Cost of Initial Care for Preterm Infants at Bolgatanga Regional Hospital, Ghana
Abstract:
Preterm birth is an important public health
problem due to its medical, economic, and social impact and constitutes about 10%
of annual global births. To improve access and equity to health care delivery of
preterm infants, identification of major cost areas and strategies to improve efficiency
in those areas must be prioritized. This study estimated the health system cost
of neonatal intensive care unit (NICU) services for preterm babies in the Regional
Hospital, Bolgatanga (RHB). A costing study based on health system perspective designed
to estimate cost of initial hospital care for preterm babies was carried out in
RHB. Participants were selected based on systematic sampling procedure of preterm
babies admitted at the facility from January 2019 to December 2019. The health system
and cost estimates of NICU services were done using both top-to-bottom and micro-costing
approaches. Preterm births constituted 30% of NICU admissions in 2019. Most preterm
infants were of low birth weight (LBW). The total cost for providing initial hospital
care for preterm infants in 2019 was GH₵212,776.96 ($35,462.83). The major cost
component was shared cost making up 59.20%, especially staff salaries. Direct medical
cost constituted 40.80% of the total cost. The RHB would have saved GH₵212,776.96
($35,462.83) in 2019 if preterm births were eliminated. Prioritizing efficient use
of shared resources would save cost for increase access to preterm care.
References:
[1] Ramokolo,
V., Malaba, T., Rhoda, N., Kauchali, S. & Goga, A., 2019, A landscape
analysis of preterm birth in South Africa: systemic gaps and solutions. South
African Heal Rev, 134–44. Available from: https://journals.co.za/doi/pdf/10.10520/EJC-1d2aeafa22.
[2] Chawanpaiboon,
S., Vogel, J.P., Moller, A.B., Lumbiganon, P., Petzold, M. & Hogan, D.,
2019, Global, regional, and national estimates of levels of preterm birth in
2014: a systematic review and modelling analysis. Lancet Glob Heal, 7(1): e37–46.
[3] W.H.O.,
2015, W.H.O. recommendations on interventions to improve preterm birth
outcomes. Geneva, 2018.
[4] Sakata,
S., Konishi, S., Fook, C., Ng, S. & Watanabe, C., 2017, Preterm birth rates
in Japan from 1979 to 2014: Analysis of national vital statistics. Wiley Online
Libr, 44(3):390–6. Available from: https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/jog.13460.
[5] Bensley,
J.G., Moore, L., De Matteo, R., Harding, R. & Black, M.J., 2018, Impact of
preterm birth on the developing myocardium of the neonate. Pediatr Res,
83(4):880–8. Available from: https://www.nature.com/articles/pr2017324.
[6] Manuck,
T.A., 2017, Racial and ethnic differences in preterm birth: a complex,
multifactorial problem. In: Seminars in perinatology. Elsevier, p. 511–8.
[7] Vogel,
J.P., Chawanpaiboon, S., Moller, A.B., Watananirun, K., Bonet, M. &
Lumbiganon, P., 2018, The global epidemiology of preterm birth. Best Pract Res
Clin Obstet Gynaecol, 52:3–12.
[8] Chen,
C., Zhang, J.W., Xia, H.W., Zhang, H.X., Betran, A.P., Zhang, L. & Zhang,
J., 2019, Preterm birth in China between 2015 and 2016. Am J Public Health,
109(11):1597–604.
[9] Pandey,
M., Chauhan, M. & Awasthi, S., 2017, Interplay of cytokines in preterm
birth. Indian Journal of Medical Research, Vol. 146, p. 316–27. Available from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5793465/.
[10] Chevallier,
M., Debillon, T., Pierrat, V., Delorme, P., Kayem, G. & Durox, M., 2017,
Leading causes of preterm delivery as risk factors for intraventricular
hemorrhage in very preterm infants: results of the EPIPAGE 2 cohort study.
