Estimating Direct Cost for Hypertension Management in Urban Primary Health Facilities in Bobo-Dioulasso, Burkina Faso: A Patient-Level Analysis

Abdoulaye Hama Diallo; Jeoffray Diendere; Sibiri Konate; Hermann Bienou Lanou; Noaga Irenee Ily; Watton Rodrigue Diao; Augustin Nawidimbasba Zeba

doi:doi:10.11648/j.cajph.20251105.18

Research Article |

| Peer-Reviewed

Estimating Direct Cost for Hypertension Management in Urban Primary Health Facilities in Bobo-Dioulasso, Burkina Faso: A Patient-Level Analysis

Abdoulaye Hama Diallo

, Jeoffray Diendere^*

, Sibiri Konate

, Hermann Bienou Lanou

, Noaga Irenee Ily

, Watton Rodrigue Diao

, Augustin Nawidimbasba Zeba

Published in Central African Journal of Public Health (Volume 11, Issue 5)

Received: 11 July 2025 Accepted: 24 September 2025 Published: 27 October 2025

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Abstract

Introduction: Hypertension is among the top 10 reasons for visiting primary health care centres (PHCCs) in Burkina Faso. Using a patient-level analysis, this study estimated the direct cost for hypertension management at outpatient care, in urban PHCCs in Bobo-Dioulasso, in the context of a universal health coverage policy development in the country. Methods: This was a cross-sectional study, using an adapted form of the “Costs for Patients Questionnaire” (CoPaQ) that includes different components for direct cost estimations. A sample of 380 hypertensive adults were interviewed from January to February 2022, at 20 public PHCCs in Bobo-Dioulasso. Results: Per patient-year, the means [95% CI] in income and direct cost were 786 947 CFA (USD 1418.3) [694 200 (USD 1251.1) - 879 695 (USD 1585.4)] and 78 623 FCFA (USD 141.3) [68 766 (124.0) - 88 480 (159.5)], respectively. Of the annual total direct cost, 47.5%, 18.5%, 16.3% and 13.5% were spent on medication, medical visits, hospitalisations and paraclinical tests, respectively. Only two patients (0.5%) were enrolled in insurance policy; and uncontrolled hypertension frequency was 72.1% (95% CI: 67.3-76.6). Conclusion: The average direct cost per patient-year of managing hypertension exceeded one-tenth of the patient's annual income, equivalent to more than one-fifth of the country's guaranteed minimum wage, which is a significant financial burden for many people. This study should be followed by cost-effectiveness analyses and community engagement building for hypertension control at small-scale piloting in Bobo-Dioulasso, then broad-based in the country.

Published in	Central African Journal of Public Health (Volume 11, Issue 5)
DOI	10.11648/j.cajph.20251105.18
Page(s)	299-310
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

Hypertension, Direct Cost, Income, Primary Health Care, Bobo-Dioulasso, Burkina Faso

1. Background

In 2019, it was estimated that 1.28 billon people aged 30-79 years worldwide lived with hypertension of whom 82% lived in low- and middle-income countries (LMICs)

[1]

. Over the long term, hypertension leads to risk for cardiovascular events, such as heart disease, stroke, kidney failure, disability, and premature mortality

[2]

. The challenge in reducing the burden of cardiovascular diseases, particularly in LMICs, includes efforts to ensure adequate management for persons living with hypertension

[3]

. Burkina Faso is a low-income Sahelian country with 42.1% of its population living on less than $3.00 a day at 2021 purchasing power adjusted prices (known as the poverty headcount ratio at $3.00 a day)

[4]

. Based on routine data of 2020, Ministry of Health ranked hypertension among the top ten most common reason for consultation and among the top ten causes of death in the country primary health care centres (PHCCs)

[5]

. Since 2012, the statistical yearbooks of the Ministry reported an increasing number of hospitalizations for hypertension

[5, 6]

. Hypertension was reported in a large proportion of patients admitted for other afflictions: 58% among patients with acute coronary syndromes

[7]

, 66% for cardioembolic disorders

[8]

, 76% for stroke

[9]

and 86% for non-valvular atrial fibrillation

[10]

. In 2013, the first country population-based study estimated, the prevalence of hypertension at 18% among overall adults and up to 24.8% in urban area

[11]

. The Declaration of Alma-Ata was endorsed jointly convened by WHO and UNICEF, that focused world attention on primary health care as the key to achieving an acceptable level of health throughout the world

[12]

. Alma-Ata recommendations for LMICs’ health systems led to the development of the primary care level for local communities’ care, including efficient management of hypertension

[13]

. Since 2015, the country has initiated a compulsory health insurance scheme policy (the Universal Health Insurance Scheme) but, as of now, it is not yet operating. There is less data on the costs of managing hypertension in Burkina Faso. Bobo-Dioulasso is the second largest city and economic capital of the country, with 984 603 inhabitants

[14]

distributed around 20 public PHCCs

[15]

. Due to rapid increasing urbanization (78% for urban population growth between 2006 and 2019) within the city, there are also informal settlements around Bobo-Dioulasso

[14]

There is limited data on the cost of managing hypertension in Burkina Faso. Only a study conducted in Bobo-Dioulasso has been found

[16]

, but did not involve primary care level.

This study estimated, the direct costs for hypertension management at ambulatory care at the patient level, in primary health care facilities in Bobo-Dioulasso, Burkina Faso.

2. Methods

2.1. Study Design

We conducted a cross-sectional patient-level study using structured interviews and physical measurements. Data were collected from January to February 2022 using an adapted version of the validated “Costs for Patients Questionnaire” (CoPaQ)

[17-19]

, which includes components for estimating direct out-of-pocket health expenditures. Permission to collect information was obtained from the Regional Directorate of Health and Public Hygiene of Hauts-Bassins region; and from the chiefs of the Health Districts in charge of urban and peri-urban PHCCs of Bobo-Dioulasso.

2.2. Study Population and Sites

The city of Bobo-Dioulasso includes an estimated 984 603 inhabitants (General Census of Population and Housing [GCPH]) and 20 public PHCCs

[5, 15]

. The study population was the hypertensive adult patients aware of their status, in ambulatory care at the peri-urban and urban public PHCC in Bobo-Dioulasso.

2.3. Inclusion and Non-Inclusion Criteria

Inclusion criteria were as follows: being 18 years of age or older, living with hypertension and being aware of his/her hypertensive status, and being an ambulatory care seeker for hypertension in one of the 20 public PHCCs. The exclusion criteria were absence of consent to participate in the study, being pregnant (due to the free healthcare available to this target population), or living with mental disorders (potentially incorrect responses attributable to the disability).

2.4. Sample Size Calculation

The sample size was estimated by the formula: n =

\frac{Z_{1 - α / 2}^{2} σ^{2}}{d²}

where n is the sample size, Z the reduced variance (1.96 for a 95% confidence level), σ the standard deviation and d the permissible margin of error. In 2018, the authors reported an average direct cost of 74,627 FCFA per patient-year, with a standard deviation of 4,214 FCFA, for a sample of hypertensive patients at secondary and tertiary care levels in Bobo-Dioulasso

[16]

. With a margin of error of 2%, the initial number of hypertensive patients to be recruited is 123. Taking into account the core of the urban city of Bobo-Dioulasso and the informal settlements around this city, this initial number was doubled. Furthermore, assuming a sampling effect (DEFF) of 1.3 and a non-response rate of 15%, the required size is 377 (i.e. 123 × 2 × 1.3 ÷ 0.85).

