Exploring risk factors associated with catastrophic health expenditure on diarrhea management in Karachi, Pakistan, 2022-2024

BackgroundCatastrophic health expenditure (CHE) is a situation where a households out of pocket medical payments are excessively high relative to its income, potentially leading to impoverishment. This study explores the risk factors associated with CHE in the management of diarrhea among children enrolled in Enterics for Global Health (EFGH) facilities in Karachi, Pakistan. MethodsWe conducted a secondary analysis of data from 1,400 children presenting with diarrhea at Pakistan EFGH facilities. We estimated households direct medical and non-medical costs incurred during a diarrhea episode. CHE was defined as healthcare expenditures exceeding 10% of total monthly household expenditure. Risk factors for CHE were assessed using univariate and multivariate regression models. ResultsCHE was observed in 9 (0.6%) households. Children experiencing severe diarrhea were 9.53 times (95% CI: 1.93-46.91, p=0.006) more likely to incur CHE compared to those with mild cases. Children with Cryptosporidium had a 7.08 times higher risk (95% CI: 1.46-34.38, p=0.015) compared to non- cryptosporidium. Children who presented at the health facility with both diarrhea and moderate or severe wasting were 5.47 and 9.71 times more likely to experience CHE compared to those without wasting (95% CI: 1.01-29.69, p=0.011 and 1.64-57.6, p=0.012) respectively. Similarly, children who were moderately underweight were 5.4 times more likely to experience CHE compared to those who were not underweight (95% CI: 1.01-29.69, p=0.043). After adjusting for diarrhea severity, the risk of CHE among households where the fathers education was limited to Quranic schooling was 8.4 times higher compared to no formal education (95% CI: 1.13-62.49, p=0.038). ConclusionAlthough CHE related to child diarrhea treatment is rare, it can have severe economic outcomes. Severe diarrhea, malnutrition, and Cryptosporidium infection were predictors of increased risk of CHE. Improving access to affordable healthcare, vaccination and nutritional programs, water, sanitation, and hygiene (WASH) practices and financial support could reduce the impact of CHE and protect vulnerable households.