Estimating the catastrophic and impoverishing health expenditure risk among malnourished under-five children in Uganda: secondary analysis of national panel data.

backgroundMalnutrition remains a significant public health issue in low- and middle-income countries (LMICs), contributing to long-term health risks and economic hardship. Despite the recognized connection between malnutrition and health-related financial risks, the intersection of these factors, particularly in relation to catastrophic (CHE) and impoverishing health expenditures (IHE), has received limited attention. This study aimed to estimate the risk of CHE/IHE among households with under-five children affected by malnutrition in Uganda.

methodsUsing data from the 2019/2020 Uganda National Panel Survey (UNPS), this study estimates the risk of CHE and IHE, with CHE defined as out-of-pocket health expenditures exceeding 10% of total household consumption, and IHE as health expenditures that push a household below the poverty line. Both measures were evaluated on a per capita basis to ensure consistency and equity in the comparison of financial hardship across households of different sizes. Bivariate and multivariate probit regression models were used to assess the association between child malnutrition (stunting, wasting, underweight), household wealth, and health expenditure risk. Marginal effects were calculated to quantify the probability changes in relation to malnutrition and wealth.

resultsThe analytical sample comprised 815 households with children under five. The study found that 18.0% of households experienced CHE/IHE, with 17.4% facing CHE and 4.5% facing IHE. Wasting was significantly associated with increased risk of CHE/IHE (β = 2.184, p < 0.001), with a marginal effect of 54.7%, indicating that households with wasted children were 54.7% more likely to experience CHE/IHE compared to those without wasted children. Households in the second and third wealth quintiles had higher odds of incurring CHE/IHE, with marginal effects of 34.3% and 37.7%, respectively. The study identified a U-shaped relationship between socio-economic status and CHE/IHE risk, where wealthier households did not significantly differ from the poorest households.

conclusionsThis study underscores the intersection between child malnutrition and health-related financial vulnerability in Uganda, highlighting acute malnutrition as a key marker of risk for catastrophic or impoverishing health expenditures. The analysis supports the need for an integrated, equity-sensitive approach to financial protection in health that considers both the nutritional and economic vulnerabilities of households. These findings contribute to the limited but growing body of evidence linking child health status to financial risk, especially in LMICs.