title: Socioeconomic factors differentiating healthcare utilization of cyclone survivors in rural Bangladesh: a case study of cyclone Sidr.
abstract: BACKGROUND
  Although many studies have been carried out to examine healthcare utilizations in rural Bangladesh, yet little is known about the healthcare utilization among survivors of a natural disaster. This study addresses this gap by examining the socioeconomic factors associated with healthcare utilization among Cyclone Sidr survivors.
  
  
  METHODS
  A systematic random sample of 384 heads of household was interviewed using a semi-structured questionnaire. This study used multivariate logistic analyses to examine post-cyclone healthcare utilizations. Healthcare utilization is defined as the process of seeking professional healthcare and submitting oneself to the application of available health services, with the purpose to prevent or treat health problems.
  
  
  RESULTS
  Over half (58%) of Cyclone Sidr survivors suffered from some type of illness occurring during the 15 days preceding the survey. The most common healthcare choices among survivors to address illnesses were seeking assistance from para-professionals (37%), qualified allopaths (26%) and drug store salespersons (17%). A principal finding was that a household's socioeconomic status, as reflected by wealth quintiles, was a major determinant in healthcare utilization. The household heads in the higher wealth quintile were significantly more likely to seek modern allopathic providers for healthcare than those in the poorest quintile (Odds ratio (OR) = 2.89, Confidence interval (CI): 1.92-5.87). The household heads who listened to health risk communications were 2.55 times more likely to seek any healthcare (CI: 1.35-5.11) and 1.77 times to seek modern allopathic care (CI: 1.62-5.09) than those who did not. Other significant predictors of healthcare utilization were education, listening to radio, distance to healthcare facility and perceived susceptibility to water-borne diseases.
  
  
  CONCLUSIONS
  Para-professionals, qualified allopath and drugstore salespeople are the primary vehicles for providing healthcare services to population at risk of cyclone. Therefore, there is a need for more medical training for these primary healthcare providers in rural Bangladesh.
authors.affiliation: Department of Sociology, Iowa State University, Ames, IA 50011, USA juddin@iastate.edu.
authors.forename: Jalal
authors.initials: J
authors.lastname: Uddin
authors.affiliation: Department of Sociology, Iowa State University, Ames, IA 50011, USA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Mazur
mesh_terms: D000328:Adult; D000368:Aged; D001459:Bangladesh; D003430:Cross-Sectional Studies; D055867:Cyclonic Storms; D004190:Disasters; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D012424:Rural Population; D012923:Social Class; D011795:Surveys and Questionnaires; D017741:Survivors; D055815:Young Adult
keywords: Cyclone Sidr; health risk; healthcare utilization; para-professionals