Acta Tropica 160 (2016) 78–85 Contents lists available at ScienceDirect Acta Tropica jo u r n al homep age: www.elsevier.com/locate/actatropica Malaria related care-seeking-behaviour and expenditures in urban settings: A household survey in Ouagadougou, Burkina Faso Idrissa Beogo a,∗,1 , Nicole Huang b , Maxime K. Drabo c , Yazoumé Yé d a École Nationale de Santé Publique, Ouagadougou, Burkina Faso b International Health Program, Institute of Public Health, School of Medicine, National Yang-Ming University, No.155, Section 2, Li-Nong Street, Taipei 112, Taiwan, ROC c Institut de Recherche en Science de la Santé Ouagadougou, Burkina Faso d ICF International, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA a r t i c l e i n f o Article history: Received 3 August 2015 Received in revised form 24 March 2016 Accepted 24 March 2016 Available online 3 May 2016 Keywords: Burkina Faso Ouagadougou Malaria Care-seeking-behaviour Expenditure Out-of-pocket Urban setting Private healthcare provider a b s t r a c t In Sub-Sahara Africa, malaria inflicts a high healthcare expenditure to individuals. However, little is known about healthcare expenditure to individual affected by malaria and determinants of healthcare seeking behaviour in urban settings where private sector is thriving. This study investigated the level and correlates of expenditure among individuals with self-reported malaria episode in Ouagadougou, Burkina Faso. A cross-sectional household survey conducted in August-November 2011 in Ouagadougou covered 8,243 individuals (1,600 households). Using Generalized Estimating Equations, the analysis included 1082 individuals from 715 households, who reported an episode of malaria. Of individuals surveyed, 38.3% sought care from public, 27.4% from private providers, and, 34.2% self-medicated. The median cost for malaria treatment was USD10.1 (4,850.0XOF) with significant different between public, private and self- medication (p < 0.001). In public primary care health facilities, the median cost was USD8.4 (4,050.0XOF) for uncomplicated malaria and USD15.2 (7,333.5XOF) for severe malaria. In private-for-profit facilities run by a medical doctor, the median cost was USD30.3 (14,600.0XOF) for uncomplicated malaria and USD 43.0 (20,725.0XOF) for severe malaria. Regardless of the source of care, patients with insurance incurred significantly higher expenditure compared to those without insurance (p < 0.001) and medicine accounted for the largest share of the expenditure. The type of provider, having insurance, and the severity of the malaria predict the amount of money spent. The high financial cost of malaria treatment regardless of the providers poses threat to the goal of universal access to malaria interventions, the unique way to achieve elimination goals. © 2016 Elsevier B.V. All rights reserved. 1. Introduction The burden of malaria remains unacceptably high worldwide, particularly in Africa. Although the disease is preventable and treat- able, Africa accounts for 90% of the global prevalence of the disease (WHO, 2012, 2013), as well as 91% (∼709,000) of deaths (Vitor- Silva et al., 2009; WHO, 2010). At the macro-level, in addition to its social costs (Sicuri et al., 2013), the annual economic growth rate was 1.3% lower in malaria endemic countries than in those where it is not endemic (Gallup and Sachs, 2001). Further, Gallup and ∗ Corresponding author at: Pavillon Ferdinand-Vandry, 1050, Avenue de la Médecine, Québec, Québec 28 G1V 0A6, Canada. E-mail addresses: kone23ide@gmail.com (I. Beogo), syhuang@ym.edu.tw (N. Huang), m drabok@yahoo.fr (M.K. Drabo), yazoume.ye@icfi.com (Y. Yé). 1 Current affiliation: Faculté des sciences infirmières, Université Laval, Canada. Sachs (2001) found that the Gross Domestic Product (GDP) growth rate was reduced by 0.4% vs. 2.3% in endemic compared to non- endemic countries. At the micro-level, individuals and households are affected by direct costs for prevention, diagnosis, and treatment. In Papua New Guinea, the total cost to treat episodes of malaria among outpatients was USD 9.20 vs. USD 25.20 for inpatients (Sicuri et al., 2012). In addition to direct costs, there are costs associ- ated with loss of income and days in school (Brooker et al., 2000; Chuma et al., 2010). Several studies have examined healthcare- seeking behaviour (HSB) for malaria and found that patients often resorted to self-medication to minimize costs (Dzator and Asafu- Adjaye, 2004; Nyamongo, 1999, 2002), which also include travel and services (Asenso-Okyere et al., 1998). Other patterns that affect HSB include geographical access, disease severity, sex, and parents’ education level (Miguel et al., 1998; Müller et al., 2003). Malaria’s prevalence has declined across Africa in recent years (Bhattarai et al., 2007; Ceesay et al., 2008; Kleinschmidt et al., 2009; http://dx.doi.org/10.1016/j.actatropica.2016.03.033 0001-706X/© 2016 Elsevier B.V. All rights reserved.