2.5. Study Variables and Direct Cost Estimation

Sociodemographic and socioeconomic variables were: demographic variables including age (≥18 years), living environment (urban Bobo-Dioulasso vs informal settlements around Bobo-Dioulasso), marital status (grouped into married/cohabitating; vs singles); household size; education level (grouped into i) no formal schooling; (ii) primary school iii) secondary or more; (v) occupation by sector of activity (grouped into i) public ii) private sector, iii) informal or self-employed; iv) traders and vii) economically inactive such as students, or unemployed). The income of patients was valued based on occupational categories and income can be compared with regards to the guaranteed minimum wage (30 684 FCFA = US$ 55.30, at the times of the study). The income of public employees was valued using the civil service salary scale while other professional categories based on their declaration.

Medical history, treatment and lifestyle: Medication for hypertension using antihypertensive platelets or not (mono-, bi-, or tri-therapy) and hospitalization was considered. Antihypertensive therapy was determined by healthy diet/lifestyle measures prescription only, or combined with the conventional mono-, bi- or tri-therapy. Self-reported data on the non-modifiable (family medical histories of hypertension, diabetes) and modifiable factors that were considered were alcohol and tobacco use, fruits and/or vegetables consumption, physical inactivity, body weight control, antihypertensive therapy and adherence to the therapy. Concerning the modifiable factors, current alcohol or tobacco consumption was defined as use in the past month. Daily fruits and/or vegetables intake was derived from the number of servings of fruits and/or vegetables consumed per day. We considered participants who reported no vigorous or low- physical activity during a typical week as being physically-inactive

[20]

. The body mass index (BMI) categories reflect body weight control.

Direct cost estimation tool: We used the valid and reliable CoPaQ instrument

[17-19]

that includes components previously identified and used by Burkinabè authors to estimate the cost for malaria management in Bobo-Dioulasso. The section regarding cost components used for hypertension management was tailored from the CoPaQ instrument, available in English and French versions (https://ssaquebec.ca/nouvelles/co-paq/

[21]

). The valuation of the costs covered the last 12 months.

Direct cost estimation components and formula: The direct cost for hypertension management was a total of costs for transportation, medical visit, medication, paraclinical tests, hospitalization, rehabilitation, gym membership and the cost for health insurance

[17, 22]

calculated on the past 12-month.

The cost for transportation was valued based on the distance travelled and the typical modes of transportation used by the patient to reach the care centres. The national guidelines specify an average 40 FCFA per kilometre (km), that we considered for those who used their own four-wheeled vehicle. When the patient used a taxi of two-wheeled and four-wheeled vehicles, we considered respectively 200 CFA and 600 FCA for a one-way trip.

The cost for medication was valued according to the regulations in force. The sales prices of essential generic drugs (EGDs) are set by Order No. 2019-0306 of the Ministry in charge of Health of Burkina Faso, while pharmaceutical brand-name drugs were valued using the cost table provided by the National Agency for Pharmaceutical Regulation. The self-reporting method was used to calculate the sub-total costs of paraclinical examination, hospitalisation and rehabilitation over the past 12 months. The patients were asked to recall all the paraclinical examinations (radiological and biological) that had been carried out over the previous 12 months, and to count and indicate the price of each one. During the same period, they were also asked to specify how many times they had been hospitalised and how much they had paid for each hospitalisation. For rehabilitation, they were asked to specify the number of sessions carried out with their unit cost. The insurance cost was the amount allocated to insurance companies in order to benefit from annual health coverage. Lastly, we intended to report the gym cost, considered as the amount of money spent for a year, to be able to practise physical exercises with the support of a specialist in a dedicated setting.

For x number of patients with hypertension, the direct cost calculation is:

DC=(C_{Transportation}+C_Visit+C_Medication+C_Paraclinical+C_{Hospitalization}+C_{Rehabilitation}+C_Gym+C_Insurance)*x

Nevertheless, the related costs of the psychological consequences, such as stress, an impaired quality of life and well-being, pain and physical disability were not included in this study.

Blood pressure and BMI measurements: Physical measurements focused on anthropometric (weight in kg, height in m, BMI as weight/height² in kg/m²) and blood pressure (SBP and DBP in mmHg) parameters. Weight was measured to the nearest 0.1 kg with a personal electronic scale on a lightly clothed subject without shoes and height was measured to the nearest 0.1 cm using a stadiometer on a subject without shoes. Using the BMI values in kg/m², individuals were categorised as underweight (BMI<18.5), normal (BMI=18.5-24.9) overweight (BMI=25-29.9) or obese (BMI≥30) states

[23]

. A mobile device (recommended by the WHO) was used for blood pressure measurement. Blood pressure was measured two times, with their mean value being used in the analysis. Based on the blood pressure values in mmHg, hypertension was categorized into were controlled hypertension (SBP<140 and DBP<90) and uncontrolled hypertension (SBP≥140-159 or DBP≥90)

[24]

2.6. Data Collection

To collect data, the standardized structured questionnaire was administered by face-to-face interview after physical (blood pressure, weight and height) measurements, in the places of PHCCs. The data collection was planned to start from January 2022 and team included a supervisor and interviewers. The supervisor was epidemiologist researcher, while interviewers were a student in a curriculum of Master in Public Health and nurses who had proven experience in data collection from patients in medical visit. The interviewers were trained to collect data.

2.7. Statistical Analyses

Variables were entered using computer Microsoft Office Excel and StataCorp^TM Stata Statistical Software for Windows (Version 14.0, College Station, Texas, United States of America) were used to describe categorical as percentages and quantitative variables such as costs (in CFA francs or US dollars) were expressed as mean, standard deviation, median and interquartile range and confidence interval at 95% (CI95). Student’s t and Anova tests were used to compare continuous variables such as costs, and the chi-square or the Fishers exact tests were used to compare frequencies of categorical variables. As the cost report mainly covered the past 12 months, the average exchange rate for 2021 can be used for conversion: US$1 = 554.88 XOF (FCFA)

[25]

2.8. Ethical Considerations

The institutional ethics committee for health research (Comité Institutionnel d'Ethique pour la Recherche en Santé [CIERS]) at the Research Institute for Health Sciences (Institut de Recherche en Sciences de la Santé [IRSS]) in Bobo-Dioulasso, approved the use of data, and the scientific dissemination of the results (deliberation No: 39-2023 CEIRS; November 22, 2023). Permission to collect information was obtained from the Regional Directorate of Health and Public Hygiene of Hauts-Bassins; and from the chiefs of the Health Districts in charge of urban and peri-urban PHCCs of Bobo-Dioulasso. Informed consent was systematically obtained from each participant in the survey and data was collected with full respect for anonymity and confidentiality on the premises of the health care facilities.

3. Results

From 17^th January to 13^th February 2022, a total of 380 hypertensive patients were consecutively enrolled at the 20 public PHCCs in Bobo-Dioulasso.

Table 1 describes the sociodemographic and socioeconomic characteristics of participants: The mean age of participants was 56.2 years (95% CI: 55.1-57.2), 57.9% were women, 73.7% married/cohabiting, 52.4% lived in monogamous households, 53.4% lived in nuclear families, and the average household size was 8.8 (95% CI: 8.3 - 9.4). There were 15.0% of occupationally inactive participants, 61.3% had no education and 51.8% lived in informal settlements around Bobo-Dioulasso. The mean income per patient-year was 786947 FCFA (694200 - 879695) with a median of 450000 FCFA (IQR = 720 000).

The mean in SBP, DBP was 161.4 mmHg (95% CI: 159.5-163.2) and 94.2 mmHg (95% CI: 93.1-95.4) respectively, and mean BMI was 25.4 (95% CI: 25.0-25.9). Table 2 reports medical history, medication, lifestyle practices in participants. Blood pressure was controlled (i.e., SBP/DBP <140/90 mmHg) and for 27.9% and frequency for uncontrolled hypertension was 72.1%. The rate of 3.7% only followed healthy lifestyle practices without antihypertensive drug, while patients with mono-, bi- and tri- therapy represented 51.6%, 42.6% and 2.1% respectively. The rate of underweight, normal weight, overweight and obesity was 0.8%, 51.6%, 32.4% and 15.2% respectively.

