.thus diseases can be managed better and accelerate towards #UHC. thank you #DOVEIV

These results also help us better understand the complexities and challenges of conducting cost-of-illness studies in resource-constrained settings and pave the way for further research, creativity, and innovation in the public health community. Detailed final results will be available soon.

Snapshots of the seminars held in the districts are shared on Twitter with #DOVEIV and #DOVE4.

The same study is being conducted as part of DOVE IV in Bangladesh by IVAC and the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b).