Catastrophic health expenditures associated with single admission for paediatric surgery in a low-resource setting: a multicentre study

Background Catastrophic healthcare expenditure (CHE) poses significant financial burdens on households globally, particularly in low- and middle-income countries. This study was designed to determine the prevalence of CHE among families of paediatric surgical patients admitted for surgery and to explore factors associated with it. Methods The study was a prospective, multicentre, cross-sectional study carried out in 25 hospitals with paediatric surgery in Nigeria from July to November 2024. Consecutive patients below 16 years of age who underwent surgery were included. CHE was defined as health expenditure above 10% of the head of household annual household income. Data on demographic data, educational and employment status of parents and other related factors were collected and analysed using Stata. Results A total of 1665 patients were recruited with ages ranging from 5 days to ≤16 years (median=4.74 years). Overall median annual income for the heads of household was US$1097.78. The median (IQR) cost of care was US$129.81 per patient and 56.3% of households spent out of pocket and only 11.7% of households had access to health insurance. A total of 981 households (58.9%; 95% CI 56.5% to 61.3%) experienced CHE. The CHE incidence rate ratio (IRR) decreased among households where the patients were male (IRR 0.92 (95% CI 0.86 to 0.98); p=0.011), the head-of-households had a graduate/postgraduate education (IRR 0.64 (95% CI 0.53 to 0.78); p<0.001), but increased when major surgery was performed (IRR 1.25 (95% CI 1.08 to 1.44); p=0.002) and with prolonged hospital stay (1.008 (95% CI 1.005 to 1.011); p<0.001). The main sources of funds for healthcare were out-of-pocket (n=936, 56.3%) and availability of health insurance was significant in preventing CHE, as three of every four households accessing health insurance did not experience it. Conclusion Catastrophic health expenditure was highly prevalent among families of children who underwent surgery in Nigeria, particularly among those who had major and emergency surgeries.