Table 1. Description of sociodemographic and economic variables in the sample (N = 380).

Sociodemographic variables and hypertension history	n (%)
Residence area
Urban Bobo-Dioulasso	183 (48.2)
Peri-urban informal settlements around Bobo-Dioulasso	197 (51.8)
Sex
Women	220 (57.9)
Men	160 (42.1)
Mean age (±standard deviation) in years*	56.2 (±10.4)
Age class
< 44	45 (11.8)
45 - 54	125 (32.9)
55 - 64	111 (29.2)
≥ 65	99 (26.1)
Education levels
No formal education	233 (61.3)
Primary level	92 (24.2)
Secondary or more	55 (14.5)
Marital status
Singles	100 (26.3)
Married/cohabiting	280 (73.7)
Mean size of household	8.8 (±5.4)
Household size
Under 5.2	113 (29.7)
Size of 5.2 or more	267 (70.3)
Type of family
Nuclear	203 (53.4)
Extended	177 (46.6)
Occupation
Farmers	98 (25.8)
Informal sector	94 (24.7)
Traders	94 (24.7)
Public sector employees	27 (7.1)
Private sector employees	10 (2.6)
Economically inactive (jobless, students, retirees etc.)	57 (15.0)
Income above the minimum wage
Less than guaranteed inter-professional minimum wage	205 (54.0)
Over the guaranteed inter-professional minimum wage	175 (46.0)

Table 2. Medical history, lifestyle practices in the sample of the hypertensive patients.

Lifestyle practices	Overall
Lifestyle practices	n (%) or x̅ (±σ)	CI at 95%
Mean age (±standard deviation) at the hypertension diagnosis (in years)	48.1 (±10.4)	47.1-49.1
Mean duration (±standard deviation) of the hypertension diagnosis (in years)	8.3 (±6.6)	7.6-8.9
With a family history of hypertension
No	219 (57.6)	52.5-62.7
Yes	161 (42.4)	37.4-47.5
Presence of diabetes
No	343 (90.3)	86.8-93.1
Yes	37 (9.7)	6.9-13.2
Use of conventional anti-hypertensive treatment
No drug (i.e.; only under healthy lifestyle) / Monotherapy	210 (55.3)	50.1-60.3
Bi-/tri-therapy	170 (44.7)	39.7-49.9
Medication adherence
Not compliant with the treatment	145 (38.2)	33.3-43.3
Compliant with the treatment	235 (61.8)	56.7-66.7
Current alcohol use
No	244 (64.2)	59.2-69.0
Yes	136 (35.8)	31.0-40.8
Current smokers
No	331 (87.1)	83.3-90.3
Yes	49 (12.9)	9.7-16.7
Daily fruits and vegetables intake
< 3 servings consumption	290 (76.3)	71.7-80.5
>= 3 servings consumption	90 (23.7)	19.5-28.3
Practice a physical activity
No	113 (29.7)	25.2-34.6
Yes	267 (70.3)	65.4-74.8
Body weight control
Body mass index less than 25 kg/m²	199 (52.3)	47.2-57.5
Overweight	123 (32.4)	27.7-37.3
Obesity	58 (15.3)	11.8-19.3
Hypertension
Controlled (< 140/90 mmHg)	106 (27.9)	23.4-32.7
Uncontrolled (≥140/90 mmHg)	274 (72.1)	67.3-76.6

Table 3. Specific components for the direct cost (in CFA) estimation (for conversion: US$1 = 554.88 XOF (FCFA)

[25]

Components for cost valuation	N	Mean (x̅)	Σ	CI	Percentiles
Components for cost valuation	N	Mean (x̅)	Σ	CI	25%	50%	75%
Medical visit	380	14529	22500	12259 - 16798	2400	4800	14400
Hospitalizations	72	67806	70811	51166 - 84446	21000	45000	90000
Medication (drugs)	366	38782	46652	33984 - 43577	2700	30477	42384
Paraclinical tests	158	25609	37701	19685 - 31533	6500	16500	26500
Rehabilitation	2	30000	0	---	30000	30000	30000
Health insurance	2	10000	0	---	10000	10000	10000
Transportation	300	3846	4015	3390 - 4302	1440	2840	4800
Gym	0	---	---	---	---	---	---
Direct cost	380	78623	97728	68766 - 88480	12000	44076	101012

Table 4. Direct cost mean (standard deviation) by sociodemographic, medical history, medication and lifestyle characteristics (for conversion: US$1 = 554.88 XOF (FCFA)

[25]

	n	Mean	(sd)	95% CI	P
Residence					0.0001
Urban Bobo-Dioulasso	183	106615	108442	90799 - 122432
Informal settlements around Bobo-Dioulasso	197	52620	5582	41613 - 63628
Sex					0.30
Women	220	83039	111589	68212 - 97867
Men	160	72550	74503	60918 - 84183
Age groups (in yeras)					0.004
≤ 44	45	51812	46228	38262 - 65362
45 - 54	125	100958	127095	78607 - 123310
55 - 64	111	79684	86906	63465 - 95903
65 or more	99	61419	76119	46238 - 76601
Levels of education					0.0001
No formal education	233	64893	83596	54103 - 75683
Primary school level	92	76585	110295	53975 - 99195
Secondary or more	55	140196	108747	111365 - 169028
Marital Statues					0.009
Singles	100	56639	79991	40767 - 72510
Married or cohabiting	280	86475	102316	74438 - 98511
Type of family					0.003
Nuclear	203	68307	93635	55349 - 81265
Extended	177	90454	101196	75443 - 105466
Patient Income level					0.0009
Less than guaranteed inter-professional minimum wage.	205	63340	89194	51057 - 75622
Over the guaranteed inter-professional minimum wage.	175	96526	104299	80965 - 112087
History of hypertension or diabetes					0.0001
No history hypertension or diabetes	219	58005	75875	47900 - 68110
Yes, with a history hypertension or diabetes	161	106668	115785	88647 - 124689
Use of conventional anti-hypertensive treatment					0.0001
Only under healthy lifestyle / with monotherapy	210	52439	73803	42399 - 62479
Bi-/tri-therapy	170	110968	113040	93853 - 128083
Medication adherence					0.022
Not compliant with the treatment	145	93148	119156	73589 - 112707
Compliant with the treatment	235	69661	80748	59283 - 80038
Used of substances					0.13
Used neither tobacco nor alcohol	228	84836	104739	71197 - 98475
Use only one substance	119	74807	90208	58548 - 91067
Use both	33	49459	63898	27588 - 71329
Daily fruits and vegetables intake					0.71
< 3 servings consumption	267	77404	99812	65378 - 89431
>= 3 servings consumption	113	81502	92988	64170 - 98834
Practice a physical activity					0.20
No	190	75057	94141	64177 - 85938
Yes	90	90112	108250	67439 - 112784
Body weight control					0.0001
Body mass index less than 25 kg/m²	199	53856	72529	43717 - 63995
Overweight	123	84253	112892	65021 - 103486
Obesity	58	151660	107748	121977 - 181343
Hypertension					0.006
Controlled (< 140/90 mmHg)	106	56711	73570	42543 - 70880
Uncontrolled (≥140/90 mmHg)	274	87100	104493	74672 - 99527

Table 3 reports details on direct cost estimation and the mean direct cost per patient per year was 78623 FCFA (95% CI: 68766 - 88480) and 47.5%; 18.5%; 16.3%; and 13.5% of the total annual direct cost were spent respectively for medication, medical visit, hospitalizations and paraclinical tests. Only two patients (0.5%) had subscribed to an insurance policy. The direct cost per patient per year was equivalent to 11.5% of the patient mean income per year.

