title: The economic burden of pediatric gastroenteritis to Bolivian families: a cross-sectional study of correlates of catastrophic cost and overall cost burden.
abstract: BACKGROUND
  Worldwide, acute gastroenteritis causes substantial morbidity and mortality in children less than five years of age. In Bolivia, which has one of the lower GDPs in South America, 16% of child deaths can be attributed to diarrhea, and the costs associated with diarrhea can weigh heavily on patient families. To address this need, the study goal was to identify predictors of cost burden (diarrhea-related costs incurred as a percentage of annual income) and catastrophic cost (cost burden ≥ 1% of annual household income).
  
  
  METHODS
  From 2007 to 2009, researchers interviewed caregivers (n = 1,107) of pediatric patients (<5 years old) seeking treatment for diarrhea in six Bolivian hospitals. Caregivers were surveyed on demographics, clinical symptoms, direct (e.g. medication, consult fees), and indirect (e.g. lost wages) costs. Multivariate regression models (n = 551) were used to assess relationships of covariates to the outcomes of cost burden (linear model) and catastrophic cost (logistic model).
  
  
  RESULTS
  We determined that cost burden and catastrophic cost shared the same significant (p < 0.05) predictors. In the logistic model that also controlled for child sex, child age, household size, rural residence, transportations taken to the current visit, whether the child presented with complications, and whether this was the child's first episode of diarrhea, significant predictors of catastrophic cost included outpatient status (OR 0.16, 95% CI [0.07, 0.37]); seeking care at a private hospital (OR 4.12, 95% CI [2.30, 7.41]); having previously sought treatment for this diarrheal episode (OR 3.92, 95% CI [1.64, 9.35]); and the number of days the child had diarrhea prior to the current visit (OR 1.14, 95% CI [1.05, 1.24]).
  
  
  CONCLUSIONS
  Our analysis highlights the economic impact of pediatric diarrhea from the familial perspective and provides insight into potential areas of intervention to reduce associated economic burden.
authors: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA. rmburke@emory.edu.
authors: Rachel M
authors: RM
authors: Burke
authors: Emily R
authors: ER
authors: Smith
authors: Rebecca Moritz
authors: RM
authors: Dahl
authors: Paulina A
authors: PA
authors: Rebolledo
authors: Maria del Carmen
authors: Mdel C
authors: Calderón
authors: Beatriz
authors: B
authors: Cañipa
authors: Edgar
authors: E
authors: Chavez
authors: Rolando
authors: R
authors: Pinto
authors: Luis
authors: L
authors: Tamayo
authors: Carlos
authors: C
authors: Terán
authors: Angel
authors: A
authors: Veizaga
authors: Remy
authors: R
authors: Zumaran
authors: Volga
authors: V
authors: Iñiguez
authors: Juan S
authors: JS
authors: Leon
mesh_terms: D000293:Adolescent; D000328:Adult; D001838:Bolivia; D017028:Caregivers; D002675:Child, Preschool; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003906:Developing Countries; D003967:Diarrhea / Q000191:economics*; D005190:Family; D005260:Female; D005759:Gastroenteritis / Q000191:economics*; D005102:Health Expenditures; D006760:Hospitalization; D006801:Humans; D007182:Income; D007223:Infant; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011203:Poverty; D012424:Rural Population; D055815:Young Adult