@article{fdi:010095828,
  title = {{H}ousehold costs of care in children under five attending primary care in {B}urkina {F}aso, {G}uinea, {M}ali and {N}iger : a cross-sectional study nested in the {AIRE} project},
  author = {{A}gbeci, {H}. and {B}akyono, {R}. and {T}our{\'e}, {A}. {O}. and {C}oulibaly, {A}. and {Z}air, {Z}. and {N}iome, {M}. and {H}ema, {A}. and {S}awadogo, {A}. {S}. and {K}eita, {S}. and {B}okol, {L}. {P}. and {H}edible, {K}. {G}. {B}. and {N}eboua, {D}. and {L}ouart, {S}. and {Z}ombr{\'e}, {V}. and {K}aba, {D}. {F}. and {S}idibe, {A}. and {S}ouleymane, {H}. {A}. and {C}ousien, {A}. and {B}usi{\`e}re, {S}. and {L}amontagne, {F}. and {R}idde, {V}al{\'e}ry and {D}esmonde, {S}. and {L}eroy, {V}. and {A}ire {R}esearch {S}tudy {G}roup,},
  editor = {},
  language = {{ENG}},
  abstract = {{I}ntroduction {O}ut-of-pocket payments limit access to care in {A}frica. {TT}he {A}m{\'e}lioration de l'{I}dentification des d{\'e}tresses {R}espiratoires de l'{E}nfant/{I}mproving {I}dentification of {R}espiratory {D}istress in {C}hildren ({AIRE}) project evaluated the implementation of pulse oximetry within {I}ntegrated {M}anagement of {C}hildhood {I}llness ({IMCI}) guidelines at primary health centres ({PHC}s) in {B}urkina {F}aso and {N}iger (with total exemption policies) and in {M}ali and {G}uinea (with partial exemption policies). {W}e measured households' out-of-pocket expenditures for treating children under 5 years of age and analysed the associated factors.{M}ethods {B}etween {J}une 2021 and {M}ay 2022, all children under 5 years of age attending {IMCI} consultations, excluding simple non-respiratory cases, aged 2-59 months, were enrolled in the {AIRE} study with parental consent. {F}ive non-severe cases and five severe cases (followed up over 14 days) per {PHC} were randomly selected every month. {W}e collected medical and non-medical direct costs and indirect costs. {W}e described the median costs and investigated the factors associated with medical direct costs ({MDC}s) using two-part models for countries with total exemption and a general linear model for those with partial exemption. {R}esults {O}verall, 940 non-severe cases and 745 severe cases were selected. {T}he median {MDC}s were {US}$0.0, {US}$7.1, {US}$5.0 and {US}$3.6 for non-severe cases and {US}$1.6, {US}$8.6, {US}$7.4 and {US}$14.4 for severe cases, in {B}urkina {F}aso, {G}uinea, {M}ali and {N}iger, respectively. {M}edicine expenditures were the main {MDC} items, accounting for 79% of costs for non-severe cases and 59% for severe cases. {I}n all countries, disease severity and the unavailability of prescribed medicines at {PHC}s or referral hospital depots were associated with out-of-pocket payments and higher expenses. {C}onclusion {W}ith the exception of {B}urkina {F}aso, household out-of-pocket payments for children under five remain high despite free care policies, particularly for treating severe cases. {T}his is mainly explained by medicines expenditures. {A}ction is needed to identify efficient financing systems that ensure the regular and adequate supply of medicines in public health facilities and to support free healthcare policies.},
  keywords = {{H}ealth economics ; {H}ealth systems evaluation ; {C}hild health ; {P}aediatrics ; {H}ealth policy ; {BURKINA} {FASO} ; {GUINEA} ; {MALI} ; {NIGER}},
  booktitle = {},
  journal = {{BMJ} {G}lobal {H}ealth},
  volume = {10},
  numero = {{S}uppl. 8},
  pages = {e017305 [15 p.]},
  ISSN = {2059-7908},
  year = {2025},
  DOI = {10.1136/bmjgh-2024-017305},
  URL = {https://www.documentation.ird.fr/hor/fdi:010095828},
}