title: Cost to households in treating maternal complications in northern Ghana: a cross sectional study.
abstract: BACKGROUND
  The cost of treating maternal complications has serious economic consequences to households and can hinder the utilization of maternal health care services at the health facilities. This study estimated the cost of maternal complications to women and their households in the Kassena-Nankana district of northern Ghana.
  
  
  METHODS
  We carried out a cross-sectional study between February and April 2014 in the Kassena-Nankana district. Out of a total of 296 women who were referred to the hospital for maternal complications from the health centre level, sixty of them were involved in the study. Socio-demographic data of respondents as well as direct and indirect costs involved in the management of the complications at the hospital were collected from the patient's perspective. Analysis was performed using STATA 11.
  
  
  RESULTS
  Out of the 60 respondents, 60% (36) of them suffered complications due to prolonged labour, 17% (10) due to severe abdominal pain, 10% (6) due to anaemia/malaria and 7% (4) due to pre-eclampsia. Most of the women who had complications were primiparous and were between 21-25 years old. Transportation cost accounted for the largest cost, representing 32% of total cost of treatment. The median direct medical cost was US$8.68 per treatment, representing 44% of the total cost of treatment. Indirect costs accounted for the largest proportion of total cost (79%). Overall, the median expenditure by households on both direct and indirect costs per complication was US$32.03. Disaggregating costs by type of complication, costs ranged from a median of US$58.33 for pre-eclampsia to US$6.84 for haemorrrhage. The median number of days spent in the hospital was 2 days - five days for pre-eclampsia. About 33% (6) of households spent more than 5% of annual household expenditure and therefore faced catastrophic payments.
  
  
  CONCLUSIONS
  Although maternal health services are free in Ghana, women still incur substantial costs when complications occur and face the risk of incurring catastrophic health expenditure.
authors.affiliation: University of Heidelberg, Institute of Public Health, Heidelberg, Germany. madalaba@yahoo.com.|Navrongo Health Research Centre, Navrongo, Ghana. madalaba@yahoo.com.
authors.forename: Maxwell Ayindenaba
authors.initials: MA
authors.lastname: Dalaba
authors.affiliation: University of Ghana, School of Public Health, Accra, Ghana. akweongo@gmail.com.
authors.forename: Patricia
authors.initials: P
authors.lastname: Akweongo
authors.affiliation: Navrongo Health Research Centre, Navrongo, Ghana. rayborigo@yahoo.com.|Global Public Health, Monash University, Monash, Malaysia. rayborigo@yahoo.com.
authors.forename: Raymond Akawire
authors.initials: RA
authors.lastname: Aborigo
authors.affiliation: University of Heidelberg, Institute of Public Health, Heidelberg, Germany. sarongahappiness@yahoo.com.|Behavioural Sciences Department, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. sarongahappiness@yahoo.com.
authors.forename: Happiness Pius
authors.initials: HP
authors.lastname: Saronga
authors.affiliation: Navrongo Health Research Centre, Navrongo, Ghana. williamsjeo@hotmail.com.
authors.forename: John
authors.initials: J
authors.lastname: Williams
authors.affiliation: Navrongo Health Research Centre, Navrongo, Ghana. Gifty.Apiung@navrongo-hrc.org.
authors.forename: Gifty Apiung
authors.initials: GA
authors.lastname: Aninanya
authors.affiliation: University of Heidelberg, Institute of Public Health, Heidelberg, Germany. rainer.sauerborn@urz.uni-heidelberg.de.
authors.forename: Rainer
authors.initials: R
authors.lastname: Sauerborn
authors.affiliation: University of Heidelberg, Institute of Public Health, Heidelberg, Germany. svetla.loukanova@urz.uni-heidelberg.de.
authors.forename: Svetla
authors.initials: S
authors.lastname: Loukanova
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D005869:Ghana; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008427:Maternal Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000191:economics* / Q000628:therapy*; D012959:Socioeconomic Factors; D055815:Young Adult