title: Economic burden of family caregiving for elderly population in southern Ghana: the case of a peri-urban district.
abstract: Health systems in low and lower-middle income countries, particularly in sub-Sahara Africa, often lack the specialized personnel and infrastructure to provide comprehensive care for elderly/ageing populations. Close-to-client community-based approaches are a low-cost way of providing basic care and social support for elderly populations in such resource-constrained settings and family caregivers play a crucial role in that regard. However, family caregiving duties are often unremunerated and their care-related economic burden is often overlooked though this knowledge is important in designing or scaling up effective interventions. The objective of this study, therefore, was to estimate the economic burden of family caregiving for the elderly in southern Ghana.
  
  
  
  The study was a retrospective cross-sectional cost-of-care study conducted in 2015 among family caregivers for elderly registered for a support group in a peri-urban district in southern Ghana. A simple random sample of 98 respondents representative of the support group members completed an interviewer-administered questionnaire. Costs were assessed over a 1-month period. Direct costs of caregiving (including out-of-pocket costs incurred on health care) as well as productivity losses (i.e. indirect cost) to caregivers were analysed. Intangible costs were assessed using the 12-item Zarit burden interview (ZBI) tool and the financial cost dimension of the cost of care index.
  
  
  
  The estimated average cost of caregiving per month was US$186.18, 66% of which was direct cost. About 78% of the family caregivers in the study reported a high level of caregiving burden (as measured with the ZBI) with females reporting a relatively higher level than males. Further, about 87% of the family caregivers reported a high level of financial stress as a result of caregiving for their elderly relative.
  
  
  
  The study shows that support/caregiving for elderly populations imposes economic burden on families, potentially influencing the economic position of families with attendant implications for equity and future family support for such vulnerable populations.
authors.affiliation: Sinel Specialist Hospital, Tema, Ghana.
authors.forename: Stephen Tettey
authors.initials: ST
authors.lastname: Nortey
authors.affiliation: Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana.
authors.forename: Genevieve Cecilia
authors.initials: GC
authors.lastname: Aryeetey
authors.affiliation: Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana.
authors.forename: Moses
authors.initials: M
authors.lastname: Aikins
authors.affiliation: African Population and Health Research Centre, Nairobi, Kenya.
authors.forename: Djesika
authors.initials: D
authors.lastname: Amendah
authors.affiliation: Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana. jnonvignon@ug.edu.gh.
authors.forename: Justice
authors.initials: J
authors.lastname: Nonvignon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D017028:Caregivers; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005190:Family; D005260:Female; D005382:Financing, Personal; D005869:Ghana; D017048:Health Care Costs; D005102:Health Expenditures; D006299:Health Services for the Aged; D006701:Home Nursing / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D012189:Retrospective Studies; D012944:Social Support; D011795:Surveys and Questionnaires; D014937:Work
keywords: Economic burden; Elderly population; Family caregivers; Ghana; Health systems