Economic burden of typhoid among hospitalised children in Kenya

Typhoid remains endemic in many low and middle-income countries, with the highest incidence reported in children under 15 years. No published study has estimated the cost of hospitalised paediatric typhoid cases in Kenya. This analysis estimated the direct medical, direct non-medical and indirect costs from the healthcare provider and societal perspectives and assessed the proportion of households that would experience catastrophic health expenditure (CHE) due to the disease.

Patient-level data on hospitalised children with typhoid were drawn from 16 public hospitals that are part of the Clinical Information Network (CIN) in Kenya. A cost-of-illness analysis was conducted. Resource quantities were extracted from CIN data and unit costs were obtained from price lists, surveys and expert interviews. All costs were converted to 2025 KES and USD. A simulation-based CHE analysis was conducted. One-way sensitivity analysis varied hospital bed, staff, non-medical and indirect costs.

Median cost per unique admission was US$79.68 from the provider and US$96.95 from the societal perspective. Staff costs accounted for up to 55% of societal costs while hospital-bed costs accounted for up to 15%. Productivity loss represented 12% of societal costs. Staff time was the most influential parameter in the sensitivity analysis, increasing median costs by up to 89% from the provider and 74% from the societal perspective. CHE incidence rose as the share paid out-of-pocket increased and house wealth declined, with rural households in the lowest wealth quintile most affected. At full out-of-pocket payment, up to 23.6% of rural and 26.5% of urban households from the poorest wealth quintile could face CHE.

Typhoid imposes a substantial economic burden among hospitalised children in Kenya, driven mainly by staff and hospital-bed costs. The findings of this study can guide policymakers in reducing strain on health services and the financial burden on families.