Table 4 reports mean in direct cost by sociodemographic categories: the mean was lower for elderly 61,419 FCFA (vs 100,958 FCFA in those of 44 - 64), p = 0.004, for those living in peri-urban informal settlements 52,620 FCFA (vs 106,615 in urban Bobo-Dioulasso), p = 0.0001, for un-educated patients 64,893 FCFA (vs 140,196 in those of high level of education), p = 0.0001, for singles 56,639 FCFA in singles (vs 86,475 in married/cohabiting), p = 0.009.

The mean direct cost for patients with uncontrolled hypertension was higher, 104,493 FCFA (vs 73,570 in those controlled hypertension), p = 0.006 as well as in those with bi/tritherapy 113,040 FCFA vs (73,803 in patients using monotherapy), p = 0.0001.

In those with BMI under 25 kg/m², overweight and obesity, the mean direct cost was 53,856, 84,253 and 151,660 FCFA, respectively, p = 0.0001.

4. Discussion

In Burkina Faso, costs’ analyses usually focus on mother-child care (e.g.; maternal care, paediatric hospitalizations)

[26, 27]

, infectious diseases such as tuberculosis

[28]

, malaria

[29]

or meningitis care

[30]

. The survey built upon the limited existing data on the financial burden of non-communicable chronic diseases in the country

[16, 31]

4.1. Main Finding

As we found, a mean direct cost of 74 627 FCFA (66 303 - 82 950) per patient-year was previously reported among 156 patients (145 recruited at the secondary level and 11 at the tertiary level) in Bobo-Dioulasso

[16]

. Elsewhere in Ethiopia, the potential mean direct cost per patient per year was US$ 136.7

[32]

(the initial calculation of the mean direct cost per patient per month was 11.39; CI: 10.6-12.1) and was similar to our finding (78 623 FCFA = US$ 141.7). As in our study, the Ethiopian and Kenyan studies identified the medication cost as the most expenditure component of the direct cost. Mean cost for medication per patient per month found in the present study (3 888 FCFA = US$ 7.0 per patient per month) was lower than the mean level reported in rural Nigeria (US$ 9.6±3.7 in 2010)

[33]

and in urban Togo (10 569 FCFA in 2011)

[34]

Despite the current comparison, the average annual direct cost of managing hypertension exceeds one-tenth of the patient's annual income, equivalent to more than one-fifth of the country's guaranteed minimum wage (30 684 FCFA = US$ 55.30), which is a significant financial burden for many people.

4.2. The Usefulness of the Findings in the Context of the Implementation of Current Health Coverage in Burkina Faso

Health financing for universal health coverage is in its early stages in SSA

[35]

and "Universal Health Insurance Scheme" is being implemented in Burkina Faso at the time of writing this paper. Therefore, a key step is to address specific costs related to each disease management.

With regard to hypertension specifically, this study provided valuable insights for small-scale community-based piloting in the study area (as in the Nepalese stepwise

[36]

), with potential application at broader regional and national scales. It can be suggested the following guidance for estimating the direct cost of the key components and the global budget based on evidence, for public health interventions in the study area.

Average annual total direct cost as a proxy: The amount found for the sample of 380 hypertensive patients can be used as a proxy and rationale for the community-wide estimate of managing hypertension in urban Bobo-Dioulasso, as done in Bangladesh

[37, 38]

, while the pool of all the hypertensive people in this study area remained to be determined. Therefore, the potential number of hypertensive individuals in this area can be estimated by extracting data from the following relevant sources: i) the latest (2019) GCPH updated with the recent Demographic and Health Survey, ii) the 'Health Statistics Yearbooks', iii) the WHO stepwise approach to surveillance surveys conducted in 2013 and 2021 (results from 2013 survey were available

[11, 20]

) usually used to explore the prevalence of hypertension in regions and urban area. Finally, supplemental reviews particularly restricted to the urban Bobo-Dioulasso, including meta-analyses should help to clearly shape data on prevalence.

To provide a full picture, estimations must consider the significant number of unscreened for hypertension (74.1% of hypertensive people, 95% CI: 67.8 - 79.7)

[20]

which should be shifted with undiagnosed and untreated hypertension

[39]

. The national social protection policy implemented the Unique Registry of Vulnerable People in 2016, which involved municipalities in Bobo-Dioulasso. To predict the specific support that will be given to marginalised people in our context of limited resources, this database needs to be updated to help ensure the efficient selection of priority recipients of financial assistance for screening and treatment.

Moreover, the low direct cost for certain sociodemographic categories, such as the elderly, those living in informal settlements around Bobo-Dioulasso, the uneducated and singles, can help to identify vulnerable people.

4.3. Further Key Avenues for Future Research

The present patient-level analysis only considered the patient's own expenditure for the direct cost calculation; expenditure incurred by the government was not included. The study should be appended with hospital- and social-levels’ analyses and therefore, the direct costs can be adjusted. In addition to the direct costs, an estimate of the indirect costs

[40]

should be performed to generate the economic cost of hypertension management, which will help to improve understanding of the burden. Although the high rate of uncontrolled hypertension (72.1% in our study) was commonly reported in primary care in SSA

[41]

, cost-effectiveness analyses are needed

[42]

and should categorised within the economic cost, the burden related to the non-modifiable factors, and the benefits of healthier lifestyle practice. This is all relevant since the average direct cost of treating obese patients was three times higher (151,660 FCFA) than that of patients with a normal (53,856 FCFA) BMI, and the double for those with overweight (84,253 FCFA), as well as the average expenditure allocated by those with uncontrolled hypertension (87,100 CFA) was about twice that of patients with controlled hypertension (56,711 FCFA). Practising a healthy lifestyle was associated with a low number of anti-hypertensive platelets used

[43]

, and interventions promoting this practice seemed beneficial, since patients on monotherapy spent approximately half as much (52,439 CFA) as those on at least bitherapy (110,968 CFA). At about 40% were not compliant with their treatment and their mean cost was significantly higher. Therefore, the effectiveness of interventions aimed at promoting adherence to the antihypertensive treatment and to a healthy lifestyle (physical activity and diet) should be evaluated.

The 'community-based health workers' were introduced to rural Primary Health Care Centres (PHCCs) in 2016, with specific assignments such as supporting mother-child care and tackling child malnutrition in the community

[44, 45]

. They performed their roles acceptably

[46]

and cost-effectively

[45]

and they may be assigned to the hypertension management in urban communities.

4.4. Raising Community Engagement for Hypertension Management in Burkina Faso

Understanding the economic benefits of a hypertension control program is valuable to decision-makers

[36, 37]

, but an incentive action to prompt community-based interventions is needed in Burkina Faso. The local health insurance coverage helped to improve management and control of hypertension in a primary care setting for general residents in municipalities including its vulnerable group

[47]

. Despite hypertension was found in 58 - 86% of hospitalised patients with cardiovascular events in Burkina Faso

[7-10]

, there was not sufficient and efficient vulgarized communication and particularly on financial resources loss by the patients. The rationale and calculation of the economic benefits resulting from hypertension control should be conducted and demonstrated by the researchers and workers in the public health field in collaboration with the country institution in charge of the “Universal Health Insurance Scheme”. Results and demonstrations should be vulgarized to the local communities of Bobo-Dioulasso, municipalities, local insurance compagnies, Ministries in charge of Health and Finance, and the stakeholders involved in the control of the non-communicable diseases.

