Three hundred fifty-five outpatients (150 in Burkina Faso and 155 in The Gambia) and 178 inpatients (70 in Burkina Faso and 108 in The Gambia) were interviewed (Table 1).
Table 1
Descriptive characteristics of the respondents
Country | Burkina Faso Gambia |
Out Patient | In Patient | Out Patient | In Patient |
Number of observations | 150 | 70 | 155 | 108 |
Age (years) | 23 | 24 | 27 | 27 |
Average Number of children | 1.43 | 1.47 | 1.75 | 1.75 |
| Percentages |
Diagnostic: clinical malaria | 100.00 | 71.43 | 65.16 | 56.48 |
severe anemia | 0.00 | 15.71 | 34.86 | 38.89 |
Malaria & severe anemia | 0.00 | 12.86 | 0.00 | 4.63 |
Education: none | 76.67 | 72.86 | 64.52 | 70.37 |
primary | 12.00 | 11.43 | 21.29 | 17.59 |
secondary | 10.67 | 14.29 | 13.55 | 12.04 |
Religion: catholic | 52.67 | 52.86 | 1.94 | 3.70 |
Islam | 32.67 | 35.71 | 97.42 | 96.30 |
traditional African religion | 14.00 | 11.43 | 0.65 | 0.00 |
none | 0.67 | 0.00 | 0.00 | 0.00 |
Ethnicity: mossi | 92.00 | 78.57 | 0.00 | 0.00 |
gourounsi | 4.67 | 8.57 | 0.00 | 0.00 |
peuhl | 2.67 | 11.43 | 0.00 | 0.00 |
mandinka | 0.00 | 0.00 | 29.68 | 40.74 |
fula | 0.00 | 0.00 | 37.42 | 26.85 |
serahuleh | 0.00 | 0.00 | 29.68 | 27.78 |
Marital status: married | 86.00 | 72.86 | 91.61 | 92.59 |
in relationship | 12.00 | 24.29 | 0.65 | 1.85 |
single | 1.33 | 2.86 | 6.45 | 5.56 |
separated | 0.67 | 0.00 | 1.29 | 0.00 |
Activity: housewife | 29.33 | 41.43 | 15.48 | 11.21 |
farmer | 54.67 | 35.71 | 54.19 | 65.42 |
market trader | 6.00 | 8.57 | 5.81 | 3.74 |
no occupation | 6.00 | 11.43 | 9.03 | 5.61 |
others | 4.00 | 2.86 | 15.49 | 14.02 |
Partner’s activity: farmer | 68.00 | 57.14 | 66.90 | 81.00 |
market trader | 8.67 | 5.71 | 11.97 | 6.00 |
civil servant | 2.67 | 2.86 | 13.38 | 8.00 |
no occupation | 0.00 | 1.43 | 0.70 | 0.00 |
others | 20.66 | 32.86 | 7.05 | 5.00 |
Outpatient Characteristics
Pregnant women were younger and had on average less children in Burkina Faso than in The Gambia. In addition, there was a higher proportion of women with no formal education in Burkina Faso (76.6%) than in The Gambia (64.5%), with only 10.6% of women having completed secondary education in Burkina Faso and 13.5% in The Gambia. In both countries, the main activity was farming, for the women (54.6% in Burkina Faso and 54.1% in The Gambia) and their partners (68.0% in Burkina Faso and 66.9% in The Gambia). About half (52.7%) of the women in Burkina Faso were Catholics while most (97.4%) Gambian women were Muslims.
Inpatient Characteristics
Inpatient characteristics were similar to outpatient ones. Women in The Gambia were older (27.02 years) and had a higher number of children (1.75) than those in Burkina Faso (23.87 years and 1.47). Similarly, most women were farmers and had no formal education.
Total Costs
Outpatient Visit Costs
Table 2 reports the outpatient visit costs broken down by all cost centres. Medical costs including lab and other fees and drug costs were significantly lower in The Gambia (0.57US$) than in Burkina Faso (3.57US$). The outpatients in both countries did not report cost for food. For outpatients, direct costs were statistically different between the two countries (Pvalue = 0.00).
