Economic Burden of Malaria and Associated Factors Among Rural Households in Chewaka District, Western Ethiopia

Background: There has been a remarkable decline in the burden of malaria in the past few decades in Ethiopia. However, malaria remains a major impediment to both health and economic development in Ethiopia, with 60% of the population at risk of contracting malaria. Hence, this study aimed to estimate the economic burden of malaria among rural households in Chewaka district, Buno Bedele zone, Oromia regional state, Western Ethiopia.

Methods: Community-based cross-sectional study design was employed to estimate the economic burden of malaria at the household level from August 13 to September 2, 2018. A retrospective costing approach was employed, and cost was estimated from the perspective of households. The study included malaria expenditure of households during a one-year period (July 9, 2017 to July 9, 2018). Data were collected from 765 randomly selected households and analyzed using SPSS version 20. Multivariate logistic regression analysis was performed to identify predictors of the economic burden of malaria among rural households and all variables with P-value <0.05 were considered as statistically significant at 95% CI.

Results: On average, each household comprised 2 malaria cases (SD 1.1) in the past one-year period and the prevalence of malaria in the study setting was 32% (95% CI, 30.5-33.2). The average annual income of households was US$626.7 (95% CI, 590.4-663.0). The mean annual cost of malaria illness to households was US$16 (95% CI, 14.8-17.2), and most of this cost (78%) was contributed by the indirect costs. In every household, on average, patients and companions or caregivers lost 3.4 productive workdays due to malaria illness, respectively. Fourteen households out of 100 spent more than 5% of their annual income on malaria treatment and hence, they were prone to high economic burden or catastrophic costs. Household level economic burden of malaria was determined by the sex and educational status of household head, means of transportation to treatment center, the episodes of malaria, the number of malaria "ill days" and type of malaria diagnosis.

Conclusion: Malaria continues to significantly impose an economic burden on the rural households of Ethiopia. Hence, the national malaria program needs to recognize and address the catastrophic costs associated with malaria illness. Efforts should be made to ensure universal access to and utilization of malaria prevention, diagnosis, and treatment services.