Cost of care for preterm babies in low resource settings: A case of Jinja Regional Referral Hospital in East Central Uganda

Abstract

Introduction: Preterm birth is still a global health burden especially in Africa and South Asia. Complications arising from preterm birth are a significant contributor to under five mortality in Uganda. Despite it being a major public health concern, it has not received the adequate attention it deserves. To inform policy to improve preterm care and so reduce deaths in this vulnerable population, there is need for information on costs of preterm care. This study took on a societal perspective to estimate the cost of care for preterm babies. Objective: We estimated the cost of care for preterm babies in Jinja Referral Hospital and explored the influence of financial costs on care for these babies in East central Uganda. Methods: This was a one-year cost analysis that took on a micro-costing approach. Accounting records were reviewed to determine costs from the provider perspective. A survey done to establish client associated costs and the influence of the costs on preterm care to providers and clients. Analysis of findings was done using the Microsoft excel sheet, STATA version 12 and manually using Thematic analysis. Costs were converted to US$ for the annual exchange average rate of 2016. One-way sensitivity analysis was done to establish the impact of cost drivers on the total cost. Results: The total annual cost of preterm care from the provider perspective was US$ 54,108 and the unit cost of care per preterm baby was US$ 107 at Jinja Regional Referral Hospital. The unit cost of care per preterm baby to the clients was US$ 104. Cost drivers from the provider perspective were equipment, personnel and utility costs, while the client perspective had opportunity costs (productivity losses), feeding costs on admission and drug costs on follow up as cost drivers. Drugs and supplies stock outs, feeding costs to the mothers/caregivers; poor birth preparedness and inadequate space in hospital were found to have a high influence on care for preterm babies from a societal perspective. Conclusion: The cost of preterm care is high and sub-optimal and characterized by stockouts on drugs and supplies which influence care and are critical to the survival of preterm babies. Recommendations: Improving funding for preterm care would ensure that inputs required for the care are available, consequently translating into better care for preterm babies. There is need to conduct more cost evaluations on the long-term financial and economic consequences of preterm birth in Uganda.