Household catastrophic out-of-pocket expenditure and the socioeconomic burden of paediatric surgery: a cross-sectional study at the highest tertiary hospital in Zambia

Abstract

Globally, about 81 million people per year are driven to financial catastrophe from the costs of surgery and other related nonmedical costs, with low- and middle-income countries (LMICs) bearing the greatest burden. This study determined the catastrophic out-of-pocket (OOP) health expenditure and the socioeconomic burden associated with accessing paediatric surgery at the highest tertiary health facility in Zambia. A cross-sectional study was conducted at the University Teaching Hospital (UTH) in Lusaka District, Zambia, involving 380 parents or guardians of paediatric patients recruited over three months using consecutive sampling. The primary outcome was catastrophic health expenditure (CHE), determined using the budget share approach. The secondary outcome was the socioeconomic burden of surgery, assessed using the reported adopted socioeconomic coping mechanisms. Data were collected using a 36-item electronic questionnaire and analysed in R version 4.5.1 with appropriate descriptive and inferential statistics. Overall, 127 (33.4%) of the participants incurred CHE, with an overall OOP expenditure of about $36 (IQR, 22.5–58.2). CHE was more likely among participants who traveled from outside Lusaka Province (aOR = 4.06, 95% CI: 2.21–7.85, p < 0.001); those with no formal education (aOR = 2.59, 95% CI: 1.05–6.62, p = 0.041); or no health insurance coverage (aOR = 1.95, 95% CI: 1.10–3.53, p = 0.024). Having more contributors to a household income reduced the likelihood of CHE (aOR = 0.65, 95% CI: 0.44–0.94, p = 0.025). Common socioeconomic burdens experienced by households included: borrowing funds or taking financial loans (170, 45.5%); selling household assets (53, 14.4%); inability to afford basic needs (282, 75.6%) or paying for children’s school expenses (176, 47.2%), and loss of income or employment (232, 62.2%). A family unit’s CHE attributed to accessing paediatric surgery is high in Zambia, influenced by geographic, institutional, and socioeconomic factors. This reality exposes households to additional socio-economic burdens that drive families into deeper poverty and potentially limit their access to basic essential needs. National interventions focusing on public education, comprehensive insurance coverage, and improving specialised surgical care services outside Lusaka could enhance equitable access to paediatric surgical care.