Within ECEVE (U1123 / UMR_S_1123), Bibata Wassonguema assessed the economic impact of severe acute malnutrition in children in Senegal.
Bibata Wassonguema, researcher at ECEVE (U1123 / UMR_S_1123) (Institut National de la Santé et de la Recherche Médicale).
Thesis defended in 2025 at the doctoral school École doctorale Pierre Louis de santé publique : épidémiologie et sciences de l'information biomédicale (Paris ; 2000-....).
Referenced in the ABES/STAR network, this thesis meets the rigorous criteria of French higher education.
Severe acute malnutrition (SAM) is a public health issue that disproportionately affects children under five, particularly in vulnerable regions like northern Senegal. This thesis by Bibata Wassonguema highlights the economic and social consequences of SAM, a topic often underestimated in political and economic debates. Indeed, although efforts have been made to improve the management of this condition, complicated cases require prolonged hospitalizations, resulting in significant costs for households and health systems.
The study's results reveal that the average total cost of hospitalization for complicated SAM amounts to 431.9 USD, of which 92% are direct costs. These costs include not only hospitalization fees but also expenses related to medications, consultations, and additional care. Households bear nearly half of these costs, despite the free care policies in place. This raises questions about the effectiveness of public health policies and how they take into account the economic realities of families. Indeed, it is concerning to note that even with initiatives aimed at reducing medical expenses, the financial burden remains heavy for families, which may lead them to forgo necessary care for their children.
Costs vary according to the child's gender, the type of complication, and the type of care facility, indicating inequality in access to care. For example, boys may be more frequently hospitalized for complications related to malnutrition, which may be attributed to cultural norms or biases in the perception of health needs. Furthermore, children treated in public hospitals may receive less expensive care than those in private clinics, but the latter may offer faster and higher-quality services, thus creating a dichotomy in access to care.
Delays in seeking care are often due to financial and logistical constraints. Families, faced with unexpected expenses, adopt coping strategies that worsen their economic situation, such as reducing food expenditures or incurring debt. For instance, a family may be forced to sell assets or take out loans at high-interest rates to cover medical expenses, plunging them into a cycle of poverty. These choices have repercussions not only on the health of children but also on their education and the overall well-being of households. Malnourished children are often absent from school, jeopardizing their future and that of their community.
It is essential for policymakers to consider these elements in order to develop more effective public policies. Decision modeling could provide interesting insights to better understand the care pathways of children with SAM and to assess the associated economic burden. By integrating this data into intervention planning, it would be possible to alleviate the economic burden on households and improve the management of malnourished children. For example, targeted financial support programs could be established to help families cover care costs while ensuring equitable access to health services.
In summary, this thesis provides a solid foundation for guiding public policies and strengthening household resilience against severe acute malnutrition. The results obtained should prompt a thorough reflection on the strategies to be implemented to combat this scourge and ensure a better future for the children of Senegal. It is imperative that governments, NGOs, and health actors collaborate to develop sustainable solutions that not only address malnutrition but also improve the living conditions of vulnerable families. Ultimately, the fight against severe acute malnutrition is a matter of social justice and the right to health, which deserves urgent and sustained attention.
Key Facts
- 431.9 USD : Average total cost of hospitalization for complicated severe acute malnutrition.
- 45.3 % : Proportion of direct costs borne by households.
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Sources and Access
Bibata Wassonguema. Évaluation de l'impact financier et économique de la malnutrition aiguë sévère chez les enfants de 6 à 59 mois dans le nord du Sénégal. Economies et finances. Université Paris Cité, 2025. Français. ⟨NNT : 2025UNIP5158⟩. ⟨tel-05676733⟩