Table 2
Unit costs of inpatient and outpatient visits (US$)
Country | Burkina Faso | The Gambia |
Out Patient | In Patient | Out Patient | In Patient |
Previous treatment seeking cost |
Total median direct cost of previous treatment | 2.04 (1.02; 2.72) | 0.34 (0; 4.59) | 0.86 (0.57;1.14) | 1.72 (1.14;3.44) |
Direct costs |
Median cost lab and other test fees | 0.17 (0; 0.34) | 1.53 (0; 5.27) | 0.80 (0.57;3.44) | 0.57 (0.57; 1.14) |
Median cost drugs | 3.4 (2.55; 4.08) | 9.27 (7.14; 13.00) | 0 (0;1.83) | 3.44 (2.75;4.02) |
Median cost transportation | 0 (0;1.7) | 2.72 (0; 5.44) | 0 (0;2.29) | 2.06 (0; 2.75) |
Median cost food | NA | 2.04 (1.36; 3.4) | NA | 3.44 (2.75; 3.44) |
Total median direct costs | 3.91 (2.93; 5.61) | 15.38 (10.54;20.31) | 0.57 (0.57;3.90) | 9.19 (7.12;11.03) |
Indirect costs |
Median value of time lost because of the illness | NA | 11.85 (7.11; 16.59) | NA | 4.07 (4.07; 5.43) |
Interquartile Range in parenthesis |
NA = Not asked |
Inpatient Visit Costs
Table 2 reports also the inpatient visit costs. Medical costs for inpatients were higher in Burkina Faso (10.80US$) than in The Gambia (4.01US$). Although, the cost of food was higher in The Gambia (3.44US$) than in Burkina Faso (2.04US$), direct costs were significantly higher in Burkina Faso (15.38 US$) than in The Gambia (9.19US$). Indirect costs, including the value of time lost because of the illness, were significantly higher (11.85US$) in Burkina Faso than in The Gambia (4.07US$), a difference explained by the longer average hospitalization in Burkina Faso (3.55 days) than in The Gambia (1.21 days).
Treatment Seeking Behavior and Associated Costs prior to Facility Visit
Table 3 reports the sample of outpatients and inpatients that sought care before the consultations or admissions to the formal health facilities. Pregnant women were asked about previous treatments sought for the symptoms associated with the same malaria episode. Seeking treatment for the current malaria episode before the OP visit was more common in Burkina Faso (6.7%) than in The Gambia (1.3%). Indeed, in The Gambia only two women (1 from home and 1 from a pharmacy) sought treatment before their OP visit while, in Burkina Faso, 3 women had treatment from home, 2 from pharmacies, and 5 from a hospital). The mean cost of this first treatment was 1.51US$ in Burkina Faso and 0.86US$ in The Gambia. Only outpatients in Burkina Faso (N = 3) reported having sought treatment from a second place, whose cost was on 4.87US$.
Table 3
Frequency and costs of previous treatment(s) sought
Country | Burkina Faso Gambia |
Out Patient | In Patient | Out Patient | In Patient |
% | N | % | N | % | N | % | N |
Any treatment before | 6.67 | 10/150 | 32.86 | 19/70 | 1.30 | 2/155 | 25.92 | 28/108 |
First place treatment sought | | | | | | | | |
home | 30.00 | 3 | 43.47 | 10 | 50.00 | 1 | 32.14 | 9 |
traditional healer | 0.00 | 0 | 4.34 | 1 | 0.00 | 0 | 10.71 | 3 |
market | 0.00 | 0 | 0.00 | 0 | 0.00 | 0 | 0.00 | 0 |
pharmacy | 20.00 | 2 | 17.39 | 4 | 50.00 | 1 | 35.71 | 10 |
hospital | 50.00 | 5 | 17.39 | 4 | 0.00 | 0 | 21.42 | 6 |
Second place treatment sought | | | | | | | | |
home | 50.00 | 2 | 25.00 | 1 | 0.00 | 0 | 0.00 | 0 |
traditional healer | 25.00 | 1 | 0.00 | 0 | 0.00 | 0 | 0.00 | 0 |
market | 0.00 | 0 | 0.00 | 0 | 0.00 | 0 | 0.00 | 0 |
pharmacy | 0.00 | 0 | 0.00 | 0 | 0.00 | 0 | 100.0 | 1 |
hospital | 25.00 | 1 | 75.00 | 2 | 0.00 | 0 | 0.00 | 0 |
| US$ | N | US$ | N | US$ | N | US$ | N |
Mean cost of first treatment | 1.51 | 10 | 2.21 | 19 | 0.86 | 2 | 2.74 | 28 |
Mean cost of second treatment | 4.87 | 3 | 20.14 | 3 | 0.00 | 0 | 0.00 | 1 |
Mean total cost previous treatment | 2.97 | 10 | 4.27 | 19 | 0.86 | 2 | 2.74 | 28 |
Before their IP visit, 32.9% and 25.9% of women sought treatment in Burkina Faso and The Gambia, respectively. Inpatients reported being ill on average 3.21 (range 1–20) days in Burkina Faso and 1.83 (range 1–4) days in The Gambia before being hospitalized. Treatment prior hospitalization was more common in Burkina Faso (43.47%) than in The Gambia (32.14%), with most treatment from home or from a pharmacy or hospital. The mean cost of the first treatment for IP was higher in The Gambia (2.74US$) than in Burkina Faso (2.21US$).
