Utilization cost of maternity services for childbirth among pregnant women with coronavirus disease 2019 in Nigeria’s epicenter

  1. Aduragbemi Banke‐Thomas
  2. Christian Chigozie Makwe
  3. Mobolanle Balogun
  4. Bosede Bukola Afolabi
  5. Theresa Amaogechukwu Alex‐Nwangwu
  6. Charles Anawo Ameh

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Abstract

Objective

To estimate utilization costs of spontaneous vaginal delivery (SVD) and cesarean delivery (CD) for pregnant women with coronavirus disease 2019 (COVID‐19) at the largest teaching hospital in Lagos, the pandemic's epicenter in Nigeria.

Methods

We collected facility‐based and household costs of all nine pregnant women with COVID‐19 managed at the hospital. We compared their mean facility‐based costs with those paid by pregnant women pre‐COVID‐19, identifying cost‐drivers. We also estimated what would have been paid without subsidies, testing assumptions with a sensitivity analysis.

Results

Total utilization costs ranged from US $494 for SVD with mild COVID‐19 to US $4553 for emergency CD with severe COVID‐19. Though 32%–66% of facility‐based cost were subsidized, costs of SVD and CD during the pandemic have doubled and tripled, respectively, compared with those paid pre‐COVID‐19. Of the facility‐based costs, cost of personal protective equipment was the major cost‐driver (50%). Oxygen was the major driver for women with severe COVID‐19 (48%). Excluding treatment costs for COVID‐19, mean facility‐based costs were US $228 (SVD) and US $948 (CD).

Conclusion

Despite cost exemptions and donations, utilization costs remain prohibitive. Regulation of personal protective equipment and medical oxygen supply chains and expansion of advocacy for health insurance enrollments are needed in order to minimize catastrophic health expenditure.

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  1. ScreenIT

    SciScore for 10.1101/2020.09.22.20199265: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: Participation in the study was entirely voluntary and written informed consent was obtained from each participant who agreed to take part with no financial incentive offered.
    IRB: Ethical approval to conduct the study was obtained from the Health Research and Ethics Committee of the Lagos University Teaching Hospital (LUTHHREC/EREV/0520/24).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableAs the COVID-19 cases mounted in the state, two of the 24 public health facilities, the federal government-owned Lagos University Teaching Hospital (LUTH) and the state government-owned Gbagada General Hospital were tasked with providing bespoke care for pregnant women who were suspected or infected with COVID-19 (Igomu, 2020a; Ishola, 2020).

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Analysis was conducted in Microsoft Excel (Microsoft Corporation, Redmond, United States) sheet following conversion of cost data to United States Dollars (US$) as per the mean exchange rate for the year on the official OANDA Corporation website (OANDA, 2020).
    Microsoft Excel
    suggested: (Microsoft Excel, RRID:SCR_016137)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    However, there are limitations to bear in mind in interpreting findings of this study. Firstly, our sample size is small, with only one SVD. Though this is not dissimilar to other studies with a recent systematic review reporting 92 women across nine studies which reported an 80% CD rate (Smith et al., 2020). One other limitation relates to the recall bias that our findings may be subject to, as we captured household costs entirely based on what they could recollect following their discharge. However, having to double-check with their partners regarding the cost data being provided helped to minimize any influence of this bias. In addition, we have only reported cost from one public tertiary hospital in Nigeria, and this cost may not be representative of the cost being incurred by women around the country, especially within the private sector, where costs for using services are typically higher than in the public sector (Banke-Thomas et al., 2020). In addition, we did not collect or report household costs data in the pre-COVID era. However, the cost of many products and services, including transportation has gone up in this period (Mogaji, 2020). As such, this additional data would not have altered our conclusion that women are paying more for childbirth during the COVID-19 pandemic.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  2. Version published to 10.1002/ijgo.13436
  3. Version published to 10.1101/2020.09.22.20199265v1 on medRxiv