Economic Burden of HIV/AIDS Upon Households in Nepal: A Critical Review

Burden of communicable diseases and cost of illness: Asia pacific region

BACKGROUND

Communicable diseases such as AIDS/HIV, dengue fever, and malaria have a great burden and subsequent economic loss in the Asian region. The purpose of this article is to review the widespread burden of communicable diseases and related health-care burden for the patient in Asia and the Pacific.

AREAS COVERED

In Central Asia, the number of new AIDS cases increased by 29%. It is more endemic in the poor population with variations in the cost of illness. Dengue is prevalent in more than 100 countries, including the Asia-Pacific region. In Southeast Asia, the annual economic burden of dengue fever was between $ 610 and $ 1,384 million, with a per capita cost of $ 1.06 to $ 2.41. Globally, 2.9 billion people are at risk of developing malaria, 90% of whom are residents of the Asia and Pacific region. The annual per capita cost of malaria control ranged from $ 0.11 to $ 39.06 and for elimination from $ 0.18 to $ 27.

EXPERT OPINION

The cost of AIDS, dengue, and malaria varies from country to country due to different health-care systems. The literature review has shown that the cost of dengue disease and malaria is poorly documented.

The potential of health literacy to address the health related UN sustainable development goal 3 (SDG3) in Nepal: a rapid review

BACKGROUND

Health literacy has been linked to health outcomes across population groups around the world. Nepal, a low income country, experiences the double burden of highly prevalent communicable as well as non-communicable diseases. The World Health Organization (WHO) has positioned health literacy as a key mechanism to meet the health-related Sustainable Development Goal (SDG3). However, there is little known about the status of health literacy in developing countries such as Nepal. This paper aims to review the potential of health literacy to address SDG3 in Nepal.

METHODS

A rapid review was conducted using the knowledge to action evidence summary approach. Articles included in the review were those reporting on barriers to health care engagements in Nepal published in English language between January 2000 and December 2015.

RESULTS

Barriers for healthcare engagement included knowledge and education as strong factors, followed by culture, gender roles, quality of service and cost of services. These barriers influence the Nepalese community to access and engage with services, and make and enact healthcare decisions, not only at the individual level but at the family level. These factors are directly linked to health literacy. Health literacy is a pivotal determinant of understanding, accessing and using health information and health services, it is important that the health literacy needs of the people be addressed.

CONCLUSION

Locally identified and developed health literacy interventions may provide opportunities for systematic improvements in health to address impediments to healthcare in Nepal. Further research on health literacy and implementation of health literacy interventions may help reduce inequalities and increase the responsiveness of health systems which could potentially facilitate Nepal to meet the sustainable development goals. While there is currently little in place for health literacy to impact on the SDG3, this paper generates insights into health literacy's potential role.

The economic burden of HIV/AIDS on individuals and households in Nepal: a quantitative study

Background

There have been only limited studies assessing the economic burden of HIV/AIDS in terms of direct costs, and there has been no published study related to productivity costs in Nepal. Therefore, this study explores in detail the economic burden of HIV/AIDS, including direct costs and productivity costs. This paper focuses on the direct costs of seeking treatment, productivity costs, and related factors affecting direct costs, and productivity costs.

Methods

This study was a cross-sectional, quantitative study. The primary data were collected through a structured face-to-face survey from 415 people living with HIV/AIDS (PLHIV). The study was conducted in six representative treatment centres of six districts of Nepal. The data analysis regarding the economic burden (direct costs and productivity costs) was performed from the household’s perspective. Descriptive statistics have been used, and regression analyses were applied to examine the extent, nature and determinants of the burden of the disease, and its correlations.

Results

Average total costs due to HIV/AIDS (the sum of average total direct and average productivity costs before adjustment for coping strategies) were Nepalese Rupees (NRs) 2233 per month (US$ 30.2/month), which was 28.5% of the sample households’ average monthly income. The average total direct costs for seeking HIV/AIDS treatment were NRs 1512 (US$ 20.4), and average productivity costs (before adjustment for coping strategies) were NRs 721 (US$ 9.7). The average monthly productivity losses (before adjustment for coping strategies) were 5.05 days per person. The major determinants for the direct costs were household income, occupation, health status of respondents, respondents accompanied or not, and study district. Health status of respondents, ethnicity, sexual orientation and study district were important determinants for productivity costs.

Conclusions

The study concluded that HIV/AIDS has caused a significant economic burden for PLHIV and their families in Nepal. The study has a number of policy implications for different stakeholders. Provision of social support and income generating programmes to HIV-affected individuals and their families, and decentralising treatment services in each district seem to be viable solutions to reduce the economic burden of HIV-affected individuals and households.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-017-1976-y) contains supplementary material, which is available to authorized users.