[In Cambodia, Dengue] Fever in the family costs more than food

A Cambodian mother watches over her child, who has dengue fever. (Photo: WHO/TDR/Nathan)

15 Jun 2009
Paul Chinnock
Source: BMC Public Health

Dengue fever affects up to 100 million people every year. While most of them recover, there is an economic cost to countries and to individual families. Increased efforts are being made to develop a vaccine against the disease. In assessing the cost-effectiveness of any dengue vaccine it will be important to have a good understanding of how much the disease costs families in specific countries.

Researchers working in rural Cambodia (1) interviewed the heads of 60 households, where a child had been ill with fever, to determine how much the illness of the child had cost each family. In 30 of these households the febrile children were dengue-positive; in the others the children had tested negative. The interviews were conducted 1-2 months after the child had recovered.

The average cost for dengue cases ($31.5) did not differ significantly from those of other febrile illnesses ($27.2). Hospitalization almost tripled the costs of dengue (from $14.3 to $40.1) and doubled the costs of other febrile illnesses (from $17.0 to $36.2). Direct medical costs accounted for about 50% of the economic impact; the remaining 50% included nonmedical costs of caring for the ill child and loss of income due to work loss or the need to pay someone to take care of the rice fields.

To pay these costs, two-thirds of households had to borrow money and 25% had to sell assets or use their savings. To finance the cost of a febrile illness, 67% of households incurred an average debt of $23.5.These costs are put into perspective by the fact that an average weekly expenditure on food for these rural Cambodians is US$ 9.5 per household.

One finding of particular note is that when children in the poorest families suffered from dengue they were less often hospitalised than those from families with more money. This is likely to be because of the cost involved. (The authors note that most previous research on the cost dengue imposes on families has focused on hospitalised patients, whereas most cases are managed out of hospital.)

The research was part of a major community-based surveillance study, involving over 6,000 children in 16 villages. During 2006 a total of 89 patients in the larger study were found to have a febrile illness that was laboratory-confirmed dengue (incidence 13/1,000). The interviews with the household heads confirm that this increasingly common infectious disease imposes major financial hardship on poor people, particularly if hospitalization is required, and can lead them into debt.