Determinants of inequalities in health care seeking behavior for childhood illness in Bangladesh: a trend analysis.

Abstract

Background: Worldwide, pneumonia and diarrhea are the leading public health problems; they kill more children under five years of age than any other infectious disease. Approximately two-thirds of all deaths occur in 15 developing countries, including Bangladesh. To achieve the targets of childhood mortality, it is essential to reduce the current rate of under-5 mortality. In Bangladesh, healthcare utilization for childhood illnesses has increased in recent years, but not to a desirable level, and disparities among different groups remain a matter of concern. This study explores the determinants contributing to unequal access to healthcare-seeking behavior for childhood illnesses, namely diarrhea and acute respiratory infection (ARI), over the last decade and a half.

Methods: This study extracted data from the latest three Bangladesh Multiple Indicator Cluster Surveys (2006, 2012-13, and 2019). Children younger than five years with diarrhea and/or ARI 2 weeks prior to the survey were included in the study. The prevalence and association of care-seeking were investigated through a chi-square test and multivariate logistic model applied to identify the determinants of unequal access to healthcare services.

Results: Care seeking for diarrhea and symptoms of acute respiratory infections showed a downward trend from 2006 to 2012-13 (30% vs. 18.5%) and an upward trend from 2012 to 13 to 2019 (18.5% vs. 74.6%). Several socioeconomic and demographic factors such as gender, administrative division, children's age, mother's education, household head's education, wealth, and ethnicity were found to have significant associations with care-seeking behavior for children under 5. Gender, division, and age were significant predictors across the three study periods.

Conclusion: This study identified some possible determinants of care-seeking behaviors in childhood illnesses. Based on the findings of this research, policymakers should revise the existing policy to increase the utilization rate and reduce inequality in health care seeking for children under the age of 5. Specifically, counseling slum residents provide a provision for subsidizing or providing free health care benefits to the poorest households and enhancing parents' counseling to remove gender bias.