Hospital Costs and Utilization Pattern for Paediatric Patients with Sickle Cell Disease Attending a Tertiary Health Institution: Northern Nigeria

Author(s): Sanusi Abubakar1, UM Lawan1, AT Bako1
Affiliation(s): 1Department of Community Medicine, Bayero University Kano/ Aminu Kano Teaching Hospital, Kano, Nigeria
1st country of focus: Nigeria
Relevant to the conference theme: Non-communicable chronic diseases
Summary (max 100 words): In sub-Saharan Africa, Nigeria suffers a very high burden of sickle cell disease.  About 4 million Nigerians suffer from SCD while 25 million others carry the sickle cell genes which they may pass to their off spring. As a group, patients with sickle cell disease contribute to a large numbers of hospital admissions, emergency visits and outpatient visits often at a substantial cost. There is a dearth of health data on the costs and pattern of hospital utilization among paediatric patients with SCD in Nigeria that can be used to inform advocacy and result based programming for this vulnerable group
Background (max 200 words): Sickle cell disease is a neglected disease that is taking a heavy toll on the health and development of the Nigerian child. Nigeria accounts for 75% of infant sickle cell cases in West Africa and about 80% of infant deaths due to sickle cell disease in Africa. The Aminu Kano Teaching Hospital serves as a referral centre for more than 10 million people in Northern Nigeria.. Resources for the provision of health care services especially for chronic diseases such as SCD are scarce and expensive, and where comprehensive medical care is less available, death from complications of SCD in early childhood is usual. This situation is worsened by high levels of poverty present in Nigeria in spite of its oil wealth. This gap presents special problems in designing health care for patients with chronic diseases such as sickle cell disease.  A key challenge is the lack of research data on the costs and utilization pattern of children with SCD in Nigeria for advocacy and results based health programming for prevention services, social safety nets, access to care, treatment, health education and health care financing options that will inform and guide advocacy champions, health institutions, governments, NGOs, formal and informal/social insurance schemes.
Objectives (max 100 words): Aim: To assess the healthcare utilization pattern and cost of care for children with sickle cell disease attending sickle cell clinics at Aminu Kano Teaching Hospital, Kano, Nigeria. Specific objectives 1. To determine the commonest forms of clinical presentations amongst children with sickle cell disease in Aminu Kano Teaching Hospital, Kano, Nigeria. 2. To assess the hospital utilization patterns of children with sickle cell disease in Aminu Kano Teaching Hospital, Kano, Nigeria. 3. To assess the specialty of physicians in attendance for children with sickle cell disease in Aminu Kano Teaching Hospital, Kano, Nigeria. 4. To assess the cost of care for hospitalized children with sickle cell disease in Aminu Kano Teaching Hospital, Kano, Nigeria.
Methodology (max 400 words): A descriptive cross-sectional study design was used to conduct this study between September and November 2010 among children with sickle cell disease attending the sickle cell clinic at Aminu Kano Teaching Hospital, Kano, Nigeria. A systematic sampling technique was used to obtain a sample of 150 respondents and semi structured, interviewer administered questionnaires were subsequently administered to the selected respondents after seeking the informed consent of the parent/caregiver. Their responses were collated and analyzed using Minitab (version 12.21) statistical software.
Results (max 400 words): The responses were obtained mainly from the mothers (74%) of the patients with SCD. There were slightly more females (77) than males in the study and the mean age of the children in the study was 6 years with a standard deviation of 3.9 years. There were 712 hospital visits recorded among the respondents in this study and 59% of the visits were to the sickle cell clinic. The median sickle cell clinic visit was 3. Only 38 out of the 150 respondents interviewed had ever been hospitalized (average admission rate of 0.3 admissions per patient per 6 months) and about 27% of these were re-admissions while the male to female ratio of all admissions was 1.1:1.  The average number of days spent by the respondents on admission was 2.2 days per patient per 6 months The emergency department was the route of admission for about 83% of the respondents who were admitted. Fever, limb pain and swelling were the main reasons for hospital visit in majority of cases. Vaso-occlusive crisis (62%) was the commonest diagnosis made at discharge in the admitted respondents. The median cost of care was N13600 ($85) with a range of ($0 - $975.6), this is in the context of a country where over 70% of the populace live on less than a dollar a day. The hematologist was the medical specialist most frequently responsible for the care of the respondents attending the hospital. There was a statistically significant difference between hospital admission and cost of care, and also between number of days on admission and cost of care.
Conclusion (max 400 words): Children with sickle cell disease incur large numbers of hospital visits and admissions are usually on a recurrent basis and this is associated with high costs for the patients. The emergency department was the major route of admission for most paediatric SCD patients. The cost of care for most paediatric patients with SCD is high, especially within the context of a developing country such as Nigeria. There is therefore a need for the government and health institutions to develop evidence based strategies and programmes that can detect and help the most vulnerable SCD population i.e. children suffering from SCD through out the health care continuum at nil or subsidized cost. There is also a need to carry out additional research in this area so as to generate data that will be useful for advocacy and result based programming purposes for governments, NGOs, health institutions etc

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