Quantifying the acute care costs of neonatal bacterial sepsis and meningitis in Mozambique and South Africa.

BACKGROUND Sepsis and meningitis are amongst the leading causes of neonatal deaths in Sub-Saharan Africa (SSA). Neonatal sepsis caused around 400000 deaths globally in 2015, half occurring in Africa. Despite this, there are few published data on the acute costs of neonatal sepsis or meningitis, particularly in low- and middle-income countries, and none in SSA. METHODS We collected data on neonates admitted to two hospitals between April 16, 2020 and April 1, 2021. In South Africa cases were microbiologically confirmed either by culture or PCR. In Mozambique clinically suspected and microbiologically confirmed cases were included. Data were collected on healthcare resource use and length-of-stay. A caregivers questionnaire gathered data on expenditure and caregiving. We used unit costs of healthcare resources in local currencies to estimate average healthcare provider cost per patient and average costs per household. Results were converted to 2019 international dollars (I$). RESULTS We enrolled 11 neonates in Mozambique, 18 neonates in South Africa. Mean length-of-stay was 10 days (median=9; IQR=4-14)) and 16 days (median=15; IQR=13-18). In Mozambique we estimated mean household costs of I$49.62 (median=10.19, IQR=5.10-95.12) and hospitalisation costs of I$307.58 (median=275.12; IQR=149.43-386.12). In South Africa these costs were I$52.31 (median=30.82; IQR=19.25-73.08) and I$684.06 (median=653.62; IQR=543.33-827.53), respectively. On average, parents in Mozambique spent an extra 52 hours (median=38.5; IQR=19-86) on caregiving, and in South Africa an extra 76 (median=3.5; IQR=0-120). CONCLUSION We found substantial costs associated with acute neonatal bacterial (all-cause) sepsis and meningitis in SSA. Our estimates will inform cost-effectiveness analyses of interventions to prevent invasive bacterial infections in neonates.