American Journal of Obstetrics and Gynecology, p. 518.e1-518.e12. Available
from: https://www.sciencedirect.com/science/article/pii/S0002937817301023.
[11] Di
Renzo, G.C., Tosto, V. & Giardina, I., 2018, The biological basis and
prevention of preterm birth. Best Practice and Research: Clinical Obstetrics
and Gynaecology, Vol. 52, p. 13–22. Available from: https://www.sciencedirect.com/science/article/pii/S1521693418300403.
[12] Walani,
S.R., 2020, Global burden of preterm birth. International Journal of Gynecology
and Obstetrics, John Wiley and Sons Ltd, Vol. 150, p. 31–3.
[13] Cheah
I.G.S., 2019, Economic assessment of neonatal intensive care. Translational
Pediatrics, Vol. 8, p. 246–56. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6675687/.
[14] Enweronu-Laryea,
C.C., Andoh, H.D., Frimpong-Barfi, A. & Asenso-Boadi, F.M., 2018, Parental
costs for in-patient neonatal services for perinatal asphyxia and low birth
weight in Ghana. PLoS One, 1;13(10).
[15] Agbanyo,
R., 2020, Ghana’s national health insurance, free maternal healthcare, and
facility‐based delivery services. African Dev Rev, 32(1):27–41.
[16] Lambon-Quayefio,
M. & Owoo, N.S., 2017, Determinants and the impact of the National Health
Insurance on neonatal mortality in Ghana. Health Econ Rev, 7(1):1–16.
[17] Bailey,
P.E., Awoonor-Williams, J.K., Lebrun, V., Keyes, E., Chen, M. & Aboagye,
P., 2019, Referral patterns through the lens of health facility readiness to
manage obstetric complications: National facility-based results from Ghana.
Reprod Health, 18;16(1).
[18] Gomez,
P.P., Nelson, A.R., Asiedu, A., Addo, E., Agbodza, D. & Allen, C., 2018,
Accelerating newborn survival in Ghana through a low-dose, high-frequency
health worker training approach: A cluster randomized trial. BMC Pregnancy
Childbirth, 18(1).
[19] Nuamah,
G.B., Agyei-Baffour, P., Mensah, K.A., Boateng, D., Quansah, D.Y. & Dobin,
D., 2019, Access and utilization of maternal healthcare in a rural district in
the forest belt of Ghana. BMC Pregnancy Childbirth, 19(1).
[20] Afulani,
P.A., Aborigo, R.A., Walker, D., Moyer, C.A., Cohen, S. & Williams, J.,
2023, Can an integrated obstetric emergency simulation training improve
respectful maternity care? Results from a pilot study in Ghana. Wiley Online
Libr, 46(3):523–32, Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/birt.12418.
[21] Saaka,
M., Ali, F. & Vuu, F., 2018, Prevalence and determinants of essential
newborn care practices in the Lawra District of Ghana. BMC Pediatr, 18(1).
[22] Drummond,
M. & Bmj, T.J., 1996, Guidelines for authors and peer reviewers of economic
submissions to the BMJ. 313:275–83. Available from: https://www.bmj.com/content/313/7052/275 pdf+html.
[23] Gauttam,
V., 2015, Introduction to Health Economics. A Complete Textbook for GNM
Internship. 429–429 p.
[24] Lim,
G., Tracey, J., Boom, N., Karmakar, S., Wang, J. & Berthelot, J.M., 2009,
CIHI survey: Hospital costs for preterm and small-for-gestational age babies in
Canada. 12(4):20–4. Available from: https://www.researchgate.net/profile/Gillian-Lim-2/publication/40895190_CIHI_Survey_Hospital_Costs_for_Preterm_and_Small-for-Gestational_Age_Babies_in_Canada/.
[25] Cömert,
S., Ağzıkuru, T., Akın, Y., Telatar, B. & Tan, D., 2012, The cost analysis
of preterm infants from a NICU of a state hospital in Istanbul. 22(2):185–90.
Available from: https://brieflands.com/articles/ijp-2728.html.