Determinants of health seeking behavior for chronic non-communicable diseases and related out-of-pocket expenditure: results from a cross-sectional survey in northern Bangladesh

• Published in: Journal of health, population and nutrition population and nutrition, 2019-12, Vol.38 (1), p.1-14, Article 48
• Main Authors: Rasul, Fatema Binte, Kalmus, Olivier, Sarker, Malabika, Adib, Hossain Ishrath, Hossain, Md Shahadath, Hasan, Md Zabir, Brenner, Stephan, Nazneen, Shaila, Islam, Muhammed Nazmul, De Allegri, Manuela
• Format: Article
• Language: English
• Subjects: Activities of daily living; Arthritis; Asthma; Averages; Cancer; Chronic conditions; Chronic diseases; Chronic illness; Chronic illnesses; Chronic obstructive pulmonary disease; Communicable diseases; Cross-sectional studies; Data collection; Diabetes; Education; Expenditures; Health behavior; Health care costs; Health care expenditures; Health care facilities; Health insurance; Health services utilization; Health-seeking behavior; Help seeking behavior; Higher education; Households; Hypertension; Infectious diseases; Low income areas; Low income groups; Medical economics; Microfinance; Multinomial logistic regression; Multivariate analysis; Non-communicable diseases; Out-of-pocket expenditure; Personal expenditure; Polls & surveys; Questionnaires; Recall; Regression analysis; RESEARCH ARTICLE; Sampling techniques; Self care; Social class; Socioeconomic factors; Socioeconomic status; Socioeconomics; Statistical analysis; Surveys; Variables
• ISSN: 1606-0997; 2072-1315; 2072-1315
• DOI: 10.1186/s41043-019-0195-z

In spite of high prevalence rates, little is known about health seeking and related expenditure for chronic non-communicable diseases in low-income countries. We assessed relevant patterns of health seeking and related out-of-pocket expenditure in Bangladesh. We used data from a household survey of 2500 households conducted in 2013 in Rangpur district. We employed multinomial logistic regression to assess factors associated with health seeking choices (no care or self-care, semi-qualified professional care, and qualified professional care). We used descriptive statistics (5% trimmed mean and range, median) to assess related patterns of out-of-pocket expenditure (including only direct costs). Eight hundred sixty-six (12.5%) out of 6958 individuals reported at least one chronic non-communicable disease. Of these 866 individuals, 139 (16%) sought no care or self-care, 364 (42%) sought semi-qualified care, and 363 (42%) sought qualified care. Multivariate analysis confirmed that the following factors increased the likelihood of seeking qualified care: a higher education, a major chronic non-communicable disease, a higher socio-economic status, a lower proportion of chronic household patients, and a shorter distance between a household and a sub-district public referral health facility. Seven hundred fifty-four (87 %) individuals reported out-of-pocket expenditure, with drugs absorbing the largest portion (85%) of total expenditure. On average, qualified care seekers encountered the highest out-of-pocket expenditure, followed by those who sought semi-qualified care and no care, or self-care. Our study reveals insufficiencies in health provision for chronic conditions, with more than half of all affected people still not seeking qualified care, and the majority still encountering considerable out-of-pocket expenditure. This calls for urgent measures to secure better access to care and financial protection.