World Journal of Surgery

, Volume 42, Issue 11, pp 3520–3527 | Cite as

Out-of-Pocket and Catastrophic Expenses Incurred by Seeking Pediatric and Adult Surgical Care at a Public, Tertiary Care Centre in Uganda

  • Nathalie MacKinnon
  • Etienne St-Louis
  • Yasmine Yousef
  • Martin Situma
  • Dan PoenaruEmail author
Original Scientific Report



Surgical care is critical to establish effective healthcare systems in low- and middle-income countries, yet the unmet need for surgical conditions is as high as 65% in Ugandan children. Financial burden and geographical distance are common barriers to help-seeking in adult populations and are unmeasured in the pediatric population. We thus measured out-of-pocket (OOP) expenses and distance traveled for pediatric surgical care in a tertiary hospital in Mbarara, Uganda, as compared to adult surgical and pediatric medical patients.


Patients admitted to pediatric surgical (n = 20), pediatric medical (n = 18) and adult surgical (n = 18) wards were interviewed upon discharge over a period of 3 weeks. Patient and caregiver-reported expenses incurred for the present illness included prior/future care needed, and travel distance/cost. The prevalence of catastrophic expenses (≥10% of annual income) was calculated and spending patterns compared between wards.


Thirty-five percent of pediatric medical patients, 45% of pediatric surgical patients and 55% of adult surgical patients incurred catastrophic expenses. Pediatric surgical patients paid more for their current treatment (p <  0.01)—specifically medications (p <  0.01) and tests (p <  0.01)—than pediatric medical patients, and comparable costs to adults. Adult patients paid more for treatment prior to the hospital (p = 0.04) and miscellaneous expenses (e.g., food while admitted) (p = 0.02). Patients in all wards traveled comparable distances.


Seeking healthcare at a publicly funded hospital is financially catastrophic for almost half of patients. Out-of-stock supplies and broken equipment make surgical care particularly vulnerable to OOP expenses because analgesics, anaesthesia and preoperative imaging are prerequisites to care.



Dr. Yousef and Dr. St-Louis received financial support for this work by the Fondation de Recherche Québec - Santé. Dr. Yousef received financial support from the Canadian Institute for Health Research.


Funding was provided by Global Health Student Bursary, Faculty of Medicine, McGill University.

Compliance with ethical standards

Conflict of interest

None declared.

Supplementary material

268_2018_4691_MOESM1_ESM.doc (266 kb)
Supplementary material 1 (DOC 265 kb)


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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Nathalie MacKinnon
    • 1
  • Etienne St-Louis
    • 2
  • Yasmine Yousef
    • 2
  • Martin Situma
    • 3
  • Dan Poenaru
    • 2
    • 4
    Email author
  1. 1.Faculty of MedicineMcGill UniversityMontrealCanada
  2. 2.Center for Global SurgeryMcGill University Health CentreMontrealCanada
  3. 3.Mbarara Regional Referral HospitalMbararaUganda
  4. 4.Montreal Children’s HospitalMontrealCanada

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