Result of this study showed that although it was done in an urban setting, most of the participants were young, fairly educated, married women of low means, mainly traders or homemakers. Many of them had moderate to severe burden of treatment because of the high cost of treatment. Result indicated that as many as thirty-three were discharged home with open wounds and/or grafting possibly to avoid further accumulation of hospital bill. This finding directly reflects the low economic capacity of most of the women and the fact that most expenditure are out-of-pocket as they reported. Almost all the participants (68) had at least one surgical intervention during their burns management, meaning that burns patients will often need huge amount of money for operation and drugs deposits. In addition, they will require fund to procure the expensive modern dressing applications (like the Epigraft, Ex salt T7 and Therabond applications), high protein diet peculiar to burns treatment as well as pay for orthodox dressing change. If patient fails to pay for drugs, then drugs supply by the Pharmacy Department may be withdrawn. Unfortunately, antibiotics used in burns treatment are usually costly (like the injection Meronem that sells between N6,000.00 to N8,000.00 per vial) and procuring such may be challenging to the patient, resulting to more burden.
According to results of this study, a client spends as high as NGN691,093 (USD1,920) on the average on drugs, surgery, investigations, nursing care, bed space and other non-medical expenses (like feeding, transportation and procurement of toiletries). This is similar to $2,766 reported by Latifi et al , but far below $7,123.28 estimated by Okafor et al . Meanwhile, the average LHS was 35.4 days – against the 19 days average found by Okafor et al ; and FMI before the burns was just about 11.1% of the hospital expenses. Unfortunately, only 5.5% accessed the services of the NHIS. The near non-existed NHIS as already demonstrated [16, 17, 18] is thus supported by findings of this study. Poor health financing has pitiable implications for achievement of goals of universal health coverage in Nigeria.
The estimated family income can only yield about 20.89% of the average total expenses incurred during hospitalization, all things being equal; meaning that the remaining 79.11% must be sourced elsewhere. Our study showed that there was worsening of economy for most of the women following hospitalization irrespective of their economic status, and that up to eleven women, mostly traders and self-employed women, lost their job due to hospitalization. Since many of the participants were women of low means, they were most likely to be sole traders operating easy and inexpensive business with unstable customers and finance. The reported drop in estimated subjective monthly income supports the fact that even the usual meagre income will stop flowing in when the woman is hospitalised. Consequently, many would secure loans from friends, money lenders, bank, cooperative society, and the likes (with interest in some situations) and/or mortgage/sell assets such as lands, automobile, power generating set, television, jewelleries and clothes to raise fund for offsetting the huge hospital bills. Borrowing, selling personal assets and sometimes, loss of job are catastrophic results of the injury. Resultant stress and financial hardship/burden for the women and their family will deepen the pre-existing low economic standard.
Further, the women’s EQ VAS and anxiety/depression scores differed significantly based on their occupation. Civil servants’ highest scores on the EQ VAS imply a better quality of life among them. Conversely, the highest anxiety/depression scores for the self-employed women mean poorer HRQOL. Civil servants work in domesticated organisations – they have little or no worry concerning the impact of hospitalization on their job because their job is secured. Self-employed women and traders, on the other hand, operate as ‘wild’ organisations because they always have to struggle for their own survival. Based on this, civil servants are more likely to have more positive assessment of their health state at any time than the self-employed and traders.
The women’s anxiety/depression dimension and EQ VAS varied based on their economic status. Although there was no significant difference in other EQ-5D-3L dimensions, women in the LES appeared to be more inclined to extreme anxiety or depression than the middle and high economic class. Tucker et al  earlier reported this downward health trajectory for women with high economic hardship. With insufficient fund, making required deposits for treatments and surgeries, paying for expensive drugs, dressing packs and other medical and non-medical needs will become difficult.
It is understandable that a good number of the women reported ‘extreme pain or discomfort’ or ‘confinement to bed after long stay in hospital’ or inability to perform usual activities independently because burns is ordinarily characterised with pain. Some women may have requested for ‘pre-mature’ discharge (even with open wound and partially healed grafting) to reduce further accumulation of hospital bill. Patients are not supposed to be discharged until they are fully recovered and capable of performing most activities of daily living unassisted. Sick patients in hospital have their sick role; the health conditions are continuously monitored while their skilled care providers institute necessary actions. When the individual is discharged home before full recovery, self-dependence and perhaps care by unskilled caregivers becomes the available option. This comes with its risk of wound breakdown, infection, pain and other complications, further worsening the already poor HRQOL and high economic burden of treatment.
There was significant difference between the women’s age and their mobility, self-care and usual activities. As earlier observed by Chinweuba et al , the older women had poorer mobility and less ability to perform usual activities than the younger women did. This is understandable because people are physically stronger, more active and better able to self-manage their problems at their youthful age and become weaker as they get old. Young women may also have less social responsibilities and fewer challenges with self-care. Increasing level of education tends to reduce the women’s anxiety levels and improve their score on EQ VAS probably because it (education) will enhance better understanding of one’s challenges, better-informed decision making and more focused health actions. Educated women will be better able to study and understand their problem and its management than their less educated counterparts.
Result showed significant difference in the women’s pain/discomfort dimension based on their parity. However, there was not any specific pattern in the differences. More studies may be required on this.