Coping strategies for financial burdens in families with childhood pneumonia in Bangladesh.
BACKGROUND
This study aimed to determine the out-of pocket expenditure and coping strategies adopted by families of children admitted in a hospital in Bangladesh with pneumonia.


METHODS
Trained interviewers surveyed parents of 90 children and conducted in-depth interviews with six families below the age of 5 years who were admitted to the largest pediatric hospital in Bangladesh with a diagnosis of pneumonia. We estimated the total cost of illness associated with hospitalization and explored the coping strategies of the families.


RESULTS
The mean expenditure of the families for the illness episode was US$ 94 (±SD 52.5) with 75% having spent more than half of their total monthly expenditure on this hospitalization. Three fourths (68/90, 76%) of the families managed the expenditure by borrowing, mortgaging or selling assets; 64% had to borrow the full cost of hospitalization and 10% borrowed from the formal sector with a monthly interest rate of 5 to 30%. The burden was highest for the people from poor income strata. Families earning ≤US$ 59 per month were 10 times more likely than families earning ≥US$ 59 per month to borrow money (OR = 10.0, 95% CI: 2.8-38.8). To repay their debts, 22% of families reported that they would work extra hours and 50% planned to reduce spending on food and education for their children.


CONCLUSIONS
Coping strategies adopted by the families to manage the out-of-pocket expenditure for children requiring hospitalization were catastrophic for the majority of the families. Efforts to prevent childhood pneumonia for example, by vaccination against the most common pathogens, by improving air quality and by improving childhood nutrition can provide a double advantage. They can prevent both disease and poverty.
James P Grant School of Public Health, BRAC University, 66 Mohakhali, Dhaka-1212, Bangladesh. nishrat@bracu.ac.bd
Nadia I
NI
Alamgir
Aliya
A
Naheed
Stephen P
SP
Luby
D000223:Adaptation, Psychological; D001459:Bangladesh; D002675:Child, Preschool; D017281:Cost of Illness; D005260:Female; D005382:Financing, Personal; D006296:Health Services; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007407:Interviews as Topic; D008297:Male; D011014:Pneumonia / Q000191:economics*; D011795:Surveys and Questionnaires