4.5. Strengths and Limitations

These findings should prompt larger and more in-depth studies intended to provide a basis for a national budget planning for universal health insurance concerning hypertension, the main cardiovascular risk factor. As limitations, the related costs of the psychological consequences, such as stress, an impaired quality of life and well-being, pain and physical disability, are evident

[17, 18]

and should have been estimated and included. In addition, it did not take into account times spent (by nurses at PHCC, by patients in pharmacy or laboratory), the amounts contributed by a third party (caregiver, family etc.)

[31]

. As the costs were collected over the past 12 months, the possibility of memory bias cannot be ruled out. What's more, the national health system's resources haven't been costed. This study included only the public PHCCs despite significant number of private care facilities.

5. Conclusion

The average annual direct cost of managing hypertension exceeded one-tenth of the occupationally active patient's annual income, equivalent to more than one-fifth of the country's guaranteed minimum wage, which is a significant financial burden for many people. This study addressed the accurate additionally parameters to be included for in-depth estimates’ analyses to guide an operative and sustainable health cover implementation in the country. It should be followed by cost-effectiveness analyses and community engagement to control hypertension, initially on a small scale in Bobo-Dioulasso and then on a broader scale across the country. A community engagement building should be triggered by the vulgarization of the rationale of estimates and benefits, to the local communities, municipalities, insurance compagnies, Ministries in charge of Health and Finances.

Abbreviations

BMI	Body Mass Index
DBP	Diastolic Blood Pressure
CoPaQ	Costs for Patients Questionnaire
LMIC	Low- and Middle-Income Country
PHCC	Primary Health Care Centre
SBP	Systolic Blood Pressure
SSA	Sub-Saharan Africa

Acknowledgments

We thank the Doctors; medical office chief of the health districts of Do and Dafra, the nurses from PHCCs of Do and Dafra health districts by making data collection easier.

Author Contributions

Abdoulaye Hama Diallo: Conceptualization, Supervision, Writing – review & editing

Jeoffray Diendere: Conceptualization, Formal Analysis, Methodology, Supervision, Validation, Writing – original draft, Writing – review & editing

Sibiri Konate: Conceptualization, Data curation, Formal Analysis, Methodology, Writing – original draft

Hermann Bienou Lanou: Supervision, Validation, Writing – review & editing

Noaga Irenee Ily: Investigation, Supervision, Writing – review & editing

Watton Rodrigue Diao: Supervision, Visualization, Writing – review & editing

Augustin Nawidimbasba Zeba: Supervision, Validation, Writing – review & editing

Conflicts of Interest

The authors declare that they have no competing interest.

