Introduction:
The Universal Health Coverage (UHC) implemented in Cameroon in April 2023, reduced the annual out-of-pocket payment for haemodialysis sessions for patients with end-stage kidney failure (ESKF), from XAF 520,000 (863 USD) to XAF 15,000 (25 USD), not covering other aspects of haemodialysis treatment. This study aimed to assess the impact of this reduction in out-of-pocket payments on the affordability of other vital aspects of treatment such as erythropoietin and vascular access as well as the impact on quality of life and mortality of patients on maintenance haemodialysis in three haemodialysis centers in Cameroon (Bamenda Regional Hospital, Douala General Hospital, and Yaounde General Hospital).
Methods:
This was a hospital-based retrospective multi-centric cohort study of 5 months duration which included consenting patients who initiated haemodialysis (HD) at least 6 months but not more than 2 years before the Universal Health Coverage, consenting patients who initiated haemodialysis under the Universal Health Coverage and files of dead patients who initiated haemodialysis during the period under consideration, excluding those whose files were missing vital information. We compared the number of arteriovenous fistulae, use of erythropoietin, quality of life and mortality, before and after the implementation of the Universal Health Coverage. Data were entered into MS Excel 2016 and CS Pro 8.0 and analysed using the statistical software R version 4.3.3. p values <0.05 were considered statistically significant. Ethical clearance was obtained from the institutional review board of the Faculty of Health Sciences, University of Bamenda, prior to the start of this study.
Results:
Out of a total of 723 patients who initiated HD (572 before UHC and 151 with UHC), 446 were included in the study (337 initiated before the UHC and 109 with the UHC) of which 148 were currently dialysing (83 initiated before the UHC, 65 with the UHC) and 298 were dead participants (254 initiated before the UHC, 44 with the UHC). The median age was the same for both populations at 48 [38.8-57.0] years. We found no statistically significant differences in the proportion of arteriovenous fistula creation and use of erythropoietin. However, there was a significant improvement of the quality of life of participants (38.7±11.7 vs 45.2±9.5, p<0.001), and a significant reduction in the mortality rate of participants (44.4% vs 29.1%, p=0.010).
Conclusions:
The implementation of Universal Health Coverage in Cameroon has led to a reduction of mortality and an improvement in the quality of life of patients on maintenance haemodialysis but failed to fully address the care requirements of these patients which may impact outcomes. Further coverage is therefore needed for optimal health outcomes.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.