{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T11:03:34Z","timestamp":1785495814993,"version":"3.56.0"},"reference-count":36,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,12,13]],"date-time":"2024-12-13T00:00:00Z","timestamp":1734048000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The largest proportion of people at risk of catastrophic expenditures for surgical care live in low\u2010 and middle\u2010income countries. This study aims to evaluate the financial impact among surgical patients at Kibuye Hope Hospital (KHH) in Burundi.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data were collected from patients undergoing a surgical procedure at KHH from January to October 2019. A predesigned questionnaire was used to collect information regarding socio\u2010demographics, pre\u2010hospital and hospitalization characteristics, finances, and surgical outcomes. Out\u2010of\u2010pocket (OOP) health expenditure, catastrophic health expenditure (CHE), impoverishing health expenditure (IHE), and financial distress (FD) were summarized.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of a total of 301 patients, 60% lived below the extreme poverty line ($2.15) at baseline. After surgery, 66% of patients faced CHE, 66% faced FD, and 73% faced IHE. Almost all patients (94%) reported having an insurance plan, although the rate of OOP expenditure was high (98%). The median cost of medications ($215.5) or surgery ($305.6) surpassed the median monthly household expenditure allocated to food ($183.4). The proportion of patients facing extreme poverty at baseline increased from 60% to 96% after direct medical expenses. Many patients reported borrowing money (30%) or selling their land\/possessions (46%) to cover OOP expenses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Most surgical patients at KHH face extremely high risks of CHEs and impoverishment due to OOP expenses for care, despite insurance coverage. The risk of families being forced into poverty and experiencing FD from surgical care are indicators of the lack of effective financial risk protection programs in Burundi.<\/jats:p><\/jats:sec>","DOI":"10.1002\/wjs.12447","type":"journal-article","created":{"date-parts":[[2024,12,14]],"date-time":"2024-12-14T03:00:17Z","timestamp":1734145217000},"page":"438-447","source":"Crossref","is-referenced-by-count":3,"title":["Financial impact and healthcare expenditures among surgical patients in Burundi"],"prefix":"10.1002","volume":"49","author":[{"given":"Alliance","family":"Niyukuri","sequence":"first","affiliation":[{"name":"Mercy James Center for Pediatric Surgery and Intensive Care  Blantyre Malawi"},{"name":"Research Department Mercy Surgeons  Bujumbura Burundi"},{"name":"Department of Surgery Kibuye Hope Hospital Hope Africa University  Gitega Burundi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siddhesh","family":"Zadey","sequence":"additional","affiliation":[{"name":"Department of Surgery Duke University School of Medicine Duke University  Durham North Carolina USA"},{"name":"Department of Emergency Medicine Duke University School of Medicine Duke University  Durham North Carolina USA"},{"name":"Association for Socially Applicable Research  Pune Maharashtra India"},{"name":"Dr. D.Y. Patil Medical College, Hospital, and Research Centre  Pune Maharashtra India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark G.","family":"Shrime","sequence":"additional","affiliation":[{"name":"Mercy Ships  Tyler Texas USA"},{"name":"Program in Global Surgery and Social Change Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pacifique","family":"Imanishimwe","sequence":"additional","affiliation":[{"name":"Department of Surgery Kibuye Hope Hospital Hope Africa University  Gitega Burundi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Fader","sequence":"additional","affiliation":[{"name":"Department of Surgery Kibuye Hope Hospital Hope Africa University  Gitega Burundi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela","family":"Espinoza","sequence":"additional","affiliation":[{"name":"Duke Global Health Institute Duke University  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlan","family":"Wendler","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Kibuye Hope Hospital Hope Africa University  Gitega Burundi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry E.","family":"Rice","sequence":"additional","affiliation":[{"name":"Department of Surgery Duke University School of Medicine Duke University  Durham North Carolina USA"},{"name":"Duke Global Health Institute Duke University  Durham North Carolina USA"},{"name":"Center for Global Surgery and Health Equity Duke University  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1745-5728","authenticated-orcid":false,"given":"Emily R.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Duke University School of Medicine Duke University  Durham North Carolina USA"},{"name":"Duke Global Health Institute Duke University  Durham North Carolina USA"},{"name":"Center for Global Surgery and Health Equity Duke University  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cesia","family":"Cotache\u2010Condor","sequence":"additional","affiliation":[{"name":"Department of Surgery Duke University School of Medicine Duke University  Durham North Carolina USA"},{"name":"Duke Global Health Institute Duke University  Durham North Carolina USA"},{"name":"Center for Global Surgery and Health Equity Duke University  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,12,13]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(15)60160\u2010X"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c924"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.10249"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0219974"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2017.03.045"},{"key":"e_1_2_11_7_1","unstructured":"World Health Organization.2010.The World Health Report 2010: Health Systems Financing: The Path to Universal Health Coverage."},{"key":"e_1_2_11_8_1","unstructured":"The World Bank. \u201cThe World Bank in Burundi.\u201d Accessed June 12 2023.https:\/\/www.worldbank.org\/en\/country\/burundi."},{"key":"e_1_2_11_9_1","unstructured":"World Health Organization.2015.Improving Health System Efficiency: Burundi: Performance Based Financing of Priority Health Services 28. 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