References

[1]	Zhou B, Carrillo-Larco RM, Danaei G, Riley LM, Paciorek CJ, Stevens GA, et al. Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. The Lancet 2021; 398: 957-80. https://doi.org/10.1016/S0140-6736(21)01330-1
[2]	Schmidt B-M, Durao S, Toews I, Bavuma CM, Hohlfeld A, Nury E, et al. Screening strategies for hypertension. Cochrane Database Syst Rev 2020; 5: CD013212. https://doi.org/10.1002/14651858.CD013212.pub2
[3]	Ataklte F, Erqou S, Kaptoge S, Taye B, Echouffo-Tcheugui JB, Kengne AP. Burden of undiagnosed hypertension in sub-saharan Africa: a systematic review and meta-analysis. Hypertens Dallas Tex 1979 2015; 65: 291-8. https://doi.org/10.1161/HYPERTENSIONAHA.114.04394
[4]	World Bank Group. World Bank Open Data: Poverty headcount ratio at $3.00 a day (2021 PPP) (% of population) - Low income. World Bank Open Data 2025. https://data.worldbank.org/indicator/SI.POV.DDAY?locations=XM (accessed July 9, 2025).
[5]	Ministère de la Santé du Burkina Faso. Annuaire Statistique de la Santé 2021 2022. https://www.sante.gov.bf/fileadmin/annuaire_2021_mshp.pdf (accessed August 11, 2023).
[6]	Ministère de la Santé du Burkina Faso. Annuaire Statistique de la Santé 2012 2013. http://cns.bf/IMG/pdf/annuaire_ms_2012.pdf (accessed August 11, 2023).
[7]	Kaboré EG, Yameogo NV, Seghda A, Kagambèga L, Kologo J, Millogo G, et al. [Evolution profiles of acute coronary syndromes and GRACE, TIMI and SRI risk scores in Burkina Faso. A monocentric study of 111 patients]. Ann Cardiol Angeiol (Paris) 2019; 68: 107-14. https://doi.org/10.1016/j.ancard.2018.09.007
[8]	Samadoulougou KA, Mandi DG, Yameogo YRA, Yameogo NV, Millogo RG, Kaboré WH, et al. Cardio embolic stroke: Data from 145 cases at the Teaching Hospital of Yalgado Ouedraogo, Ouagadougou, Burkina Faso. Int J Cardiovasc Res 2016; 2015. https://doi.org/10.4172/2324-8602.1000191
[9]	Labodi LD, Kadari C, Judicael KN, Christian N, Athanase M, Jean KB. Impact of Medical and Neurological Complications on Intra-Hospital Mortality of Stroke in a Reference Hospital in Ouagadougou (Burkina Faso). J Adv Med Med Res 2018: 1-13. https://doi.org/10.9734/JAMMR/2018/42376
[10]	Samadoulougou K MDG. Non Valvular Atrial Fibrillation Related Ischaemic Stroke at the Teaching Hospital of Yalgado Ouédraogo, Burkina Faso. J Vasc Med Surg 2015; 03. https://doi.org/10.4172/2329-6925.1000171
[11]	Soubeiga JK, Millogo T, Bicaba BW, Doulougou B, Kouanda S. Prevalence and factors associated with hypertension in Burkina Faso: a countrywide cross-sectional study. BMC Public Health 2017; 17: 64. https://doi.org/10.1186/s12889-016-3926-8
[12]	WHO, UNICEF. Primary health care : report of the International Conference on Primary Health Care, Alma-Ata, 1978. World Health Organ 1978. https://www.who.int/publications/i/item/9241800011 (accessed July 3, 2025).
[13]	Cárdenas MK, Pérez-León S, Singh SB, Madede T, Munguambe S, Govo V, et al. Forty years after Alma-Ata: primary health-care preparedness for chronic diseases in Mozambique, Nepal and Peru. Glob Health Action 2021; 14: 1975920. https://doi.org/10.1080/16549716.2021.1975920
[14]	Institut National de la Statistique et de la Démographie (INSD). Monographie des Hauts-Bassins 5ème RGPH 2022. https://www.insd.bf/sites/default/files/2023-02/MONOGRAPHIE%20DES%20HAUTS-BASSINS%205E%20RGPH.pdf (accessed June 1, 2025).
[15]	Direction générale des études et des statistiques sectorielles (DGESS). Annuaire Statistique de la Santé 2024. Ministère Santé Burkina Faso 2025. http://cns.bf/IMG/pdf/ms_annuaire_statistique_de_la_sante_2024.pdf (accessed July 7, 2025).
[16]	Hien H, Sie M a. W, Tougouma JB, Meda ZC, Ilboudo P, Sakana L, et al. Direct cost of care for hypertensive patients in Burkina Faso. Sci Santé 2018; 41: 35-43.
[17]	Laberge M, Coulibaly LP, Berthelot S, Borges da Silva R, Guertin JR, Strumpf E, et al. Development and Validation of an Instrument to Measure Health-Related Out-of-Pocket Costs: The Cost for Patients Questionnaire. Value Health 2021; 24: 1172-81. https://doi.org/10.1016/j.jval.2021.03.016
[18]	Poder TG, Coulibaly LP, Gaudreault M, Berthelot S, Laberge M. Validated Tools to Measure Costs for Patients: A Systematic Review. The Patient 2022; 15: 3-19. https://doi.org/10.1007/s40271-021-00527-x
[19]	Poder TG, Coulibaly LP, Hassan AI, Conombo B, Laberge M. Test-retest reliability of the Cost for Patients Questionnaire. Int J Technol Assess Health Care 2022; 38: e65. https://doi.org/10.1017/S0266462322000460
[20]	Diendéré J, Kaboré J, Bosu WK, Somé JW, Garanet F, Ouédraogo PV, et al. A comparison of unhealthy lifestyle practices among adults with hypertension aware and unaware of their hypertensive status: results from the 2013 WHO STEPS survey in Burkina Faso. BMC Public Health 2022; 22: 1601. https://doi.org/10.1186/s12889-022-14026-7
[21]	Conombo B, Coulibaly L, Dragomir A, Guertin JR, Idriss-Hassan A, Laberge M, et al. CoPaQ: mesure des coûts supportés par les patient(e)s pour des soins de santé. Unité Soutien SSA Qué 2021. https://ssaquebec.ca/nouvelles/co-paq/ (accessed September 1, 2022).
[22]	Guiguemdé TR, Coulibaly N, Coulibaly SO, Ouedraogo JB, Gbary AR. Esquisse d’une méthode d’estimation du coût économique chiffré des accès palustres: application à une zone rurale au Burkina Faso (Afrique de l’Ouest). Trop Med Int Health 1997; 2: 646-53. https://doi.org/10.1046/j.1365-3156.1997.d01-351.x
[23]	World Health Organization. Obesity: Preventing and Managing the Global Epidemic. Technical Report 894. Geneva: World Health Organization; 2000.
[24]	Giles TD, Berk BC, Black HR, Cohn JN, Kostis JB, Izzo Jr. JL, et al. Expanding the Definition and Classification of Hypertension. J Clin Hypertens 2005; 7: 505-12. https://doi.org/10.1111/j.1524-6175.2005.04769.x
[25]	Exchange-Rates.org. US Dollar (USD) To CFA BCEAO Franc (XOF) Exchange Rate History for 2021 n.d. https://www.exchange-rates.org/exchange-rate-history/usd-xof-2021 (accessed July 9, 2025).
[26]	Nguyen HT, Torbica A, Brenner S, Kiendrébéogo JA, Tapsoba L, Ridde V, et al. Economic Evaluation of User-Fee Exemption Policies for Maternal Healthcare in Burkina Faso: Evidence From a Cost-Effectiveness Analysis. Value Health 2020; 23: 300-8. https://doi.org/10.1016/j.jval.2019.10.007
[27]	Aliabadi N, Bonkoungou IJO, Pindyck T, Nikièma M, Leshem E, Seini E, et al. Cost of pediatric hospitalizations in Burkina Faso: A cross-sectional study of children aged <5 years enrolled through an acute gastroenteritis surveillance program. Vaccine 2020; 38: 6517-23. https://doi.org/10.1016/j.vaccine.2020.08.028
[28]	Laokri S, Drabo MK, Weil O, Kafando B, Dembélé SM, Dujardin B. Patients are paying too much for tuberculosis: a direct cost-burden evaluation in Burkina Faso. PloS One 2013; 8: e56752. https://doi.org/10.1371/journal.pone.0056752
[29]	Duval L, Sicuri E, Scott S, Traoré M, Daabo B, Tinto H, et al. Household costs associated with seeking malaria treatment during pregnancy: evidence from Burkina Faso and The Gambia. Cost Eff Resour Alloc CE 2022; 20: 42. https://doi.org/10.1186/s12962-022-00376-x
[30]	Colombini A, Trotter C, Madrid Y, Karachaliou A, Preziosi M-P. Costs of Neisseria meningitidis Group A Disease and Economic Impact of Vaccination in Burkina Faso. Clin Infect Dis Off Publ Infect Dis Soc Am 2015; 61 Suppl 5: S473-482. https://doi.org/10.1093/cid/civ600
[31]	Toure AO, Balde MD, Diallo A, Camara S, Soumah AM, Sall AO, et al. The direct cost of dialysis supported by families for patients with chronic renal failure in Ouagadougou (Burkina Faso). BMC Nephrol 2022; 23: 222. https://doi.org/10.1186/s12882-022-02847-y
[32]	Zawudie AB, Lemma TD, Daka DW. Cost of Hypertension Illness and Associated Factors Among Patients Attending Hospitals in Southwest Shewa Zone, Oromia Regional State, Ethiopia. Clin Outcomes Res 2020; 12: 201-11. https://doi.org/10.2147/CEOR.S241591
[33]	Ilesanmi OS, Ige OK, Adebiyi AO. The managed hypertensive: the costs of blood pressure control in a Nigerian town. Pan Afr Med J 2012; 12: 96.
[34]	Pio M, Baragou S, Afassinou Y, Pessinaba S, Atta B, Ehlan K, et al. [Adherence to hypertension and its determinants in the cardiology department of the University Hospital of Lomé Tokoin]. Pan Afr Med J 2013; 14: 48. https://doi.org/10.11604/pamj.2013.14.48.1973
[35]	Ifeagwu SC, Yang JC, Parkes-Ratanshi R, Brayne C. Health financing for universal health coverage in Sub-Saharan Africa: a systematic review. Glob Health Res Policy 2021; 6: 8. https://doi.org/10.1186/s41256-021-00190-7
[36]	Krishnan A, Finkelstein EA, Kallestrup P, Karki A, Olsen MH, Neupane D. Cost-effectiveness and budget impact of the community-based management of hypertension in Nepal study (COBIN): a retrospective analysis. Lancet Glob Health 2019; 7: e1367-74. https://doi.org/10.1016/S2214-109X(19)30338-9
[37]	Finkelstein EA, Krishnan A, Naheed A, Jehan I, de Silva HA, Gandhi M, et al. Budget impact and cost-effectiveness analyses of the COBRA-BPS multicomponent hypertension management programme in rural communities in Bangladesh, Pakistan, and Sri Lanka. Lancet Glob Health 2021; 9: e660-7. https://doi.org/10.1016/S2214-109X(21)00033-4
[38]	Hong JC, Padula WV, Hollin IL, Hussain T, Dietz KB, Halbert JP, et al. Care Management to Reduce Disparities and Control Hypertension in Primary Care: A Cost-effectiveness Analysis. Med Care 2018; 56: 179-85. https://doi.org/10.1097/MLR.0000000000000852
[39]	Cissé K, Kouanda S, Coppieters’t Wallant Y, Kirakoya-Samadoulougou F. Awareness, Treatment, and Control of Hypertension among the Adult Population in Burkina Faso: Evidence from a Nationwide Population-Based Survey. Int J Hypertens 2021; 2021: 5547661. https://doi.org/10.1155/2021/5547661
[40]	Oyando R, Njoroge M, Nguhiu P, Kirui F, Mbui J, Sigilai A, et al. Patient costs of hypertension care in public health care facilities in Kenya. Int J Health Plann Manage 2019; 34: e1166-78. https://doi.org/10.1002/hpm.2752
[41]	Macquart de Terline D, Kramoh KE, Bara Diop I, Nhavoto C, Balde DM, Ferreira B, et al. Poor adherence to medication and salt restriction as a barrier to reaching blood pressure control in patients with hypertension: Cross-sectional study from 12 sub-Saharan countries. Arch Cardiovasc Dis 2020; 113: 433-42. https://doi.org/10.1016/j.acvd.2019.11.009
[42]	Pozo-Martin F, Akazili J, Der R, Laar A, Adler AJ, Lamptey P, et al. Cost-effectiveness of a Community-based Hypertension Improvement Project (ComHIP) in Ghana: results from a modelling study. BMJ Open 2021; 11: e039594. https://doi.org/10.1136/bmjopen-2020-039594
[43]	Chiuve SE, McCullough ML, Sacks FM, Rimm EB. Healthy Lifestyle Factors in the Primary Prevention of Coronary Heart Disease Among Men. Circulation 2006; 114: 160-7. https://doi.org/10.1161/CIRCULATIONAHA.106.621417
[44]	Tougri H, Bocoum FY, Compaore R, Ouedraogo AM, Congo B, Pietra V, et al. Evaluation de la mise en oeuvre du dépistage de la malnutrition aiguë sévère chez les enfants de moins de cinq ans par les mères dans la région du Centre-Ouest au Burkina Faso. Sci Santé 2019; 42: 21-31.
[45]	Shen Y, Cliffer IR, Suri DJ, Langlois BK, Vosti SA, Webb P, et al. Impact of stakeholder perspectives on cost-effectiveness estimates of four specialized nutritious foods for preventing stunting and wasting in children 6-23 months in Burkina Faso. Nutr J 2020; 19: 20. https://doi.org/10.1186/s12937-020-00535-x
[46]	Ouedraogo AM, Compaore R, Tougri H, Some A, Dahourou DL, Baguiya A, et al. Acceptabilité des tests de diagnostic rapide du paludisme administrés par les agents de santé communautaire et satisfaction des bénéficiaires au Burkina Faso. Sci Tech Sci Santé 2020; 43: 74-86.
[47]	Li H, Wu Z, Hui X, Hu Y. Impact of local health insurance schemes on primary care management and control of hypertension: a cross-sectional study in Shenzhen, China. BMJ Open 2019; 9: e031098. https://doi.org/10.1136/bmjopen-2019-031098

