Short term outcome and cost analysis of children admitted with rotavirus gastroenteritis

Abstract

Background Rotavirus infection is the single most common cause of acute gastroenteritis in children under five years of age. Rotavirus gastroenteritis (RVG) has a high morbidity and mortality in children in Kenya. The costs of care and treatment for rotavirus gastroenteritis are high. Comprehensive data on the outcomes and cost of care of RVG in Kenya are lacking. Objective To determine the short term clinical outcomes and compute average cost of care for children admitted to Kenyatta National Hospital (KNH) with rotavirus gastroenteritis. Methodology A short longitudinal survey at Kenyatta National Hospital, Nairobi, Kenya from February to May 2008. A minimum sample size of 165 was sufficient for both primary and secondary objectives of this study. This samples size was calculated using mortality as the worst outcome with a mortality rate of 11.6%. Children less than 3 years of age admitted to the paediatric wards with a diagnosis of acute gastroenteritis were tested for rotavirus in stool samples using a rapid antigen detection kit and ELISA. Those found positive for rotavirus and gave consent were recruited into the study. A full clinical evaluation was done and a predesigned questionnaire administered. The recruited patients were followed up till discharge or death. Their outcomes, costs incurred and the bills they paid were entered into the questionnaire. The average costs were then calculated. Results Five hundred of the children admitted to KNH with acute gastroenteritis were screened for rotavirus. One hundred and ninety one (38.2%) of them tested positive for rotavirus in stool and 172 children were recruited into the study. Of the 172 children, 87.8% were discharged within one week, 8.1% stayed for more than 7 days while 4.1% died. The average cost of care per child admitted with rotavirus gastroenteritis was Kshs 6,505.79 to the patient, Kshs. 14,178.21 and Kshs. 16,556.08 to the hospital and economy/society respectively using the National Hospital Insurance Fund bed charge rates. Children who had co-morbidities had worse outcomes in comparison to those who did not have any co-morbidity. Conclusion Rotavirus gastroenteritis has a significant impact on young children and their families in terms of long hospital stay, high morbidity and mortality. It incurs considerable resource utilization in health care settings, substantial costs for national health care and lost work days to the economy. Recommendation A cost benefit analysis for the whole country should be done to guide in policy making for routine rotavirus vaccination