title: Household health care-seeking costs: experiences from a randomized, controlled trial of community-based malaria and pneumonia treatment among under-fives in eastern Uganda.
abstract: BACKGROUND
  Home and community-based combined treatment of malaria and pneumonia has been promoted in Uganda since mid 2011. The combined treatment is justified given the considerable overlap between the symptoms of malaria and pneumonia among infants. There is limited evidence about the extent to which community-based care reduces healthcare-seeking costs at the household level in rural and urban settings. This paper assesses the rural-urban differences in direct and indirect costs of seeking care from formal health facilities compared to community medicine distributors (CMDs).
  
  
  METHODS
  Exit interviews were conducted for 282 (159 rural and 123 urban) caregivers of children below five years who had received treatment for fever-related illnesses at selected health centres in Iganga and Mayuge districts. Data on the direct and indirect costs incurred while seeking care at the health centre visited were obtained. Using another tool, household level direct and indirect costs of seeking care from CMDs were collected from a total of 470 caregivers (304 rural and 166 urban). Costs incurred at health facilities were then compared with costs of seeking care from CMDs.
  
  
  RESULTS
  Household direct costs of seeking care from health facilities were significantly higher for urban-based caregivers than the rural (median cost = US$0.42 for urban and zero for rural; p < 0.0001). The same is true for seeking care from CMDs (p = 0.0038). Overall, caregivers travelled for an average of 75 min to reach health centres and spent an average of 80 min at the health centre while receiving treatment. However, households in rural areas travelled for a significantly longer time (p < 0.001 to reach health care facilities than the urban-based caregivers. Besides travelling longer distances, rural caregivers spent 150 min seeking care from health facilities compared to 30 min from CMDs.
  
  
  CONCLUSIONS
  Time and monetary savings for seeking care from CMDs are significantly larger for rural than urban households. Thus, home and community-based treatment of child febrile illnesses is much more cost-saving for rural poor communities, who would spend more time travelling to health facilities - which time could be re-directed to productive and income-generating activities.
authors.affiliation: School of Economics, Makerere University, PO Box 7062, Kampala, Uganda. frmatov2000@yahoo.co.uk.
authors.forename: Fred
authors.initials: F
authors.lastname: Matovu
authors.forename: Aisha
authors.initials: A
authors.lastname: Nanyiti
authors.forename: Elizeus
authors.initials: E
authors.lastname: Rutebemberwa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005191:Family Characteristics; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008288:Malaria / Q000175:diagnosis*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011014:Pneumonia / Q000175:diagnosis*; D016032:Randomized Controlled Trials as Topic; D012424:Rural Population; D014454:Uganda; D014505:Urban Population; D055815:Young Adult