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Diallo, A. H., Diendere, J., Konate, S., Lanou, H. B., Ily, N. I., et al. (2025). Estimating Direct Cost for Hypertension Management in Urban Primary Health Facilities in Bobo-Dioulasso, Burkina Faso: A Patient-Level Analysis. Central African Journal of Public Health, 11(5), 299-310. https://doi.org/10.11648/j.cajph.20251105.18

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Diallo, A. H.; Diendere, J.; Konate, S.; Lanou, H. B.; Ily, N. I., et al. Estimating Direct Cost for Hypertension Management in Urban Primary Health Facilities in Bobo-Dioulasso, Burkina Faso: A Patient-Level Analysis. Cent. Afr. J. Public Health 2025, 11(5), 299-310. doi: 10.11648/j.cajph.20251105.18

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AMA Style

Diallo AH, Diendere J, Konate S, Lanou HB, Ily NI, et al. Estimating Direct Cost for Hypertension Management in Urban Primary Health Facilities in Bobo-Dioulasso, Burkina Faso: A Patient-Level Analysis. Cent Afr J Public Health. 2025;11(5):299-310. doi: 10.11648/j.cajph.20251105.18

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@article{10.11648/j.cajph.20251105.18,
  author = {Abdoulaye Hama Diallo and Jeoffray Diendere and Sibiri Konate and Hermann Bienou Lanou and Noaga Irenee Ily and Watton Rodrigue Diao and Augustin Nawidimbasba Zeba},
  title = {Estimating Direct Cost for Hypertension Management in Urban Primary Health Facilities in Bobo-Dioulasso, Burkina Faso: A Patient-Level Analysis
},
  journal = {Central African Journal of Public Health},
  volume = {11},
  number = {5},
  pages = {299-310},
  doi = {10.11648/j.cajph.20251105.18},
  url = {https://doi.org/10.11648/j.cajph.20251105.18},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cajph.20251105.18},
  abstract = {Introduction: Hypertension is among the top 10 reasons for visiting primary health care centres (PHCCs) in Burkina Faso. Using a patient-level analysis, this study estimated the direct cost for hypertension management at outpatient care, in urban PHCCs in Bobo-Dioulasso, in the context of a universal health coverage policy development in the country. Methods: This was a cross-sectional study, using an adapted form of the “Costs for Patients Questionnaire” (CoPaQ) that includes different components for direct cost estimations. A sample of 380 hypertensive adults were interviewed from January to February 2022, at 20 public PHCCs in Bobo-Dioulasso. Results: Per patient-year, the means [95% CI] in income and direct cost were 786 947 CFA (USD 1418.3) [694 200 (USD 1251.1) - 879 695 (USD 1585.4)] and 78 623 FCFA (USD 141.3) [68 766 (124.0) - 88 480 (159.5)], respectively. Of the annual total direct cost, 47.5%, 18.5%, 16.3% and 13.5% were spent on medication, medical visits, hospitalisations and paraclinical tests, respectively. Only two patients (0.5%) were enrolled in insurance policy; and uncontrolled hypertension frequency was 72.1% (95% CI: 67.3-76.6). Conclusion: The average direct cost per patient-year of managing hypertension exceeded one-tenth of the patient's annual income, equivalent to more than one-fifth of the country's guaranteed minimum wage, which is a significant financial burden for many people. This study should be followed by cost-effectiveness analyses and community engagement building for hypertension control at small-scale piloting in Bobo-Dioulasso, then broad-based in the country.
},
 year = {2025}
}

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TY  - JOUR
T1  - Estimating Direct Cost for Hypertension Management in Urban Primary Health Facilities in Bobo-Dioulasso, Burkina Faso: A Patient-Level Analysis

AU  - Abdoulaye Hama Diallo
AU  - Jeoffray Diendere
AU  - Sibiri Konate
AU  - Hermann Bienou Lanou
AU  - Noaga Irenee Ily
AU  - Watton Rodrigue Diao
AU  - Augustin Nawidimbasba Zeba
Y1  - 2025/10/27
PY  - 2025
N1  - https://doi.org/10.11648/j.cajph.20251105.18
DO  - 10.11648/j.cajph.20251105.18
T2  - Central African Journal of Public Health
JF  - Central African Journal of Public Health
JO  - Central African Journal of Public Health
SP  - 299
EP  - 310
PB  - Science Publishing Group
SN  - 2575-5781
UR  - https://doi.org/10.11648/j.cajph.20251105.18
AB  - Introduction: Hypertension is among the top 10 reasons for visiting primary health care centres (PHCCs) in Burkina Faso. Using a patient-level analysis, this study estimated the direct cost for hypertension management at outpatient care, in urban PHCCs in Bobo-Dioulasso, in the context of a universal health coverage policy development in the country. Methods: This was a cross-sectional study, using an adapted form of the “Costs for Patients Questionnaire” (CoPaQ) that includes different components for direct cost estimations. A sample of 380 hypertensive adults were interviewed from January to February 2022, at 20 public PHCCs in Bobo-Dioulasso. Results: Per patient-year, the means [95% CI] in income and direct cost were 786 947 CFA (USD 1418.3) [694 200 (USD 1251.1) - 879 695 (USD 1585.4)] and 78 623 FCFA (USD 141.3) [68 766 (124.0) - 88 480 (159.5)], respectively. Of the annual total direct cost, 47.5%, 18.5%, 16.3% and 13.5% were spent on medication, medical visits, hospitalisations and paraclinical tests, respectively. Only two patients (0.5%) were enrolled in insurance policy; and uncontrolled hypertension frequency was 72.1% (95% CI: 67.3-76.6). Conclusion: The average direct cost per patient-year of managing hypertension exceeded one-tenth of the patient's annual income, equivalent to more than one-fifth of the country's guaranteed minimum wage, which is a significant financial burden for many people. This study should be followed by cost-effectiveness analyses and community engagement building for hypertension control at small-scale piloting in Bobo-Dioulasso, then broad-based in the country.

