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, such as Ghana. Methods: A prospective case-control study was undertaken in two regional hospitals to analyze the cost of PI. 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 costs were analyzed between patients with and without PI. Results: Within the study period, the prevalence of PI was 9.1% at ERH and 14.9% at GARH. Overall, patients with PI reported excess length of hospital stay (LOS), corresponding to 46.8% and 33.5% increases in average direct cost at ERH and GARH, respectively, compared with their control groups. In almost all cases, the attributable indirect cost was consistent with productivity loss. Conclusion: 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 higher in Greater Accra than in the Eastern region.