THE ECONOMICS OF CARING FOR CHILDREN WITH PEDIATRIC GASTROENTERITIS IN BOLIVIA: A CAREGIVER'S PERSPECTIVE Público

Abstract

BACKGROUND Globally, diarrheal disease is responsible for approximately 1.3
millions deaths annually for children under the age of five and rotaviruses are the primary
agent for 40% of all acute diarrheal cases. In Bolivia, rotaviruses are the primary cause
for almost half of all diarrheal related hospitalizations and a mortality rate of 66 per
100,000 children. Therefore, it is important to understand the conditions that perpetuate
the country's diarrheal morbidity and mortality rates by exploring the role of the
caregiver and the relationship between the caregiver's socio-economic factors and a
diarrheal event.

GOALS To quantify the financial impact an episode of diarrhea has on a Bolivian
caregiver and to determine which characteristics of a Bolivian caregiver for a child
suffering from a diarrheal episode are associated with a catastrophic cost of 1% or greater
to the caregiver's household.

METHODS This cross-sectional study took place during the summer months of 2007-
2009. The study population consisted of 1,109 Bolivian caregivers of children who
presented with diarrhea to various pediatric wards, emergency rooms and outpatient
clinics in four Bolivian cities: El Alto, La Paz, Cochabamba and Santa Cruz. The
caregivers were asked questions related to treatment habits, access to care, perceptions of
health care costs and cost estimates attributed to the diarrheal event. A logistic regression
was conducted modeling the probability that a caregiver's behavioral characteristics were
associated with a catastrophic cost of 1% or greater.

RESULTS The median total direct costs for a diarrheal episode in a Bolivian household
were approximately 23 bolivianos and the median indirect costs were 60 bolivianos. The
presence of a working spouse had a "protective" effect whereas a caregiver who took the
child to any place prior to the current site of treatment proved to be a significant risk
factor for experience catastrophic cost at the 1% or greater level.

CONCLUSION Bolivia should work towards improving the economic conditions of
Bolivian caregivers' and their households by providing support to mitigate the financial
ramifications of a diarrheal episode and thereby reducing the probability that a household
will experience catastrophic cost as a result of the diarrheal event.

Table of Contents

REVIEW OF THE LITERATURE..................................................................................................... 1
ROTAVIRUSES AND DIARRHEAL DISEASES.................................................................................................... 1
Epidemiology and Pathology............................................................................................................................1
Classification of Rotaviruses ............................................................................................................................3
ROTAVIRUS VACCINATIONS ......................................................................................................................... 5
Types of Rotavirus Vaccines .............................................................................................................................5
Efficacy and Effectiveness.................................................................................................................................7
CAREGIVERS OF CHILDREN WITH DIARRHEA ................................................................................................. 8
COST-EFFECTIVE MODELS ........................................................................................................................... 12
IN BOLIVIA................................................................................................................................................. 13
GOALS ...................................................................................................................................................... 15
SIGNIFICANCE ........................................................................................................................................... 16
AUTHOR CONTRIBUTION ............................................................................................................ 18
MANUSCRIPT .............................................................................................................................. 19
ABSTRACT ........................................................................................................................................ 20
INTRODUCTION ................................................................................................................................ 21
MATERIALS AND METHODS ............................................................................................................... 25
STUDY POPULATION.................................................................................................................................... 25
HEALTH CARE COST DETERMINATION............................................................................................................ 25
DEFINITIONS.............................................................................................................................................. 25
STATISTICAL METHODS ............................................................................................................................... 27
RESULTS ........................................................................................................................................... 29
DISCUSSION ..................................................................................................................................... 34
TABLES ............................................................................................................................................. 45
FIGURES ........................................................................................................................................... 51
PUBLIC HEALTH IMPLICATIONS ................................................................................................ 52
REFERENCES .............................................................................................................................. 55
APPENDIX .................................................................................................................................. 60

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Palavra-chave	caregiver Bolivia cost burden rotavirus catastrophic cost
Committee Chair / Thesis Advisor	Leon, Juan, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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