Assessment for the Cost of Care for Children with Sickle Cell Anaemia in a Tertiary Hospital in Northeastern Nigeria

Background: Sickle cell anaemia (SCA) is a chronic haemolytic anaemic condition resulting in various forms of crises leading to repeated hospitalizations, due to severe pains, infections and anaemia. Knowing this chronic symptomatic disorder that requires constant care by the caregivers of these children, the caregivers of the children with SCA undergo financial hardship in the course of taking care of them. The caregivers experience lots of financial stress from feeding them, taking them to the regular clinic for routine follow-up, paying for their regular drugs, hospital bills/beds when admitted and transportation. As of now, in Nigeria, there is no special programme or legislature to advocate for the Federal or State Government to subsidize SCA patient treatments. The cost implication of sustaining health through routine care and providing healthcare services to SCA patients during any form of crisis is very variable that is borne by the triad of the family caregiver, community or society and state health system itself. The cost of care estimation methods tends to align with these three perspectives singly or in combination with the caregiver of the SCA patient playing a major role. We, therefore, decided to look into the aspect of finances, and how the caregivers are coping as seen in the University of Maiduguri Teaching Hospital (UMTH), insurgency devastated State in Nigeria.

Objective: To assess the cost of care for children with sickle cell anaemia in a Tertiary Hospital of an insurgency devastated region in Nigeria.

Methods: This was a cross-sectional study of caregivers of children with SCA seen at the University of Maiduguri Teaching Hospital. A total of 130 caregivers were randomly selected in a systematic random sampling method where alternate caregivers were recruited when they met the inclusion criteria and were interviewed using a structured questionnaire to assess the cost of care for a child with SCA in the family. They were all administered the questionnaire during the clinic appointment, after going through the questionnaire with them over two months period. The clinic holds every Wednesday and the average clinic attendance ranges from 30 to 45.

Results: One hundred and twenty-seven questionnaires were valid for analysis. Ninety-eight (77.2%) of the respondents were mothers, two-third were from low social class and unemployed full-time housewives. The majority of the caregivers 111 (87.4%) pay for medical bills out-of-pocket, only 16 (12.6%) had registration with NHIS. Fifty-one (40.2%) of the caregivers had to borrow money to pay hospital bills, while 76 (59.8%) do not borrow money for the cost of care of their children with SCD. Of the SCA patients, 46 were not admitted in the last 1 year, 51 (40.2%) were admitted once, 16 (12.6%) were admitted twice, 10 (7,9%) thrice and 4 (3.1%) had 4 or more admissions. For just one admission, they spend a range of ₦750 ($1.6) – ₦4,050:00 ($8.6), thus for 4 admissions, ₦3,000 ($6.4) to ₦16,200 ($34.5) was spent per admission. Forty-seven (37%) of the caregivers have expenses incurred during the treatment of their children which affect their ability to provide for the family basic need, while 80 (63%) did not incur any funds for the care of their children with SCA.

Conclusion: The study demonstrated that caregivers of children with SCA experienced heavy financial burdens and this experience culminate in socio-political and economic situations occasioned by the insurgency devastation of the northeastern region of Nigeria.