Open Access Research article

The economic burden of pediatric gastroenteritis to Bolivian families: a cross-sectional study of correlates of catastrophic cost and overall cost burden

Rachel M Burke12*, Emily R Smith1, Rebecca Moritz Dahl1, Paulina A Rebolledo13, Maria del Carmen Calderón4, Beatriz Cañipa5, Edgar Chavez6, Rolando Pinto7, Luis Tamayo8, Carlos Terán9, Ángel Veizaga6, Remy Zumaran5, Volga Iñiguez10 and Juan S Leon11112

Author Affiliations

1 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA

2 Laney Graduate School, Emory University, Atlanta, GA, USA

3 Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA

4 Hospital Mario Ortiz Suárez, Santa Cruz, Bolivia

5 Hospital Materno-Infantil, La Paz, Bolivia

6 Hospital Boliviano Holandés, El Alto, Bolivia

7 Hospital del Niño Manuel Ascencio Villarroel, Cochabamba, Bolivia

8 Hospital del Niño, La Paz, Bolivia

9 Centro Pediatría, Hospital Albina R. Patiño, Cochabamba, Bolivia

10 Instituto de Biología Molecular y Biotecnología, Universidad Mayor de San Andrés, La Paz, Bolivia

11 Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA

12 Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA

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BMC Public Health 2014, 14:642  doi:10.1186/1471-2458-14-642

Published: 24 June 2014



Worldwide, acute gastroenteritis causes substantial morbidity and mortality in children less than five years of age. In Bolivia, which has one of the lower GDPs in South America, 16% of child deaths can be attributed to diarrhea, and the costs associated with diarrhea can weigh heavily on patient families. To address this need, the study goal was to identify predictors of cost burden (diarrhea-related costs incurred as a percentage of annual income) and catastrophic cost (cost burden ≥ 1% of annual household income).


From 2007 to 2009, researchers interviewed caregivers (n = 1,107) of pediatric patients (<5 years old) seeking treatment for diarrhea in six Bolivian hospitals. Caregivers were surveyed on demographics, clinical symptoms, direct (e.g. medication, consult fees), and indirect (e.g. lost wages) costs. Multivariate regression models (n = 551) were used to assess relationships of covariates to the outcomes of cost burden (linear model) and catastrophic cost (logistic model).


We determined that cost burden and catastrophic cost shared the same significant (p < 0.05) predictors. In the logistic model that also controlled for child sex, child age, household size, rural residence, transportations taken to the current visit, whether the child presented with complications, and whether this was the child’s first episode of diarrhea, significant predictors of catastrophic cost included outpatient status (OR 0.16, 95% CI [0.07, 0.37]); seeking care at a private hospital (OR 4.12, 95% CI [2.30, 7.41]); having previously sought treatment for this diarrheal episode (OR 3.92, 95% CI [1.64, 9.35]); and the number of days the child had diarrhea prior to the current visit (OR 1.14, 95% CI [1.05, 1.24]).


Our analysis highlights the economic impact of pediatric diarrhea from the familial perspective and provides insight into potential areas of intervention to reduce associated economic burden.

Pediatric gastroenteritis; Diarrhea; Societal costs; Health economics