Assessment of hospitalization costs and its determinants in infants with clinical severe infection at a public tertiary hospital in Nepal.

Sepsis, an important and preventable cause of death in the newborn, is associated with high out of pocket hospitalization costs for the parents/guardians. The government of Nepal's Free Newborn Care (FNC) service that covers hospitalization costs has set a maximum limit of Nepalese rupees (NPR) 8000 i.e. USD 73.5, the basis of which is unclear. We aimed to estimate the costs of treatment in neonates and young infants fulfilling clinical criteria for sepsis, defined as clinical severe infection (CSI) to identify determinants of increased cost. This study assessed costs for treatment of 206 infants 3-59 days old, enrolled in a clinical trial, and admitted to the Kanti Children's Hospital in Nepal through June 2017 to December 2018. Total costs were derived as the sum of direct costs for bed charges, investigations, and medicines and indirect costs calculated by using work time loss of parents. We estimated treatment costs for CSI, the proportion exceeding NPR 8000 and performed multivariable linear regression to identify determinants of high cost. Of the 206 infants, 138 (67%) were neonates (3-28 days). The median (IQR) direct costs for treatment of CSI in neonates and young infants (29-59 days) were USD 111.7 (69.8-155.5) and 65.17 (43.4-98.5) respectively. The direct costs exceeded NPR 8000 (USD 73.5) in 69% of neonates with CSI. Age <29 days, moderate malnutrition, presence of any sign of critical illness and documented treatment failure were found to be important determinants of high costs for treatment of CSI. According to this study, the average treatment cost for a newborn with CSI in a public tertiary level hospital is substantial. The maximum limit offered for free newborn care in public hospitals needs to be revised for better acceptance and successful implementation of the FNC service to avert catastrophic health expenditures in developing countries like Nepal. Trial Registration: CTRI/2017/02/007966 (Registered on: 27/02/2017).

Economics of climate adaptive water management practices in Nepal.

This study analyses costs and benefits of the selected climate adaptive and equitable water management practices and strategies (CAEWMPS) in Dhulikhel Municipality and Dharan Sub-metropolitan city of Nepal. The CAEWMPS adopted the construction of water recharge pit at household level in Dharan and recharge ponds at community level in Dhulikhel. The results of household survey reveal that households have employed different coping strategies including minimizing consumption, purchasing from market, harvesting rain water and installing equipment for storing and pumping in both cities. In Dhulikhel, a significant number of households (18.56%) minimize consumption during the dry season but this is not the case in Dharan. Rather, around one-fifth (19.27%) of the households harvest rainwater in Dharan. In addition, households are forced to give-up their regular activities in order to implement coping strategies such as household chores, leisure time, meeting and gardening. The average estimated annual coping cost in Dharan (USD 87.5) is eight times higher than in Dhulikhel (USD 11.05); however, per unit coping cost is nearly equal in both the cities. In terms of benefit-cost ration, the community level recharge ponds in Dhulikhel (5.15) were found to be cost effective compared to the household level recharge pits of Dharan (1.72). These results provide policy makers with a comparative basis for adopting appropriate strategies to tackle problems related to water shortage under city-specific contexts.