title: Health coping strategies of the people vulnerable to climate change in a resource-poor rural setting in Bangladesh.
abstract: BACKGROUND
  Among the many challenges faced by the people of Bangladesh, the effects of climate change are discernibly threatening, impacting on human settlement, agricultural production, economic development, and human health. Bangladesh is a low-income country with limited resources; its vulnerability to climate change has influenced individuals to seek out health coping strategies. The objectives of the study were to explore the different strategies/measures people employ to cope with climate sensitive diseases and sickness.
  
  
  METHODS
  A cross-sectional study was conducted among 450 households from Rajshahi and Khulna districts of Bangladesh selected through multi-stage sampling techniques, using a semi-structured questionnaire supplemented by 12 focus group discussions and 15 key informant interviews.
  
  
  RESULTS
  Respondents applied 22 types of primary health coping strategies to prevent climate related diseases and sickness. To cope with health problems, 80.8% used personal treatment experiences and 99.3% sought any treatments available at village level. The percentage of respondents that visited unqualified health providers to cope with climate induced health problems was quite high, namely 92.7% visited village doctors, 75.9% drug stores, and 67.3% self-medicated. Ninety per cent of the respondents took treatment from unqualified providers as their first choice. Public health facilities were the first choice of treatment for only 11.0% of respondents. On average, every household spent Bangladesh Currency Taka 9,323 per year for the treatment of climate sensitive diseases and sickness. Only 46% of health expenditure was managed from their savings. The rest, 54% expenditure, was supported by using 24 different sources, such as social capital and the selling of family assets. The rate of out-of-pocket payment was almost 100%.
  
  
  CONCLUSIONS
  People are concerned about climate induced diseases and sickness and sought preventive as well as curative measures to cope with health problems. The most common and widely used climate health coping strategies among the respondents included self-medicating and seeking the health service of unqualified private health care providers. Per family spending to cope with such health problems is expensive and completely based on out of pocket payment. There is no fund pooling, community funding or health insurance program in rural areas to support the health coping of the people. Policies are needed to reduce out-of-pocket payment, to improve the quality of the unqualified providers and to extend public health services at rural areas and support climate related health coping. Collection of such knowledge on climate related health coping strategies can allow researchers to study any specific issue on health coping, and policy makers to initiate effective climate related health coping strategies for climate vulnerable people.
authors.affiliation: Institute of Public Health, Heidelberg University, 69120, Heidelberg, Im Neuenheimer Feld 324, Germany. aminuldps@gmail.com
authors.forename: Md Aminul
authors.initials: MA
authors.lastname: Haque
authors.forename: Aji
authors.initials: A
authors.lastname: Budi
authors.forename: Ahmad
authors.initials: A
authors.lastname: Azam Malik
authors.forename: Shelby
authors.initials: S
authors.lastname: Suzanne Yamamoto
authors.forename: Valérie R
authors.initials: VR
authors.lastname: Louis
authors.forename: Rainer
authors.initials: R
authors.lastname: Sauerborn
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001459:Bangladesh; D057231:Climate Change; D003080:Cold Temperature; D003625:Data Collection; D004194:Disease / Q000523:psychology*; D004522:Educational Status; D005260:Female; D017144:Focus Groups; D015438:Health Behavior; D005102:Health Expenditures; D007722:Health Knowledge, Attitudes, Practice; D006358:Hot Temperature; D006801:Humans; D008297:Male; D008875:Middle Aged; D011204:Poverty Areas; D012111:Residence Characteristics; D012424:Rural Population; D011795:Surveys and Questionnaires