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Altare C, Kostandova N, Hasan MA, Agbogan JA, Miah ML, Crockett H, Bates M, Leslie S, Tonon B, Antoine C, Spiegel P. Health care utilisation in Cox's Bazar district, Bangladesh, during the first year of the COVID-19 pandemic: A mixed-methods study among host communities. Glob Public Health 2024; 19:2305364. [PMID: 38252791 DOI: 10.1080/17441692.2024.2305364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024]
Abstract
To respond to the COVID-19 pandemic, countries introduced public health and social measures that had indirect societal, economic consequences. Concerns during epidemics include continuity of routine health services. We investigate how healthcare utilisation and healthcare seeking behaviour changed during the first year of the COVID-19 pandemic among host communities in Cox's Bazar, Bangladesh. This mixed-methods study combines quantitative analyses of routine health data and population-based findings about healthcare seeking behaviours. Trends in consultations changed according to facility level (higher-level facilities included Upazila Health Complexes and District Hospitals; lower-level facilities included Community Clinics and Union Health and Family Welfare Centers). At the pandemic's beginning, drops were seen at higher-level health facilities for outpatient department (OPD) consultations, respiratory infections, and antenatal care. Minor reductions or increases were seen at lower-level facilities for the same services. Half of the subdistricts reported a cumulative increase in OPD and respiratory tract infection consultations. Most subdistricts reported a cumulative decrease in antenatal care. Child vaccinations dropped in all subdistricts, half of which did not catch-up, resulting in a cumulative decrease of delivered doses. Fear of contracting COVID-19 and financial constraints were the main reasons for decreased access. Drivers of healthcare seeking behaviours should be better understood to guide preparedness and service delivery modalities at primary and secondary levels.
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Affiliation(s)
- Chiara Altare
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Center for Humanitarian Health, Baltimore, MD, USA
| | | | | | | | | | - Hannah Crockett
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Center for Humanitarian Health, Baltimore, MD, USA
| | - Madison Bates
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Center for Humanitarian Health, Baltimore, MD, USA
| | - Sharon Leslie
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Center for Humanitarian Health, Baltimore, MD, USA
| | | | | | - Paul Spiegel
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Center for Humanitarian Health, Baltimore, MD, USA
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Mahumud RA, Gow J, Mosharaf MP, Kundu S, Rahman MA, Dukhi N, Shahajalal M, Mistry SK, Alam K. The burden of chronic diseases, disease-stratified exploration and gender-differentiated healthcare utilisation among patients in Bangladesh. PLoS One 2023; 18:e0284117. [PMID: 37130132 PMCID: PMC10153713 DOI: 10.1371/journal.pone.0284117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 03/13/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Chronic diseases are considered one of the major causes of illness, disability, and death worldwide. Chronic illness leads to a huge health and economic burden, especially in low- and middle-income countries. This study examined disease-stratified healthcare utilisation (HCU) among Bangladesh patients with chronic diseases from a gender perspective. METHODS Data from the nationally representative Household Income and Expenditure Survey 2016-2017 consisting of 12,005 patients with diagnosed chronic diseases was used. Gender differentiated chronic disease stratified-analytical exploration was performed to identify the potential factors to higher or lower utilisation of healthcare services. Logistic regression with step-by-step adjustment for independent confounding factors was the method used. RESULTS The five most prevalent chronic diseases among patients were gastric/ulcer (Male/Female, M/F: 16.77%/16.40%), arthritis/rheumatism (M/F: 13.70%/ 13.86%), respiratory diseases/asthma/bronchitis (M/F: 12.09% / 12.55%), chronic heart disease (M/F: 8.30% / 7.41%), and blood pressure (M/F: 8.20% / 8.87%). Eighty-six percent of patients with chronic diseases utilised health care services during the previous 30 days. Although most patients received outpatient healthcare services, a substantial difference in HCU among employed male (53%) and female (8%) patients were observed. Chronic heart disease patients were more likely to utilise health care than other disease types, which held true for both genders while the magnitude of HCU was significantly higher in males (OR = 2.22; 95% CI:1.51-3.26) than their female counterparts (OR = 1.44; 1.02-2.04). A similar association was observed among patients with diabetes and respiratory diseases. CONCLUSION A burden of chronic diseases was observed in Bangladesh. Patients with chronic heart disease utilised more healthcare services than patients experiencing other chronic diseases. The distribution of HCU varied by patient's gender as well as their employment status. Risk-pooling mechanisms and access to free or low-cost healthcare services among the most disadvantaged people in society might enhance reaching universal health coverage.
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Affiliation(s)
- Rashidul Alam Mahumud
- Health Research Group, Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- School of Business, Faculty of Business, Education, Law and Arts, University of Southern Queensland, Toowoomba, Australia
| | - Jeff Gow
- School of Business, Faculty of Business, Education, Law and Arts, University of Southern Queensland, Toowoomba, Australia
- School of Accounting, Economics and Finance, College of Law and Management Studies, University of KwaZulu-Natal, Durban, South Africa
| | - Md Parvez Mosharaf
- Health Research Group, Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
- School of Business, Faculty of Business, Education, Law and Arts, University of Southern Queensland, Toowoomba, Australia
| | - Satyajit Kundu
- Global Health Institute, North South University, Dhaka, Bangladesh
- Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, Bangladesh
| | - Md Ashfikur Rahman
- Development Studies Discipline, Social Science School, Khulna University, Khulna, Bangladesh
| | - Natisha Dukhi
- Human Sciences Research Council, Cape Town, South Africa
| | - Md Shahajalal
- Department of Public Health, School of Health and Life Sciences, North South University, Dhaka, Bangladesh
| | - Sabuj Kanti Mistry
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
- ARCED Foundation, Dhaka, Bangladesh
- Department of Public Health, Daffodil International University, Dhaka, Bangladesh
- Brain and Mond Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Khorshed Alam
- School of Business, Faculty of Business, Education, Law and Arts, University of Southern Queensland, Toowoomba, Australia
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