Patient-level cost of home- and facility-based child pneumonia treatment in Suba Sub County, Kenya

Autoři: Joel Amenya Machuki aff001;  Dickens S. Omondi Aduda aff002;  Abong’o B. Omondi aff003;  Maricianah Atieno Onono aff001
Působiště autorů: Department of Research, Kenya Medical Research Institute, Kisumu, Kenya aff001;  Department of Public Health and Community Development, University of Kabianga, Kericho, Kenya aff002;  Department of Biomedical Sciences and Technology, The National University of Lesotho, Maseru, Lesotho aff003;  Department of Biology, National University of Lesotho, Lesotho, South Africa aff004
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225194



Globally, pneumonia accounted for 16% of deaths among children under 5 years of age and was one of the major causes of death overall in 2018. Kenya is ranked among the top 15 countries with regard to pneumonia prevalence and contributed approximately 74% of the world's annual pneumonia cases in 2018. Unfortunately, less than 50% of children with pneumonia receive appropriate antibiotics for treatment. Homa-Bay County implemented pneumonia community case management utilizing community health workers, as recommended by the World Health Organization (WHO), in 2014. However, since implementation of the program, the relative patient-level cost of home-based and facility-based treatment of pneumonia, as well as the main drivers of these costs in Suba Subcounty, remain uncertain. Therefore, the main objective of this study was to compare the patient-level costs of home based treatment of pneumonia by a community health worker with those of health facility-based treatment.

Methods and findings

Using a cross-sectional study design, a structured questionnaire was used to collect quantitative data from 208 caregivers on the direct costs (consultation, medicine, transportation) and indirect costs (opportunity cost) of pneumonia treatment. The average household cost for the community managed patients was KSH 122.65 ($1.29) compared with KSh 447.46 ($4.71), a 4-fold difference, for those treated at the health facility. The largest cost drivers for home treatment and health facility treatment were opportunity costs (KSH 88.25 ($ 0.93)) and medicine costs (KSH 126.16 ($ 1.33)), respectively.


This study demonstrates that the costs incurred for home-based pneumonia management are considerably lower compared to those incurred for facility-based management. Opportunity costs (caregiver time and forgone wages) and the cost of medication were the key cost-drivers in the management of pneumonia at the health facility and at home, respectively. These findings emphasize the need to strengthen and scale community case management to overcome barriers and delays in accessing the correct treatment for pneumonia for sick children under 5 years of age.

Klíčová slova:

Health economics – Child health – Indirect costs – Kenya – Mothers – Pneumonia – Socioeconomic aspects of health – Transportation


1. Ho Y-C, Lee P-L, Wang Y-C, Chen S-C, Chen K-T. The economic burden of childhood invasive pneumococcal diseases and pneumonia in Taiwan: Implications for a pneumococcal vaccination program. Hum Vaccines Immunother. 2015 Apr 15;11.

2. Mathers C, Fat DM, Boerma JT, World Health Organization, editors. The global burden of disease: 2004 update. Geneva, Switzerland: World Health Organization; 2008. 146 p.

3. WHO. Revised WHO Classification and Treatment of Pneumonia in Children at Health Facilities: Evidence Summaries. [Internet]. World Health Organization; 2014 [cited 2018 Aug 21]. Available from:

4. Sazawal S, Black RE, Pneumonia Case Management Trials Group. Effect of pneumonia case management on mortality in neonates, infants, and preschool children: a meta-analysis of community-based trials. Lancet Infect Dis. 2003 Sep;3(9):547–56. doi: 10.1016/s1473-3099(03)00737-0 12954560

5. Ingram M, Reinschmidt KM, Schachter KA, Davidson CL, Sabo SJ, De Zapien JG, et al. Establishing a Professional Profile of Community Health Workers: Results from a National Study of Roles, Activities and Training. J Community Health. 2012 Apr 1;37(2):529–37. doi: 10.1007/s10900-011-9475-2 21964912

6. Onono M, Abdi M, Mutai K, Asadhi E, Nyamai R, Okoth P, et al. Community case management of lower chest indrawing pneumonia with oral amoxicillin in children in Kenya. Acta Paediatr Oslo Nor 1992. 2018 Dec;107 Suppl 471:44–52.

