Reported healthcare-seeking of loiasis patients and estimation of the associated monetary burden in Gabon: Data from a cross-sectional survey

Background Loiasis is a disease of relevance in endemic populations and there has been advocacy for its inclusion on the World Health Organization's neglected tropical diseases list. As loiasis-related healthcare-seeking behaviors and related costs are unknown, we aimed to evaluate these aspects in a population residing in an endemic region in Gabon.Methods Data were collected during a community-based, cross-sectional study assessing the disease burden due to loiasis. Diagnostics for microfilaremia were performed and a history of eyeworm was obtained. In addition, a standardized questionnaire about type of healthcare resources and frequency of use, as well as respective associated costs was administered to each participant. Loiasis related healthcare-seeking behaviors were evaluated, and the associated monetary burden was estimated as a secondary outcome of the study.Findings Individuals diagnosed with loiasis more frequently reported any healthcare-seeking (OR 1.52 (95%CI: 1.21-1.91)), self-medicating (OR 1.62 (1.26-2.08)), inability to work (OR 1.86 (1.47-2.35)), and consulting with traditional healers (logOdds 1.03 (0.52-1.53)), compared to loiasis negative individuals. The most frequently reported treatment for the eyeworm was traditional herbs. The estimated healthcare associated costs, per positive individual, was US-$ 58 (95% CI: 21-101) per year, which would correspond to 3.5% of the reported mean household income. Extrapolation to the rural population of Gabon (n = 204,000), resulted in an annual monetary burden estimate of US-$ 3,206,000 (1,150,000-5,577,000).Interpretation Loiasis patients have demonstrated healthcare needs, often consulted traditional healers, and used traditional treatments for disease specific symptoms. Further, loiasis seems to be associated with substantial direct and indirect costs for individuals and thus may cause a relevant economic burden for endemic populations and economies of affected countries. Loiasis has long been considered a negligible infection, however disease perception is changing as more data on significant disease-associated morbidity and mortality are being published. Still, many important aspects of the disease, such as the socioeconomic impact, are unknown. This study was part of a larger project on loiasis associated disease burden and aimed to evaluate healthcare seeking behaviors and estimate associated costs in individuals with loiasis living in a highly endemic region. We found that loiasis is associated with healthcare consultation, self-medicating, and sick leave. Self-medicating for treatment of disease specific symptoms was frequent. Traditional treatments and pain medication were most frequently used. Based on these data, we estimated loiasis related direct healthcare costs and indirect costs due to sickness, resulting in a monetary burden of US-$ 58 (95% CI: 21-101) per loiasis positive individual per year. Extrapolating these numbers to the rural population of Gabon (n = 204,000) would correspond to a monetary burden of US-$ 3,206,000 (95% CI: 1,150,000-5,577,000). Thus, loiasis is not only associated with morbidity and mortality but also with healthcare-seeking and may cause a relevant socioeconomic burden on affected populations. Therefore, considering loiasis a negligible disease is not appropriate anymore.