Impact of 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. The study draws on primary survey data from 407 households sampled proportionally across the localities of Kassala, Rural Kassala, and Rural West Kassala. The epidemic displayed 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 ordered logistic regression reveal that Chikungunya infection significantly increases out-of-pocket health expenditures (OOPHE), while health insurance offers notable financial protection. Furthermore, probit regression analysis confirms that catastrophic health expenditure (CHE), defined as OOPHE exceeding 20% 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, 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 in Sudan.