SynthesisPloS one2022
Factors associated with catastrophic health expenditure in sub-Saharan Africa: A systematic review.
Synthesis in PloS one, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 6 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
30 citing papers in PubMed, 6 syntheses or guidelines pooled it, 50 citations in OpenAlex.
- Catastrophic health expenditure and associated factors in low-, lower-middle and upper-middle-income countries: systematic review and meta-analysis.Global health action · 2026Pooled it
- Magnitude of catastrophic health expenditure and its determinants among cancer patients in low and middle-income countries: a systematic review and meta-analysis.BMC health services research · 2025Pooled it
- The socioeconomic and health system determinants of financial protection indicators: a global systematic review (2008-2023).BMJ global health · 2025Pooled it
- Costs of Influenza Illness and Acute Respiratory Infections by Household Income Level: Catastrophic Health Expenditures and Implications for Health Equity.Influenza and other respiratory viruses · 2025Pooled it
- A Systematic Review of the World's Largest Government Sponsored Health Insurance Scheme for 500 Million Beneficiaries in India: Pradhan Mantri Jan Arogya Yojana.Applied health economics and health policy · 2024Pooled it
- Impact of community-based health insurance in low- and middle-income countries: A systematic review and meta-analysis.PloS one · 2023Pooled it
- A machine learning analysis of perceived healthcare access barriers among women of reproductive age in Sub-Saharan Africa: using demographic and health surveys.AJOG global reports · 2026Article
- Article
- Regional programme of the African Network of Medical Excellence (ANME): a sub-Saharan collaborative model for sustainable specialised surgical programmes.BMJ global health · 2026Article
- Catastrophic and impoverishing health expenditures in fragmented public health systems: lessons from Mexico, 2000-2022.Health economics review · 2026Article
- Health financing and systems in African small and island states: Unique challenges and opportunities in achieving universal health coverage.SSM - health systems · 2025Article
- Catastrophic and impoverishing out-of-pocket payments for health care in Poland in 2013-2021.Health policy OPEN · 2025Article
- An evaluation of the impacts of health insurance coverage on wealth stratification in some selected sub-Saharan countries.Health economics review · 2025Article
- Barriers and facilitators to accessing healthcare services among elderly people living in a rural Amazonian community, Brazil.BMC health services research · 2025Article
- Trends and determinants of healthcare-induced poverty in China 2013-2019.Health policy and planning · 2025Article
- Analysis of travel-time to HIV treatment in sub-Saharan Africa reveals inequities in access to antiretrovirals.Communications medicine · 2025Article
- The discrepancy between objective and subjective assessments of catastrophic health expenditure: evidence from China.Health policy and planning · 2025Article
- Assessing Household Out-of-Pocket Expenditures for Non-communicable Diseases in a 4Acta medica Philippina · 2025Article
- ASSESSING CATASTROPHIC HEALTHCARE EXPENDITURES IN THE EMERGENCY SURGICAL CARE OF CHILDREN WITH INTUSSUSCEPTION: INSIGHTS FROM A TERTIARY HOSPITAL IN NIGERIA.Annals of Ibadan postgraduate medicine · 2024Article
- Health insurance's contribution to reducing the financial burden of tuberculosis in Guizhou Province, China.Epidemiology and infection · 2024Article
Corrections and comments
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Authors and funding
6 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveA non-negligible proportion of sub-Saharan African (SSA) households experience catastrophic costs accessing healthcare. This study aimed to systematically review the existing evidence to identify factors associated with catastrophic health expenditure (CHE) incidence in the region.
methodsWe searched PubMed, CINAHL, Scopus, CNKI, Africa Journal Online, SciELO, PsycINFO, and Web of Science, and supplemented these with search of grey literature, pre-publication server deposits, Google Scholar®, and citation tracking of included studies. We assessed methodological quality of included studies using the Appraisal tool for Cross-Sectional Studies for quantitative studies and the Critical Appraisal Skills Programme checklist for qualitative studies; and synthesized study findings according to the guidelines of the Economic and Social Research Council.
resultsWe identified 82 quantitative, 3 qualitative, and 4 mixed-methods studies involving 3,112,322 individuals in 650,297 households in 29 SSA countries. Overall, we identified 29 population-level and 38 disease-specific factors associated with CHE incidence in the region. Significant population-level CHE-associated factors were rural residence, poor socioeconomic status, absent health insurance, large household size, unemployed household head, advanced age (elderly), hospitalization, chronic illness, utilization of specialist healthcare, and utilization of private healthcare providers. Significant distinct disease-specific factors were disability in a household member for NCDs; severe malaria, blood transfusion, neonatal intensive care, and distant facilities for maternal and child health services; emergency surgery for surgery/trauma patients; and low CD4-count, HIV and TB co-infection, and extra-pulmonary TB for HIV/TB patients.
conclusionsMultiple household and health system level factors need to be addressed to improve financial risk protection and healthcare access and utilization in SSA. PROTOCOL REGISTRATION: PROSPERO CRD42021274830.
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Registered trials
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