Health care provider costs of child health services for severe anaemia and malaria in Malawi, Kenya, and Uganda

Background Severe anaemia and malaria are among the leading causes of childhood hospital admissions in Africa south of the Sahara. For children being discharged from hospital, readmissions often occur raising the costs for inpatient care. This study aims to estimate healthcare provider costs for children under-five diagnosed with severe anaemia and severe malaria at Zomba and Kamuzu Central Hospitals in Malawi, Kisumu Referral Hospital in Kenya and Jinja Children’s Referral Hospital in Uganda. This is a sub-study of the clinical trial “Dihydroartemisinin-piperaquine and azithromycin for the post-discharge management of children with severe anaemia in Malawi, Kenya and Uganda”. Methods Cost data were collected from January 2024 to October 2024. Using bottom-up costing, we estimated annual economic costs for personnel, supplies and overheads required for a paediatric medical admission, referral, and blood transfusion processes. Individual cost components were identified, measured and valued for the services of in-patient and outpatient care, laboratory processing and ambulance referrals. Results The cost to healthcare providers for one bed-day for a general paediatric medical admission was $18 at Zomba Central Hospital, $50 at Kisumu County Referral Hospital, and $15 at Jinja Children’s Referral Hospital. When accounting for laboratory services, blood transfusions, and malaria medication for the duration of the entire hospital stay, the total costs of care were: $118 in Zomba, $427 in Kisumu and $167 in Jinja. At Kamuzu Central Hospital, a bed-day costs $9 in the main children’s medical ward, and $24 in the High Dependency Unit. The costs of providing for the entire hospital admission were $79 and $310, respectively. Personnel and operational costs were the main cost drivers for admissions costs, while laboratory supplies were the main cost component when providing blood testing services. Conclusion This study demonstrates how the costs of providing health care are influenced by fixed and variable cost components, health service utilization, and country-specific investments in health care. Our findings contribute to an evidence base to inform resource allocation and cost-effectiveness analyses of interventions targeting severe anaemia and malaria in children in Malawi, Kenya, and Uganda. Clinical trial registration Registry: pactr.samrc.ac.za Date of Registration: 8 th March 2023, Trial Registration Number: PACTR202303630742194.