Emergency obstetric care in Mali: catastrophic spending and its impoverishing effects on households
Catherine Arsenault, Pierre Fournier, Aline Philibert, Koman Sissoko, Aliou Coulibaly, Caroline Tourigny, Mamadou Traoré & Alexandre Dumont
Volume 91, Number 3, March 2013, 207-216
Table 3. Odds of catastrophic expenditure, as defined by three income thresholds, resulting from emergency obstetric care, by maternal characteristic, Kayes, Mali, 2008–2011
| Characteristic | OR (95% CI) by income thresholda |
||
|---|---|---|---|
| 5% (n = 259) | 10% (n = 162) | 15% (n = 100) | |
| Residence | |||
| Urban | 1 | 1 | 1 |
| Rural | 3.94 (1.80–8.62) | 7.14 (2.51–20.41) | 5.38 (1.34–21.74) |
| Distance to closest comprehensive EmOC centre (km) | |||
| ≤ 5 | 1 | 1 | 1 |
| 5–20 | 1.18 (0.53–2.63) | 1.02 (0.43–2.41) | 0.92 (0.33–2.57) |
| 20–40 | 1.85 (0.84–4.12) | 0.49 (0.20–1.18) | 0.84 (0.29–2.46) |
| > 40 | 4.56 (2.18–9.55) | 2.54 (1.22–5.30) | 3.97 (1.63–9.69) |
| District of residence | |||
| Yélimané | 1 | 1 | 1 |
| Kita | 2.25 (0.83–6.14) | 1.73 (0.58–5.13) | 1.15 (0.32–4.10) |
| Kayes | 2.94 (1.24–6.99) | 2.67 (1.04–6.89) | 3.04 (1.00–9.21) |
| Bafoulabé | 1.95 (0.62–6.11) | 1.56 (0.46–5.36) | 0.89 (0.21–3.86) |
| Diéma | 0.97 (0.37–2.53) | 1.89 (0.66–5.40) | 1.35 (0.38–4.80) |
| Nioro | 3.69 (1.55–8.76) | 3.92 (1.57–9.79) | 3.34 (1.14–9.78) |
| Age category (years) | |||
| 17–34 | 1 | 1 | 1 |
| ≤ 16 | 1.93 (0.95–3.93) | 1.14 (0.58–2.22) | 1.22 (0.60–2.50) |
| ≥ 35 | 1.64 (0.86–3.14) | 1.44 (0.74–2.80) | 1.50 (0.70–3.19) |
| Education | |||
| At least primary | 1 | 1 | 1 |
| None | 3.40 (1.92–5.99) | 4.41 (2.18–8.93) | 3.29 (1.38–7.87) |
| Ethnic group | |||
| Sarakole | 1 | 1 | 1 |
| Bambara | 2.17 (1.00–4.68) | 3.18 (1.34–7.55) | 2.62 (0.87–7.91) |
| Malinke | 1.97 (0.83–4.65) | 2.27 (0.90–5.72) | 3.05 (1.03–9.05) |
| Fulani | 3.32 (1.72–6.38) | 4.72 (2.44–9.12) | 6.24 (2.90–13.40) |
| Other | 1.01 (0.49–2.09) | 1.30 (0.59–2.88) | 2.57 (1.02–6.47) |
| Maternal outcome | |||
| Death | 1 | 1 | 1 |
| Near-miss | 2.82 (1.77–4.51) | 1.81 (1.13–2.92) | 1.66 (0.97–2.84) |
| Diagnosis | |||
| Haemorrhage | 1 | 1 | 1 |
| Eclampsia | 2.05 (1.17–3.61) | 2.63 (1.44–4.83) | 2.45 (1.24–4.85) |
| Uterine rupture | 1.18 (0.45–3.06) | 1.51 (0.57–4.03) | 1.25 (0.40–3.92) |
| Postpartum infection | 2.90 (1.29–6.51) | 5.64 (2.51–12.65) | 6.40 (2.69–15.20) |
| Blood transfusion | |||
| No | 1 | 1 | 1 |
| Yes | 3.09 (1.68–5.68) | 2.78 (1.47–5.25) | 1.59 (0.78–3.24) |
CI, confidence interval; OR, odds ratio.
a Any expenditure above the threshold was considered catastrophic. Since monetary income and consumption expenditures were not directly measured in the study, the average income of the corresponding quintile, adjusted for household size, was used instead. Each quintile’s average income was obtained from a study conducted in Kayes in 2008.28