Work

Household costs and catastrophic health expenditure from malaria in pregnancy in Western Kenya

Year: 2026

Type: preprint

Abstract: Background Malaria in pregnancy (MiP) imposes a substantial economic burden on households in sub-Saharan Africa. We estimated household costs of MiP and their distribution across wealth quintiles among HIV-uninfected pregnant women in western Kenya receiving intermittent preventive treatment (IPTp) with sulfadoxine-pyrimethamine (SP), dihydroartemisinin-piperaquine (DP), or dihydroartemisinin-piperaquine plus provider education. Methods This study was nested within a three-armed, pragmatic, open-label, cluster-randomised trial across 15 health facilities over 10 months. Exit interviews were conducted during the second and third trimesters, approximately 5–6 months after the start of the intervention period. Direct and indirect household costs from the most recent malaria episode were compared with income to estimate catastrophic health expenditure (CHE). Costs were analysed using mixed-effects generalised linear model and their distribution across wealth quintiles using the concentration index. Cost data collected in 2020 (Kenyan shillings) were inflated and converted to 2024 US dollars. Findings Among 1,189 participants, 247 (21%) self-reported having sought care for MiP (212 outpatients, 24 inpatients, 11 unspecified). Mean costs were USD 24.9 for outpatient and USD 57.1 for inpatient care per episode. Indirect costs accounted for 87% and 70% of outpatient and inpatient costs, respectively. The mean outpatient malaria costs were equivalent to six or more days while inpatient costs were half a month or more of the minimum wages in the study area. The incidence of CHE for outpatient care was 8%, and neither outpatient costs nor CHE varied between wealth quintiles (concentration index =0.02, p=0.571 and 0.01, p=0.304, respectively). Conclusions MiP imposes a substantial economic burden on households in western Kenya, despite a national policy of free maternal health services. Most costs arose from productivity losses rather than payments for care; financial protection therefore depends on the prevention of malaria episodes.

Source: medRxiv

DOI: 10.64898/2026.09.21.26363610