title: Determinants of perceived morbidity and use of health services by children less than 15 years old in rural Bangladesh.
abstract: This study examined the association of a number of social and economic and other factors with perceived morbidity and use of health services by children in rural Bangladesh, using the data of a health and socioeconomic survey conducted in Matlab, Bangladesh in 1996. One of the factors of interest was women's social position measured with indicators such as their education, domestic autonomy, social networks and social prestige. Other factors of interest were economic in nature and included the availability of high-quality primary health care (PHC) facilities in one part of the study area. A total of 52% of the 3,793 children below 15 had an episode of an acute illness in the month preceding the interview. The medical care sought for acute illnesses was grouped into four categories: medical doctors, paramedics, traditional and untrained village doctors (including drug sellers) and homeopaths. A total of 55% of the children who were sick in the past month consulted any type of health provider. Logistic regression was used to estimate the effects of the various independent variables on the two dependent variables: perceived morbidity of under-15 children and health service use for under-15 sick children. The results revealed that age of the child was the most important factor influencing perceived morbidity while social and economic variables were in general not related to perceived morbidity. Prolonged and severe illnesses and illnesses of young and male children were more likely to be treated by health providers, particularly by physicians. While women's education and social network influenced visits to any health providers socioeconomic indicators influenced visits to physicians. Availability of PHC facilities in one part of the study area also led to more use of modern medical care. The findings highlight that improvement of women's education and of social and economic status in general, in combination with more availability of high-quality PHC will in Bangladesh lead to better health care of children.
authors.affiliation: Public Health Sciences Division, ICDDR,B: Centre for Health and Population Research, GPO Box 128, Dhaka, 1000, Bangladesh. nalam@icddrb.org
authors.forename: Nurul
authors.initials: N
authors.lastname: Alam
authors.forename: Jeroen K
authors.initials: JK
authors.lastname: van Ginneken
authors.forename: Ian
authors.initials: I
authors.lastname: Timaeus
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001459:Bangladesh / Q000453:epidemiology; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009017:Morbidity; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data*; D012923:Social Class; D012944:Social Support