Exploring Consumer Perceptions and Economic Burden of Onchocerciasis on Households in Enugu State, South-East Nigeria

Introduction: Onchocerciasis or river blindness constitutes a major burden to households especially in resource-poor settings, causing a significant reduction in household productivity. There has been renewed interest from policy makers to reduce the burden of Neglected Tropical Diseases (NTDs) such as onchocerciasis on individuals and households. This paper provides new information on the patient’s perceptions of onchocerciasis and its economic burden on households in South-eastern Nigeria. The information will be useful to health providers and policy makers for evidence-informed resource allocation decisions. Methods: Information was generated from a cross-sectional household survey conducted in Achi community, Oji River Local Government Area (LGA) of Enugu State, Southeast Nigeria. A pre-tested interviewer-administered questionnaire was used to collect data. A total of 747 households were visited randomly and data were collected using pre-tested interviewer administered questionnaire from 370 respondents. The respondents’ knowledge of the cause of symptoms of the disease, costs incurred for seeking treatment and productivity losses were elicited. Data were analyzed using tabulations and inferential statistics. A socio-economic status (SES) index was used to disaggregate some key variables by SES quintiles for equity analysis. Results: Many people had more than one type of manifestation of onchocerciasis. However, more than half of the respondents (57%) had no knowledge of the cause of their symptoms. Male respondents had significantly more knowledge of the cause of symptoms than females (P = 0.04) but knowledge did not differ across SES (P = 0.82). The average monthly treatment cost per respondent was US$ 14.0. Drug cost (US$10) made up about 72% of total treatment cost. The per capita productivity loss among patients was US$16 and it was higher in the poorest (Q1) (US$20) and the third SES quintiles (Q3) (US$21). The average monthly productivity loss among caregivers was US$3.5. Conclusion: Onchocerciasis still constitutes considerable economic burden on patients due to the high cost of treatment and productivity loss. Prioritizing domestic resource allocation for the treatment of onchocerciasis is important for significant and sustained reduction in the burden of the disease. In addition, focused health promotion interventions such as health education campaigns should be scaled up in onchocerciasis-endemic communities. Author Summary: Onchocerciasis is a public health problem in Nigeria, especially among the poor living in endemic communities. There is a dearth of evidence on the burden of onchocerciasis and studies suggest poor knowledge of the cause of onchocerciasis. This information could facilitate evidence-informed decisions on resource allocation towards the control of this neglected tropical disease. A cross-sectional survey was used to assess the knowledge of disease causation among patients, costs incurred for seeking treatment and productivity losses. About 43% had no knowledge of what caused their symptoms. The average monthly treatment cost per respondent was US$ 14.0. Drug cost (US$10) made up 72% of total treatment cost. The per capita productivity loss among patients was $16 and it was higher among the least poor (Q1) (US$20) and the poor SES (Q3) (US$21). The average cost of lost productivity among caregivers was US $3.5. These findings suggest that onchocerciasis still constitutes considerable economic burden on patients due to the high cost of treatment and lost productivity. This survey provided a measure of patient treatment cost in a setting with paucity of information. It also shows that targeted health education campaigns remain a fundamental policy option.