• Nathaniel Hendrix, Naor Bar-Zeev, Deborah Atherly, Jean Chikafa, Hazzie Mvula, Richard Wachepa, Amelia C Crampin, Themba Mhango, Charles Mwansambo, Robert S Heyderman, Neil French, Nigel A Cunliffe, Clint Pecenka, and VacSurv Consortium.
• Center for Vaccine Innovation and Access, PATH, Seattle, Washington, USA.
• BMJ Open. 2017 Sep 3; 7 (9): e017347.

ObjectivesThis prospective cohort study sought to estimate health system and household costs for episodes of diarrhoeal illness in Malawi.SettingData were collected in two Malawian settings: a rural health centre in Chilumba and an urban tertiary care hospital in Blantyre.ParticipantsChildren under 5 years of age presenting with diarrhoeal disease between 1 January 2013 and 21 November 2014 were eligible for inclusion. Illnesses attributed to other underlying causes were excluded, as were illnesses commencing more than 2 weeks prior to presentation. Complete data were collected on 514 cases at both the time of the initial visit to the participating healthcare facility and 6 weeks after discharge.Primary And Secondary Outcome MeasuresThe primary outcome measure was the total cost of an episode of illness. Costs to the health system were gathered from chart review (drugs and diagnostics) and actual hospital expenditure (staff and facility costs). Household costs, including lost income, were obtained by interview with the parents/guardians of patients.ResultsTotal costs in 2014 US$ for rural inpatient, rural outpatient, urban inpatient and urban outpatient were $65.33, $8.89, $60.23 and $14.51, respectively (excluding lost income). Mean household contributions to these costs were 15.8%, 9.8%, 21.3% and 50.6%.ConclusionThis study found significant financial burden from childhood diarrhoeal disease to the healthcare system and to households. The latter face the risk of consequent impoverishment, as the study demonstrates how the costs of seeking treatment bring the income of the majority of families in all income strata below the national poverty line in the month of illness.© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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