Emergency obstetric care in Mali: catastrophic spending and its impoverishing effects on households
OBJECTIVE: To investigate the frequency of catastrophic expenditures for emergency obstetric care, explore its risk factors, and assess the effect of these expenditures on households in the Kayes region, Mali. METHODS: Data on 484 obstetric emergencies (242 deaths and 242 near-misses) were collected...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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The World Health Organization
2013-03-01
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| Series: | Bulletin of the World Health Organization |
| Online Access: | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862013000300012&lng=en&tlng=en |
| _version_ | 1797284194119843840 |
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| author | Catherine Arsenault Pierre Fournier Aline Philibert Koman Sissoko Aliou Coulibaly Caroline Tourigny Mamadou Traoré Alexandre Dumont |
| author_facet | Catherine Arsenault Pierre Fournier Aline Philibert Koman Sissoko Aliou Coulibaly Caroline Tourigny Mamadou Traoré Alexandre Dumont |
| author_sort | Catherine Arsenault |
| collection | DOAJ |
| description | OBJECTIVE: To investigate the frequency of catastrophic expenditures for emergency obstetric care, explore its risk factors, and assess the effect of these expenditures on households in the Kayes region, Mali. METHODS: Data on 484 obstetric emergencies (242 deaths and 242 near-misses) were collected in 2008-2011. Catastrophic expenditure for emergency obstetric care was assessed at different thresholds and its associated factors were explored through logistic regression. A survey was subsequently administered in a nested sample of 56 households to determine how the catastrophic expenditure had affected them. FINDINGS: Despite the fee exemption policy for Caesareans and the maternity referral-system, designed to reduce the financial burden of emergency obstetric care, average expenses were 152 United States dollars (equivalent to 71 535 Communauté Financière Africaine francs) and 20.7 to 53.5% of households incurred catastrophic expenditures. High expenditure for emergency obstetric care forced 44.6% of the households to reduce their food consumption and 23.2% were still indebted 10 months to two and a half years later. Living in remote rural areas was associated with the risk of catastrophic spending, which shows the referral system's inability to eliminate financial obstacles for remote households. Women who underwent Caesareans continued to incur catastrophic expenses, especially when prescribed drugs not included in the government-provided Caesarean kits. CONCLUSION: The poor accessibility and affordability of emergency obstetric care has consequences beyond maternal deaths. Providing drugs free of charge and moving to a more sustainable, nationally-funded referral system would reduce catastrophic expenses for households during obstetric emergencies. |
| first_indexed | 2024-03-07T17:45:37Z |
| format | Article |
| id | doaj.art-0e0272d1cae24464b261a3d9bbdac022 |
| institution | Directory Open Access Journal |
| issn | 0042-9686 |
| language | English |
| last_indexed | 2024-03-07T17:45:37Z |
| publishDate | 2013-03-01 |
| publisher | The World Health Organization |
| record_format | Article |
| series | Bulletin of the World Health Organization |
| spelling | doaj.art-0e0272d1cae24464b261a3d9bbdac0222024-03-02T15:01:20ZengThe World Health OrganizationBulletin of the World Health Organization0042-96862013-03-0191320721610.2471/BLT.12.108969S0042-96862013000300012Emergency obstetric care in Mali: catastrophic spending and its impoverishing effects on householdsCatherine Arsenault0Pierre Fournier1Aline Philibert2Koman Sissoko3Aliou Coulibaly4Caroline Tourigny5Mamadou Traoré6Alexandre Dumont7Centre de recherche du Centre Hospitalier de l'Université de MontréalCentre de recherche du Centre Hospitalier de l'Université de MontréalCentre de recherche du Centre Hospitalier de l'Université de MontréalCARE InternationalCentre de recherche du Centre Hospitalier de l'Université de MontréalCentre de recherche du Centre Hospitalier de l'Université de MontréalUniversité de BamakoL'Institut de recherche pour le développementOBJECTIVE: To investigate the frequency of catastrophic expenditures for emergency obstetric care, explore its risk factors, and assess the effect of these expenditures on households in the Kayes region, Mali. METHODS: Data on 484 obstetric emergencies (242 deaths and 242 near-misses) were collected in 2008-2011. Catastrophic expenditure for emergency obstetric care was assessed at different thresholds and its associated factors were explored through logistic regression. A survey was subsequently administered in a nested sample of 56 households to determine how the catastrophic expenditure had affected them. FINDINGS: Despite the fee exemption policy for Caesareans and the maternity referral-system, designed to reduce the financial burden of emergency obstetric care, average expenses were 152 United States dollars (equivalent to 71 535 Communauté Financière Africaine francs) and 20.7 to 53.5% of households incurred catastrophic expenditures. High expenditure for emergency obstetric care forced 44.6% of the households to reduce their food consumption and 23.2% were still indebted 10 months to two and a half years later. Living in remote rural areas was associated with the risk of catastrophic spending, which shows the referral system's inability to eliminate financial obstacles for remote households. Women who underwent Caesareans continued to incur catastrophic expenses, especially when prescribed drugs not included in the government-provided Caesarean kits. CONCLUSION: The poor accessibility and affordability of emergency obstetric care has consequences beyond maternal deaths. Providing drugs free of charge and moving to a more sustainable, nationally-funded referral system would reduce catastrophic expenses for households during obstetric emergencies.http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862013000300012&lng=en&tlng=en |
| spellingShingle | Catherine Arsenault Pierre Fournier Aline Philibert Koman Sissoko Aliou Coulibaly Caroline Tourigny Mamadou Traoré Alexandre Dumont Emergency obstetric care in Mali: catastrophic spending and its impoverishing effects on households Bulletin of the World Health Organization |
| title | Emergency obstetric care in Mali: catastrophic spending and its impoverishing effects on households |
| title_full | Emergency obstetric care in Mali: catastrophic spending and its impoverishing effects on households |
| title_fullStr | Emergency obstetric care in Mali: catastrophic spending and its impoverishing effects on households |
| title_full_unstemmed | Emergency obstetric care in Mali: catastrophic spending and its impoverishing effects on households |
| title_short | Emergency obstetric care in Mali: catastrophic spending and its impoverishing effects on households |
| title_sort | emergency obstetric care in mali catastrophic spending and its impoverishing effects on households |
| url | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862013000300012&lng=en&tlng=en |
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