Gender and Socioeconomic Inequalities in Health and Healthcare Use for Children in Rural Bangladesh: Does Public Health Intervention Make a Difference?

Nurul Alam, ICDDR,B: Centre for Health and Population Research

This study examined the extent of gender and socioeconomic inequalities in health status and healthcare use for children living in the ICDDR,B service area that has additional high quality health facilities and in the government service area that has usual government health facilities in Matlab - a rural area of Bangladesh. The ICDDR,B service area is a proxy for high quality service delivery system. Health is measured by the monthly prevalence of acute illness symptoms, and the three-monthly prevalence of chronic symptoms. Healthcare use is measured as a two-step process: (a) use of any health providers as opposed to home-care, and (b) use of formally trained providers (doctors and paramedics) or traditional healers as opposed to untrained village doctors practicing modern medicine, given that they have used health providers. In 1996, caretakers, usually mothers of 3,798 children (aged less than 15 years) selected randomly were asked whether the child had any acute illness symptoms in last one month, any chronic illness symptoms in last three months, perceived severity of symptoms and healthcare options used to combat illness. Household socioeconomic conditions are measured by maternal education, sanitation condition, housing condition (indicated by number of persons share a living room) and per head asset values. Weighted logistic regression was used to estimate the effects of the gender and household socioeconomic variables, controlling for child and illness characteristics on health status and healthcare use for children in these two areas. The prevalence of acute and chronic symptoms was 52.4% and 13.9% respectively. Most prevalent acute symptoms were cough and fever (32.1%) followed by diarrhoea (12.8%) and chronic symptoms were asthma or respiratory problems (4.7%) followed by general weakness (3.2%). Maternal education was positively associated with the prevalence of both acute and chronic symptoms and this was opposite to what one would expect - a negative relationship. The prevalence of chronic morbidity was higher for boys than for girls. The better the housing condition, the lower was the prevalence of chronic illness. Sanitation condition, per head asset values and area of residence were not related to the prevalence of acute and chronic illnesses. The chances of treating children with acute illnesses by any health providers, particularly by trained ones were 2 times higher in the ICDDR,B service area than in the government area. Boys and girls when sick, were treated by similar type of health providers in the ICDDR,B service area, but not in the government service area. Maternal education was positively associated with use of any health providers outside home, and household sanitation condition and higher per head asset values were related to increased use of trained health providers for sick children. In conclusion, the public health intervention was not able to reduce disease burden, but was able to reduce gender disparity, not socioeconomic disparity in healthcare use.