Research Article: “It Is Me Who Endures but My Family That Suffers”: Social Isolation as a Consequence of the Household Cost Burden of Buruli Ulcer Free of Charge Hospital Treatment

Date Published: October 15, 2008

Publisher: Public Library of Science

Author(s): Koen Peeters Grietens, Alphonse Um Boock, Hans Peeters, Susanna Hausmann-Muela, Elizabeth Toomer, Joan Muela Ribera, Melissa Van Dyke

Abstract: Despite free of charge biomedical treatment, the cost burden of Buruli ulcer disease (Bu) hospitalisation in Central Cameroon accounts for 25% of households’ yearly earnings, surpassing the threshold of 10%, which is generally considered catastrophic for the household economy, and calling into question the sustainability of current Bu programmes. The high non-medical costs and productivity loss for Bu patients and their households make household involvement in the healing process unsustainable. 63% of households cease providing social and financial support for patients as a coping strategy, resulting in the patient’s isolation at the hospital. Social isolation itself was cited by in-patients as the principal cause for abandonment of biomedical treatment. These findings demonstrate that further research and investment in Bu are urgently needed to evaluate new intervention strategies that are socially acceptable and appropriate in the local context.

Partial Text: Buruli ulcer disease (henceforth, Bu) is the third most common mycobacterial disease in humans, after tuberculosis and leprosy [1]; nonetheless, despite the dramatic increase in incidence rates in West Africa during the last decade, it remains largely neglected [2]. Its causative agent, Mycobacterium ulcerans, is an environmental mycobacterium endemic to restricted foci throughout the tropics and directly related to stagnant or slow-flowing water [3]. Inoculation of Mycobacterium ulcerans into the subcutaneous tissues likely occurs through penetrating skin trauma, though the mode of transmission is not entirely clear. The agent produces a potent toxin known as mycolactone which destroys cells in the subcutis leading to the development of large skin ulcers [4]. Major advances have been made in the management of the disease with the introduction of rational antibiotic therapy [4], however, successful clinical outcomes require that patients initiate treatment promptly and adhere to treatment regimens [5],[6],[7]. Furthermore, because Bu often leads to irreversible physical disabilities, the disease takes a significant toll on affected patients and their households [7].

Growing awareness of the connection between ill health and impoverishment has placed health at the centre of development agencies’ poverty reduction targets and strategies and strengthened arguments for a substantial increase in health sector investment. Subsequent research, however, has shown the difficulty in alleviating the cost burden of illness for poor households due to the presence of hidden costs. Our research found that despite the availability of free of charge medical care, households of Bu patients in the study area faced an unbearable cost burden. The majority of households responded by withdrawing involvement in care, leaving patients socially isolated. This reality raises questions of how to increase accessibility to biomedical treatment and how to proceed with future programs.



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