7. Onono M, Abdi M, Opondo I, Okung’u J, Asadhi E, Nyamai R, et al. Using the RE-AIM framework to evaluate the implementation of integrated community case management in Kenya. Acta Paediatr. 2018;107(S471):53–62.

8. Druetz T, Siekmans K, Goossens S, Ridde V, Haddad S. The community case management of pneumonia in Africa: a review of the evidence. Health Policy Plan. 2015 Mar 1;30(2):253–66. doi: 10.1093/heapol/czt104 24371218

9. Anh DD, Riewpaiboon A, Tho LH, Kim SA, Nyambat B, Kilgore P. Treatment Costs of Pneumonia, Meningitis, Sepsis, and Other Diseases among Hospitalized Children in Viet Nam. J Health Popul Nutr. 2010 Oct;28(5):436. doi: 10.3329/jhpn.v28i5.6151 20941894

10. Cupurdija V, Lazic Z, Petrovic M, Mojsilovic S, Cekerevac I, Rancic N, et al. Community-acquired pneumonia: economics of inpatient medical care vis-à-vis clinical severity,. J Bras Pneumol. 2015;41(1):48–57. doi: 10.1590/S1806-37132015000100007 25750674

11. Kenya National Bureau of Statistics., UNICEF. Homa Bay County Multiple Indicator Cluster Survey 2011, Final Report. Nairobi, Kenya. Kenya National Bureau of Statistics.; 2013 Jul p. 12–4.

12. Sadruddin S, Shehzad S, Bari A, Khan A, Ibad-ul-Haque, Khan A, et al. Household Costs for Treatment of Severe Pneumonia in Pakistan. Am J Trop Med Hyg. 2012 Nov 7;87(5 Suppl):137–43.

13. Krishnan F, Arora N, Pandav C, Kapoor S. Cost of curative pediatric services in a public sector setting. Indian J Pediatr. 2005 Aug;72(8):657–60. doi: 10.1007/bf02724072 16131769

14. Ayieko P, Akumu AO, Griffiths UK, English M. The economic burden of inpatient paediatric care in Kenya: household and provider costs for treatment of pneumonia, malaria and meningitis. Cost Eff Resour Alloc CE. 2009;7:3.

15. Matovu F, Nanyiti A, Rutebemberwa E. Household health care-seeking costs: experiences from a randomized, controlled trial of community-based malaria and pneumonia treatment among under-fives in eastern Uganda. Malar J. 2014;13(1):222.

16. Madsen HO, Hanehøj M, Das AR, Moses PD, Rose W, Puliyel M, et al. Costing of severe pneumonia in hospitalized infants and children aged 2–36 months, at a secondary and tertiary level hospital of a not-for-profit organization: Costing of severe pneumonia. Trop Med Int Health. 2009 Oct;14(10):1315–22. doi: 10.1111/j.1365-3156.2009.02374.x 19719464

17. Hussain H, Waters H, Omer SB, Khan A, Baig IY, Mistry R, et al. The cost of treatment for child pneumonias and meningitis in the Northern Areas of Pakistan. 2006 Aug 2;21(3):229–238. doi: 10.1002/hpm.847 17044548

18. Munge K, Briggs AH. The progressivity of health-care financing in Kenya. Health Policy Plan. 2014 Oct 1;29(7):912–20. doi: 10.1093/heapol/czt073 24107660

19. Abdi M, Shaw BI, Asadhi E, Owuor K, Cohen CR, Onono M, et al. Perceived Quality of Care of Community Health Worker and Facility-Based Health Worker Management of Pneumonia in Children Under 5 Years in Western Kenya: A Cross-Sectional Multidimensional Study. Am J Trop Med Hyg. 2016 May 4;94(5):1170–6. doi: 10.4269/ajtmh.15-0784 26976883

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2019 Číslo 11