Impact of the Chikungunya Epidemic on Household Out-of-Pocket Health Expenditures in Kassala State, Sudan

This study examines the health and economic repercussions of the 2018 Chikungunya epidemic on households in Kassala State, Sudan, drawing on primary survey data from 407 households sampled proportionally across the localities of Kassala, Rural Kassala, and Rural West Kassala. The epidemic was characterized by widespread prevalence, with infection rates highest in urban areas due to greater population density and vector exposure. The study finds that existing socioeconomic vulnerabilities—particularly high illiteracy rates, female-headed households, and low-income prevalence in rural localities—substantially exacerbated financial pressures on affected households. The results from the ordered logistic regression reveal that Chikungunya infections significantly increase out-of-pocket health expenditures (OOPHE), and health insurance offers notable financial protection. Furthermore, the probit regression analysis confirms that catastrophic health expenditure (CHE), defined as OOPHE exceeding 20 percent of household income, is common across all income groups and strongly correlated with infection status. Elevated OOPHE is further shown to depress household consumption levels, thereby deepening poverty risks—especially among economically disadvantaged groups. In coping with these health shocks, the majority of households turned to borrowing and informal support networks, highlighting the limited reach of formal safety nets. Taken together, these findings point to the urgent need for robust public health interventions, expanded insurance coverage, and strengthened financial protection systems. Enhancing epidemic preparedness through improved vector control, health education, and equitable access to healthcare is essential to safeguarding vulnerable populations and promoting resilience in Kassala State and similar contexts.