Investigating household catastrophic health expenditure and coping mechanisms in patients with Chronic Kidney Disease in Enugu, Nigeria: a single center experience

The methods of financing healthcare expenditure for any country are vital in determining the health status of the country. To meet the rising costs of seeking health care, many poor households in managing chronic disease conditions like Chronic Kidney Disease (CKD) often resort to coping strategies that are further detrimental to their well-being. CKD is the 12th highest cause of death and 17th highest cause of disability worldwide. This study assessed the incidence of household catastrophic health expenditure and payment coping mechanism of patients with CKD. It was a descriptive cross-sectional study involving 100 patients with various stages of CKD attending the Nephrology clinics of University of Nigeria Teaching Hospital Enugu, South eastern Nigeria. They were recruited using a systematic sampling technique. A questionnaire was used to collect data. Data were collected using pre-tested semi-structured questionnaires and analyzed using descriptive statistics of frequencies, percentages, mean, standard deviation and interquartile range. Chi-square was used to test for association between payment coping mechanisms used by patients across socioeconomic groups. The study demonstrated uniformly high incidence of catastrophic expenditure for all the respondents both at 10% and 40% threshold (100% and 97%) respectively, with cost of treatment uniformly distributed among the various socioeconomic classes. Most of the patients assessed their treatment by paying out of pocket without reimbursement (88%), with money from personal bank savings being the commonest coping mechanism especially among the poorest Socioeconomic Status (SES) class, and borrowing among the least poor SES class. The study concluded that the prevalence of catastrophic expenditure was very high across all the socioeconomic status. It is recommended that the Nigerian Health Insurance program should be expanded to cover at least dialysis treatment of CKD, if not all aspects of CKD management in order to protect these patients and their household from ill-health mediated catastrophic expenditure.