The Financial Impact of Puerperal Infections On Patients, Carers and Public Hospitals in Two Regions in Ghana.

BACKGROUND Puerperal infection (PI) is a known maternal health problem globally. However, there is limited information on its economic impact on patients, carers and public hospitals in lower-middle-income countries, as Ghana. METHODS A prospective case-control study was undertaken in two regional hospitals to analyse the cost of puerperal infections. A total of 667 and 559 participants were enrolled in the study at the Greater Accra Regional Hospital (GARH) and the Eastern Regional Hospital (ERH) respectively. Total, average and marginal cost were analysed between patients with and without PI. RESULTS Within the study period, the prevalence of PI was 9.1% at the ERH and 14.9% at the GARH. Overall, patient with PI reported excess length of hospital stay (LOS), corresponding to 46.8% and 33.5% increase in average direct cost at the ERH and the GARH than their control groups. In almost all the cases, the attributable indirect cost was consistent with productivity loss. CONCLUSIONS In both hospitals, patients with PI reported excess LOS and increased direct and indirect costs. The total cost of PI to society, which is the sum of the direct cost, productivity loss and hospital cost was relatively high in the Greater Accra than in the Eastern region.