The mean total cost for an OP consultation, including any previous treatment, was 2.97US$ in Burkina Faso and 0.86US$ in The Gambia. For hospitalization, the cost was 4.27US$ in Burkina Faso and 2.74US$ in The Gambia for an admission. For inpatients, costs for first treatment sought and total were statistically different between the two countries (Pvalue = 0.0023 and Pvalue = 0.0241, respectively). For outpatients, costs for first, second treatment sought and total were not statistically different between the two countries (Pvalue = 1.000, Pvalue = 0.6547 and Pvalue = 0.5163, respectively).
Transportation to the Health Facility
Table 4 reports transportation costs. They are considered as direct non-medical costs. In Burkina Faso, most outpatients travelled by bicycle (52.6%) and motorbike (26.0%) while in The Gambia about half (51.61%) travelled by foot. The time taken to reach the health facility was similar in the two countries, around 24 minutes (range 2–90 minutes in Burkina Faso; range 1–60 minutes in The Gambia). The use of an ambulance for inpatients was slightly higher in Burkina Faso (5.71%) than in The Gambia (3.85%).
Table 4
Transportation to the health facility
Country | Burkina Faso Gambia |
Out Patient | In Patient | Out Patient | In Patient |
% | N | % | N | % | N | % | N |
Transport*: foot | 21.33 | 32 | 8.57 | 6 | 51.61 | 48 | 7.70 | 2 |
bicycle | 52.67 | 79 | 17.14 | 12 | 0.00 | 0 | 0.00 | 0 |
motorbike | 26.00 | 39 | 67.14 | 47 | 13.97 | 13 | 3.85 | 1 |
taxi-moto | 0.00 | 0 | 0.00 | 0 | 13.97 | 13 | 34.60 | 9 |
Car | 0.00 | 0 | 0.00 | 0 | 13.97 | 13 | 42.30 | 11 |
donkey | 0.00 | 0 | 0.00 | 0 | 6.45 | 6 | 7.70 | 2 |
ambulance | 0.00 | 0 | 5.71 | 4 | 0.00 | 0 | 3.85 | 1 |
| time | N | time | N | time | N | time | N |
Time taken to reach the health facility (minutes) | 24.70 | 150 | 34.77 | 70 | 24.15 | 155 | 36.33 | 108 |
Financial Support
Table 5 reports additional information on financial support. In terms of health insurance, no pregnant woman in Burkina had a health insurance while there were a few women with health insurance in The Gambia. Almost all women in The Gambia reported household savings while in Burkina Faso the proportion was extremely low. In The Gambia, a large part of household savings consisted of remittances sent by family members living abroad, with most of them made by siblings to the household (around 65%). Remittances were also made by other members of the family (27%). About half of the remittances sent to The Gambia came from Italy, followed by France (12.5%), Germany (9.6%), United States (6.7%) and United Kingdom (0.9%).
Table 5
Country | Burkina Faso Gambia |
Out Patient | In Patient | Out Patient | In Patient |
Number of observations | 150 | 70 | 155 | 108 |
| Percentages |
Health insurance | 0.00 | 0.00 | 1.29 | 3.70 |
Savings in the household | 0.67 | 2.86 | 90.32 | 96.30 |
Receiving government support | 0.00 | 0.00 | 0.00 | 0.00 |
Money from abroad | 4.67 | 1.43 | 87.74 | 96.30 |
Remitter: husband | 3.33 | 1.43 | 5.88 | 3.85 |
brothers/sisters | 0.00 | 0.00 | 63.24 | 68.27 |
Children | 0.00 | 0.00 | 1.47 | 0.00 |
other family members | 0.67 | 0.00 | 28.68 | 27.88 |
Friends | 0.00 | 0.00 | 0.74 | 0.00 |
Country’s remitter: Italy | 0.00 | 0.00 | 38.24 | 57.69 |
Germany | 0.00 | 0.00 | 11.76 | 9.62 |
France | 0.00 | 0.00 | 19.12 | 12.50 |
United States | 0.00 | 0.00 | 4.41 | 6.73 |
United Kingdom | 0.00 | 0.00 | 8.82 | 0.96 |
Ivory Coast | 4.67 | 1.43 | 0.00 | 0.00 |