Direct Healthcare Cost and Resources Utilization of Malaria among Households in Madani Locality, Gezira State. Sudan

Abstract

Background: Malaria continues to pose a significant health and economic challenge in Sudan, imposing substantial out-of-pocket expenditures and Catastrophic Health Expenditure (CHE) for affected households. This study aims to estimate direct healthcare costs, analyze healthcare resource utilization, and identify socioeconomic and demographic predictors of the economic burden of malaria in Madani Locality, Gezira State.
Methodology: A community-based study was conducted in 2017 among 385 households selected through multi-stage sampling. Data on direct treatment expenditure (consultation fees, laboratory tests, drugs, special food, transportation, and other costs) and healthcare-seeking behaviors were collected via a piloted questionnaire. Statistical analysis employed descriptive methods, ANOVA, Chi-square tests, and multiple regression to assess cost distribution and predictors of economic burden.
Results: Drugs constituted the highest proportion of direct treatment costs (107.61 SDG / 16.3 USD), followed by special food (38, 78 SDG / 5.7 USD). Pharmacies were the most common treatment source (11.77 SDG / 1.7 USD per case). Public health centers were the most common treatment source (47.3%), with proximity (53%) the primary reason for facility choice. Regression analysis identified socioeconomic status (p=0.001), occupation of household head (p=0.01), age (p=0.01), gender (p=0.03), and use of preventive methods (p=0.02) as significant predictors of economic burden, while diagnostic method and facility choice were not significant. These findings highlight that structural socioeconomic conditions outweigh service-level factors in shaping household vulnerability to Catastrophic Health Expenditure (CHE).
Conclusion: Malaria impose substantial and catastrophic financial burden on households in Sudan, driven primarily by poverty, occupation, gender, and age. Preventive methods were protective, reducing household vulnerability. The study contributes to debates on Universal Health Coverage (UHC) and malaria financing by demonstrating that socioeconomic determinants, rather than service-level factors, are decisive in predicting Catastrophic Health Expenditure (CHE). Strengthening drug availability in public facilities, expanding insurance coverage, and prioritizing preventive interventions are critical to reducing economic vulnerability, advancing HUC, and achieving global malaria control targets.