VL  - 11
IS  - 5
ER  -

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Abdoulaye Hama Diallo

Department of Public Health, Joseph Ki-Zerbo University, Ouagadougou, Burkina Faso

Contact Email

http://orcid.org/0000-0002-5362-3346
Jeoffray Diendere

Unit of Nutrition-Research Institute for Health Sciences (IRSS), National Centre for Scientific and Technologic Research (CNRST), Bobo-Dioulasso, Burkina Faso

Contact Email

http://orcid.org/0000-0002-2654-5135
Sibiri Konate

Ministry of Health-Hauts-Bassins Regional Health Directorate, Medical Center with Surgical Unit in Dafra, Bobo-Dioulasso, Burkina Faso

Contact Email

http://orcid.org/0009-0008-1473-7472
Hermann Bienou Lanou

Unit of Nutrition-Research Institute for Health Sciences (IRSS), National Centre for Scientific and Technologic Research (CNRST), Ouagadougou, Burkina Faso

Contact Email

http://orcid.org/0000-0001-6780-2700
Noaga Irenee Ily

Ministry of Health-Hauts-Bassins Regional Health Directorate, Medical Center with Surgical Unit in Dafra, Bobo-Dioulasso, Burkina Faso

Contact Email

http://orcid.org/0009-0006-3898-4932
Watton Rodrigue Diao

Minsitry of Health, Hauts-Bassins Regional Health Directorate, Bobo-Dioulasso, Burkina Faso

Contact Email

http://orcid.org/0009-0009-5330-6197
Augustin Nawidimbasba Zeba

Unit of Nutrition-Research Institute for Health Sciences (IRSS), National Centre for Scientific and Technologic Research (CNRST), Bobo-Dioulasso, Burkina Faso

Contact Email

http://orcid.org/0000-0002-0271-7414

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Diallo, A. H., Diendere, J., Konate, S., Lanou, H. B., Ily, N. I., et al. (2025). Estimating Direct Cost for Hypertension Management in Urban Primary Health Facilities in Bobo-Dioulasso, Burkina Faso: A Patient-Level Analysis. Central African Journal of Public Health, 11(5), 299-310. https://doi.org/10.11648/j.cajph.20251105.18

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ACS Style

Diallo, A. H.; Diendere, J.; Konate, S.; Lanou, H. B.; Ily, N. I., et al. Estimating Direct Cost for Hypertension Management in Urban Primary Health Facilities in Bobo-Dioulasso, Burkina Faso: A Patient-Level Analysis. Cent. Afr. J. Public Health 2025, 11(5), 299-310. doi: 10.11648/j.cajph.20251105.18

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AMA Style

Diallo AH, Diendere J, Konate S, Lanou HB, Ily NI, et al. Estimating Direct Cost for Hypertension Management in Urban Primary Health Facilities in Bobo-Dioulasso, Burkina Faso: A Patient-Level Analysis. Cent Afr J Public Health. 2025;11(5):299-310. doi: 10.11648/j.cajph.20251105.18

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@article{10.11648/j.cajph.20251105.18,
  author = {Abdoulaye Hama Diallo and Jeoffray Diendere and Sibiri Konate and Hermann Bienou Lanou and Noaga Irenee Ily and Watton Rodrigue Diao and Augustin Nawidimbasba Zeba},
  title = {Estimating Direct Cost for Hypertension Management in Urban Primary Health Facilities in Bobo-Dioulasso, Burkina Faso: A Patient-Level Analysis
},
  journal = {Central African Journal of Public Health},
  volume = {11},
  number = {5},
  pages = {299-310},
  doi = {10.11648/j.cajph.20251105.18},
  url = {https://doi.org/10.11648/j.cajph.20251105.18},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cajph.20251105.18},
  abstract = {Introduction: Hypertension is among the top 10 reasons for visiting primary health care centres (PHCCs) in Burkina Faso. Using a patient-level analysis, this study estimated the direct cost for hypertension management at outpatient care, in urban PHCCs in Bobo-Dioulasso, in the context of a universal health coverage policy development in the country. Methods: This was a cross-sectional study, using an adapted form of the “Costs for Patients Questionnaire” (CoPaQ) that includes different components for direct cost estimations. A sample of 380 hypertensive adults were interviewed from January to February 2022, at 20 public PHCCs in Bobo-Dioulasso. Results: Per patient-year, the means [95% CI] in income and direct cost were 786 947 CFA (USD 1418.3) [694 200 (USD 1251.1) - 879 695 (USD 1585.4)] and 78 623 FCFA (USD 141.3) [68 766 (124.0) - 88 480 (159.5)], respectively. Of the annual total direct cost, 47.5%, 18.5%, 16.3% and 13.5% were spent on medication, medical visits, hospitalisations and paraclinical tests, respectively. Only two patients (0.5%) were enrolled in insurance policy; and uncontrolled hypertension frequency was 72.1% (95% CI: 67.3-76.6). Conclusion: The average direct cost per patient-year of managing hypertension exceeded one-tenth of the patient's annual income, equivalent to more than one-fifth of the country's guaranteed minimum wage, which is a significant financial burden for many people. This study should be followed by cost-effectiveness analyses and community engagement building for hypertension control at small-scale piloting in Bobo-Dioulasso, then broad-based in the country.
},
 year = {2025}
}

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TY  - JOUR
T1  - Estimating Direct Cost for Hypertension Management in Urban Primary Health Facilities in Bobo-Dioulasso, Burkina Faso: A Patient-Level Analysis

AU  - Abdoulaye Hama Diallo
AU  - Jeoffray Diendere
AU  - Sibiri Konate
AU  - Hermann Bienou Lanou
AU  - Noaga Irenee Ily
AU  - Watton Rodrigue Diao
AU  - Augustin Nawidimbasba Zeba
Y1  - 2025/10/27
PY  - 2025
N1  - https://doi.org/10.11648/j.cajph.20251105.18
DO  - 10.11648/j.cajph.20251105.18
T2  - Central African Journal of Public Health
JF  - Central African Journal of Public Health
JO  - Central African Journal of Public Health
SP  - 299
EP  - 310
PB  - Science Publishing Group
SN  - 2575-5781
UR  - https://doi.org/10.11648/j.cajph.20251105.18
AB  - Introduction: Hypertension is among the top 10 reasons for visiting primary health care centres (PHCCs) in Burkina Faso. Using a patient-level analysis, this study estimated the direct cost for hypertension management at outpatient care, in urban PHCCs in Bobo-Dioulasso, in the context of a universal health coverage policy development in the country. Methods: This was a cross-sectional study, using an adapted form of the “Costs for Patients Questionnaire” (CoPaQ) that includes different components for direct cost estimations. A sample of 380 hypertensive adults were interviewed from January to February 2022, at 20 public PHCCs in Bobo-Dioulasso. Results: Per patient-year, the means [95% CI] in income and direct cost were 786 947 CFA (USD 1418.3) [694 200 (USD 1251.1) - 879 695 (USD 1585.4)] and 78 623 FCFA (USD 141.3) [68 766 (124.0) - 88 480 (159.5)], respectively. Of the annual total direct cost, 47.5%, 18.5%, 16.3% and 13.5% were spent on medication, medical visits, hospitalisations and paraclinical tests, respectively. Only two patients (0.5%) were enrolled in insurance policy; and uncontrolled hypertension frequency was 72.1% (95% CI: 67.3-76.6). Conclusion: The average direct cost per patient-year of managing hypertension exceeded one-tenth of the patient's annual income, equivalent to more than one-fifth of the country's guaranteed minimum wage, which is a significant financial burden for many people. This study should be followed by cost-effectiveness analyses and community engagement building for hypertension control at small-scale piloting in Bobo-Dioulasso, then broad-based in the country.

VL  - 11
IS  - 5
ER  -

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