Date Published: April 19, 2018
Publisher: The American Society of Tropical Medicine and Hygiene
Author(s): Ayok M. Tembei, Jonas A. Kengne-Ouaffo, Elvis A. Ngoh, Bonekeh John, Theobald M. Nji, Kebede Deribe, Peter Enyong, Theresa Nkuo-Akenji, Gail Davey, Samuel Wanji.
Leprosy and podoconiosis (podo) are neglected tropical diseases that cause severe disfigurement and disability, and may lead to catastrophic health expenditure and hinder economic development of affected persons and households. This study compared economic costs of both diseases on affected households with unaffected neighboring households in the Northwest Region (N.W.R.) of Cameroon. A matched comparative cross-sectional design was used enrolling 170 households (43 podo case households, 41 podo control households, 43 leprosy case households, and 43 leprosy control households) from three health districts in the N.W.R. Direct treatment costs for podo averaged 142 United State dollar (USD), compared with zero for leprosy (P < 0.001). This was also reflected in the proportion of annual household income consumed (0.4 versus 0.0, respectively, P < 0.001). Both diseases caused considerable reductions in working days (leprosy 115 versus podo 135 days. P for comparison < 0.001). The average household income was considerably lower in podo-affected households than unaffected households (410 versus 913 USD, P = 0.01), whereas income of leprosy-affected households was comparable to unaffected households (329 versus 399 USD, P = 0.23). Both leprosy and podo cause financial burdens on affected households, but those on podo-affected families are much greater. These burdens occur through direct treatment costs and reduced ability to work. Improved access to public health interventions for podo including prevention, morbidity management and disability prevention are likely to result in economic returns to affected families. In Cameroon, one approach to this would be through subsidized health insurance for these economically vulnerable households.
Neglected tropical diseases (NTDs) are chronic, disabling, and disfiguring conditions commonly occurring in settings of extreme poverty, particularly in the rural poor and some disadvantaged urban populations.1 Neglected tropical diseases are both the consequence and cause of poverty. They are common among very poor individuals and they cause poverty, through stigma, disability, and reduced productivity. The world’s greatest concentration of poverty occurs in sub-Saharan Africa (SSA). The World Bank analyzed 51% of the population of SSA as living on less than 1.25 United State dollar (USD) per day, and 73% of the population living on less than 2 USD per day.2 Leprosy and podoconiosis (podo) are diseases that hinder economic development and cause chronic life-long disability in the poor and disenfranchised communities in which they are most prevalent.
This study quantifies the economic burden of leprosy and podo in the N.W.R. of Cameroon. Podoconiosis leads to significant financial consequences on affected households, through direct and indirect treatment costs, whereas leprosy has a smaller, but still important, financial impact. In addition, both diseases cause significant loss of productive days per annum. Given the World Bank definition of catastrophic health expenditure as out-of-pocket expenditure of > 10% monthly income,16 our findings show that households affected by podo do experience catastrophic health expenditure, which is likely to cause further impoverishment, indicating the importance of prioritizing podo in the national NTD plan in order that affected households may benefit from schemes such as subsidized health insurance so they are better financially protected.
Given the catastrophic out-of-pocket expenditure on treatment of podo in affected families, and the prevalence of the condition,4 health policy in Cameroon must prioritize prevention and treatment interventions for these households and communities. This study suggests that the economic effects of leprosy have been partly mitigated by government and nongovernment provision of treatment and rehabilitation services to patients and their families who no longer suffer catastrophic health expenditure to access treatment. Similar provision is urgently needed for podo patients. Models of disease management for people with podo have been tested in other low-resource settings, whereas disability inclusion models can be adapted from those used so successfully for people with leprosy. We call on the government of Cameroon to prioritize podo—to prevent new disease and disability and to ensure financial risk protection for affected households.