Catastrophic health expenditure and impoverishment in households of persons with depression: a cross-sectional, comparative study in rural Ethiopia

Simple item page
dc.contributor.authorHailemichael, Yohannes
dc.contributor.authorHanlon, Charlotte
dc.contributor.authorTirfessa, Kebede
dc.contributor.authorDocrat, Sumaiyah
dc.contributor.authorAlem, Atalay
dc.contributor.authorMedhin, Girmay
dc.contributor.authorLund, Crick
dc.contributor.authorChisholm, Dan
dc.contributor.authorFekadu, Abebaw
dc.contributor.authorHailemariam, Damen
dc.date.accessioned2019-12-10T09:05:24Z
dc.date.available2019-12-10T09:05:24Z
dc.date.issued2019-07-11
dc.date.updated2019-07-14T03:32:57Z
dc.description.abstractAbstract Background The extent of catastrophic health expenditure and impoverishment associated with depression in low-and middle-income countries is not known. The aim of this study was to estimate the incidence and intensity of catastrophic out-of-pocket (OOP) health expenditure, level of impoverishment and coping strategies used by households of persons with and without depression in a rural Ethiopian district. Methods A comparative cross-sectional survey was conducted, including 128 households of persons with depression and 129 households without. Depression screening was conducted using the Patient Health Questionnaire, nine item version (PHQ-9). People in the depression group were classified into high and low disability groups based on the median value on the World Health Organization Disability Assessment Schedule (WHODAS) polytomous summary score. Health expenditure greater than thresholds of 10 and 25% of total household consumption was used for the primary analyses. The poverty headcount, poverty gap and normalized poverty gap were estimated using retrospective recall of total household expenditure pre- and post-OOP payments for health care. Linear probability model using binreg command in STATA with rr option was used to estimate risk ratio for the occurrence of outcomes among households with and without depression based on level of disability. Results Catastrophic OOP payments at any threshold level for households with depression and high disability were higher than control households. At the 10% threshold level, 24.0% of households of persons with depression and high disability faced catastrophic payments compared with 15.3% for depression and low disability and 12.1% for control households (pā€‰=ā€‰0.041). Depression and high disability level was an independent predictor of catastrophic OOP payments: RR 2.1; 95% CI:1.1, 4.6. An estimated 5.8% of households of persons with depression and high disability were pushed into poverty because of paying for health care compared with 3.5% for households of persons with depression and low disability and 2.3% for control households (p =ā€‰0.039). Conclusions Households of people with depression and high disability were more likely to face catastrophic expenditures and impoverishment from OOP payments. Financial protection interventions through prepayment schemes, exemptions and fee waiver strategies need to target households of persons with depression.
dc.identifier.apacitationHailemichael, Y., Hanlon, C., Tirfessa, K., Docrat, S., Alem, A., Medhin, G., ... Hailemariam, D. (2019). Catastrophic health expenditure and impoverishment in households of persons with depression: a cross-sectional, comparative study in rural Ethiopia. http://hdl.handle.net/11427/30681en_ZA
dc.identifier.chicagocitationHailemichael, Yohannes, Charlotte Hanlon, Kebede Tirfessa, Sumaiyah Docrat, Atalay Alem, Girmay Medhin, Crick Lund, Dan Chisholm, Abebaw Fekadu, and Damen Hailemariam "Catastrophic health expenditure and impoverishment in households of persons with depression: a cross-sectional, comparative study in rural Ethiopia." (2019) http://hdl.handle.net/11427/30681en_ZA
dc.identifier.citationBMC Public Health. 2019 Jul 11;19(1):930
dc.identifier.ris TY - Journal Article AU - Hailemichael, Yohannes AU - Hanlon, Charlotte AU - Tirfessa, Kebede AU - Docrat, Sumaiyah AU - Alem, Atalay AU - Medhin, Girmay AU - Lund, Crick AU - Chisholm, Dan AU - Fekadu, Abebaw AU - Hailemariam, Damen AB - Abstract Background The extent of catastrophic health expenditure and impoverishment associated with depression in low-and middle-income countries is not known. The aim of this study was to estimate the incidence and intensity of catastrophic out-of-pocket (OOP) health expenditure, level of impoverishment and coping strategies used by households of persons with and without depression in a rural Ethiopian district. Methods A comparative cross-sectional survey was conducted, including 128 households of persons with depression and 129 households without. Depression screening was conducted using the Patient Health Questionnaire, nine item version (PHQ-9). People in the depression group were classified into high and low disability groups based on the median value on the World Health Organization Disability Assessment Schedule (WHODAS) polytomous summary score. Health expenditure greater than thresholds of 10 and 25% of total household consumption was used for the primary analyses. The poverty headcount, poverty gap and normalized poverty gap were estimated using retrospective recall of total household expenditure pre- and post-OOP payments for health care. Linear probability model using binreg command in STATA with rr option was used to estimate risk ratio for the occurrence of outcomes among households with and without depression based on level of disability. Results Catastrophic OOP payments at any threshold level for households with depression and high disability were higher than control households. At the 10% threshold level, 24.0% of households of persons with depression and high disability faced catastrophic payments compared with 15.3% for depression and low disability and 12.1% for control households (pā€‰=ā€‰0.041). Depression and high disability level was an independent predictor of catastrophic OOP payments: RR 2.1; 95% CI:1.1, 4.6. An estimated 5.8% of households of persons with depression and high disability were pushed into poverty because of paying for health care compared with 3.5% for households of persons with depression and low disability and 2.3% for control households (p =ā€‰0.039). Conclusions Households of people with depression and high disability were more likely to face catastrophic expenditures and impoverishment from OOP payments. Financial protection interventions through prepayment schemes, exemptions and fee waiver strategies need to target households of persons with depression. DA - 2019-07-11 DB - OpenUCT DP - University of Cape Town KW - Depression KW - Disability KW - Catastrophic health expenditure KW - Impoverishment KW - Low-and middle-income country KW - Universal health coverage LK - https://open.uct.ac.za PY - 2019 T1 - Catastrophic health expenditure and impoverishment in households of persons with depression: a cross-sectional, comparative study in rural Ethiopia TI - Catastrophic health expenditure and impoverishment in households of persons with depression: a cross-sectional, comparative study in rural Ethiopia UR - http://hdl.handle.net/11427/30681 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s12889-019-7239-6
dc.identifier.urihttp://hdl.handle.net/11427/30681
dc.identifier.vancouvercitationHailemichael Y, Hanlon C, Tirfessa K, Docrat S, Alem A, Medhin G, et al. Catastrophic health expenditure and impoverishment in households of persons with depression: a cross-sectional, comparative study in rural Ethiopia. 2019; http://hdl.handle.net/11427/30681.en_ZA
dc.language.rfc3066en
dc.rights.holderThe Author(s).
dc.subjectDepression
dc.subjectDisability
dc.subjectCatastrophic health expenditure
dc.subjectImpoverishment
dc.subjectLow-and middle-income country
dc.subjectUniversal health coverage
dc.titleCatastrophic health expenditure and impoverishment in households of persons with depression: a cross-sectional, comparative study in rural Ethiopia
dc.typeJournal Article
Files
Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
12889_2019_Article_7239.pdf
Size:
641.35 KB
Format:
Adobe Portable Document Format
Description:
Download
License bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
license.txt
Size:
0 B
Format:
Item-specific license agreed upon to submission
Description:
Download
Collections
Journal Articles