Prevalence and predictors of catastrophic health expenditure due to out-of-pocket payment among rural households in Delta State, Nigeria: a community-based cross-sectional study

Any healthcare expenditure that threatens a household’s financial capacity to maintain its subsistence living is regarded as catastrophic health expenditure (CHE). Many people in low- and middle-income countries such as Nigeria face financial difficulties when they fall sick. This study assessed the prevalence and predictors of CHE due to out-of-pocket (OOP) payments among rural households in Delta State, Nigeria. A cross-sectional study design was employed to assess the prevalence of CHE among a random multistage sample of 412 households. Data was collected using an interviewer-administered semi-structured questionnaire. Descriptive and inferential analyses of data collected were carried out using the IBM SPSS version 22 software. The sex distribution revealed that 50.5% (n = 208) of the household heads were females, while 49.5% (n = 204) were males. The prevalence of household CHE at 5% and 10% thresholds of household income was 30.3% (n = 125) and 21.8% (n = 90) respectively. When both direct medical and direct non-medical costs were considered the prevalence of household CHE increased to 35.4% (n = 146) and 25.5% (n = 105) respectively. Households with no history of hospitalisation, with less than seven persons, whose heads were aged below 40 years, and had no formal education had 88% (AOR = 0.12; 95% CI 0.05–0.32), 79% (AOR = 0.21; 95% CI 0.09–0.49), 93% (AOR = 0.07; 95% CI 0.01–0.45), and 43% (AOR = 0.57; 95% CI 0.34–0.96) decreased odds respectively of experiencing CHE. This study revealed a relatively high prevalence of CHE due to OOP payments among rural households. There is an urgent need to scale up health insurance coverage to reduce the burden of CHE experienced by rural households.