title: The economic burden of childhood pneumococcal diseases in The Gambia.
abstract: BACKGROUND
  Streptococcus pneumoniae is a common cause of child death. However, the economic burden of pneumococcal disease in low-income countries is poorly described. We aimed to estimate from a societal perspective, the costs incurred by health providers and families of children with pneumococcal diseases.
  
  
  METHODS
  We recruited children less than 5 years of age with outpatient pneumonia, inpatient pneumonia, pneumococcal sepsis and bacterial meningitis at facilities in rural and urban Gambia. We collected provider costs, out of pocket costs and productivity loss for the families of children. For each disease diagnostic category, costs were collected before, during, and for 1 week after discharge from hospital or outpatient visit.
  
  
  RESULTS
  A total of 340 children were enrolled; 100 outpatient pneumonia, 175 inpatient pneumonia 36 pneumococcal sepsis, and 29 bacterial meningitis cases. The mean provider costs per patient for treating outpatient pneumonia, inpatient pneumonia, pneumococcal sepsis and meningitis were US$8, US$64, US$87 and US$124 respectively and the mean out of pocket costs per patient were US$6, US$31, US$44 and US$34 respectively. The economic burden of outpatient pneumonia, inpatient pneumonia, pneumococcal sepsis and meningitis increased to US$15, US$109, US$144 and US$170 respectively when family members' time loss from work was taken into account.
  
  
  CONCLUSIONS
  The economic burden of pneumococcal disease in The Gambia is substantial, costs to families was approximately one-third to a half of the provider costs, and accounted for up to 30 % of total societal costs. The introduction of pneumococcal conjugate vaccine has the potential to significantly reduce this economic burden in this society.
authors.affiliation: MRC, The Gambia Unit, PO Box 273, Banjul, Gambia.
authors.forename: Effua
authors.initials: E
authors.lastname: Usuf
authors.affiliation: MRC, The Gambia Unit, PO Box 273, Banjul, Gambia ; Pneumococcal Group, Murdoch Children's Research Institute, Parkville, Australia ; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Grant
authors.initials: G
authors.lastname: Mackenzie
authors.affiliation: Ministry of Health, Banjul, Gambia.
authors.forename: Sana
authors.initials: S
authors.lastname: Sambou
authors.affiliation: PATH, Seattle, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Atherly
authors.affiliation: PATH, Seattle, USA ; U.S. Centers for Disease Control and Prevention, Atlanta, USA.
authors.forename: Chutima
authors.initials: C
authors.lastname: Suraratdecha