title: Health care seeking patterns and out of pocket payments for children under five years of age living in Katchi Abadis (slums), in Islamabad, Pakistan.
abstract: BACKGROUND
  Since 1990, Pakistan has faced an unprecedented rate of urbanization, thereby resulting in the uncontrolled proliferation of slums (Katchi Abadis) in all large cities. These areas lack the basic municipal services such as safe water supply, sanitation and waste collection. There is limited access to quality health care services, both curative and preventive. Therefore, communities living in katchi abadis are faced with health seeking challenges and catastrophic expenditure to pay for health care services (formal or informal).
  
  
  METHODS
  This cross-sectional quantitative study was conducted in Islamabad, using a semi-structured questionnaire with mothers of children 5 years of age. There are 34 katchi abadis, 11 are recognized by the Capital Development Authority, out of which seven were included in the study. The calculated sample size was 207.
  
  
  RESULTS
  Average household income was found to be Pak Rupee 10,000 (approx.US$100) per month. Diarrhea, fever, common cold and cough were common illnesses among under 5 children. Approximately 43% of the mothers were illiterate and they preferred consulting a private doctor or a private dispenser in the katchi abadi. Mother's level of education was significantly associated with the type of health provider consulted. Majority had to spend out of pocket, while many either borrowed money from relatives or friends or sold a household item. Delay in seeking health care added to the out of pocket expense. The mean cost on child's treatment was approximately PkRs400 (approximately US$ 4) for a single consultation.
  
  
  CONCLUSIONS
  There are several factors associated with health seeking behavior of mothers of children under the age of 5 years, living in the katchi abadis of Islamabad. The latter population group is one of the most vulnerable given their poor standard of living conditions. A multi-sectoral approach is needed to address the provision of basic amenities, the availability of safety nets to pay for health care is crucial to avoid catastrophic expenditure and the provision of community-based health promotion programs are essential to improve health seeking behaviors whilst simultaneously promoting and protecting health.
authors.forename: Aneeqa
authors.initials: A
authors.lastname: Rehman
authors.affiliation: Health Systems & Policy Department, Health Services Academy, Park Road, Islamabad, Chak Shahzad 44000, Pakistan. shaikh.babar@gmail.com.
authors.forename: Babar Tasneem
authors.initials: BT
authors.lastname: Shaikh
authors.forename: Katrina A
authors.initials: KA
authors.lastname: Ronis
mesh_terms: D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005382:Financing, Personal; D015438:Health Behavior; D005102:Health Expenditures; D006296:Health Services / Q000191:economics; D006297:Health Services Accessibility / Q000191:economics*; D054625:Healthcare Disparities / Q000191:economics*; D006801:Humans; D007182:Income; D007223:Infant; D009035:Mothers; D010154:Pakistan; D010342:Patient Acceptance of Health Care; D011204:Poverty Areas; D012111:Residence Characteristics; D011795:Surveys and Questionnaires; D035862:Vulnerable Populations
references.citation: J Public Health (Oxf). 2005 Mar;27(1):49-54
references.pmid: 15590705
references.citation: Southeast Asian J Trop Med Public Health. 2006 Nov;37(6):1242-53
references.pmid: 17333784
references.citation: Qual Health Res. 2008 Jun;18(6):747-55
references.pmid: 18503016
references.citation: J Child Health Care. 2008 Dec;12(4):314-28
references.pmid: 19052189
references.citation: Int J Equity Health. 2008 Apr 25;7:10
references.pmid: 18439268
references.citation: J Biosoc Sci. 2003 Jan;35(1):131-44
references.pmid: 12537161
references.citation: Int J Equity Health. 2009 Jun 05;8:21
references.pmid: 19497130
references.citation: BMC Health Serv Res. 2011 Nov 17;11:315
references.pmid: 22094076
references.citation: Bull World Health Organ. 2008 May;86(5):332-8
references.pmid: 18545734
references.citation: PLoS Med. 2012;9(3):e1001183
references.pmid: 22412355
references.citation: J Pak Med Assoc. 2008 May;58(5):267-70
references.pmid: 18655406
references.citation: BMC Health Serv Res. 2009 Jun 03;9:89
references.pmid: 19493354
references.citation: Int J Equity Health. 2006 Jul 11;5:9
references.pmid: 16831231
references.citation: Health Policy Plan. 2009 Jan;24(1):1-17
references.pmid: 19060032
references.citation: Soc Sci Med. 2004 Jan;58(2):247-58
references.pmid: 14604611
references.citation: Int J Equity Health. 2012 Sep 04;11:51
references.pmid: 22947067
references.citation: J Pak Med Assoc. 2007 Aug;57(8):411-4
references.pmid: 17902526
references.citation: Indian J Community Med. 2009 Oct;34(4):335-7
references.pmid: 20165629
references.citation: J Coll Physicians Surg Pak. 2008 Jun;18(6):388-91
references.pmid: 18760057
references.citation: J Biosoc Sci. 2008 Jan;40(1):53-68
references.pmid: 17537278
references.citation: World Health Popul. 2011;12(4):24-34
references.pmid: 21677532
references.citation: BMC Health Serv Res. 2009 Apr 02;9:61
references.pmid: 19341473
references.citation: BMC Public Health. 2011 May 25;11:389
references.pmid: 21612640