title: Treatment-seeking and out-of-pocket expenditure on childhood illness in a migrant tribal community in Bhubaneswar, Odisha State, India.
abstract: BACKGROUND
  In India, migrant status, tribal affiliation and poverty render tribal migrants more vulnerable than any other group which leads to high treatment costs and the risk of low access to health care.
  
  
  OBJECTIVE
  To examine treatment-seeking behaviour and out-of-pocket (OOP) expenditure on the treatment of childhood illnesses, with a focus on gender in a migrant tribal community in Bhubaneswar, eastern India.
  
  
  METHODS
  A total of 175 households with a child aged 0-14 years and who had migrated within the last 12 years were selected from tribal-dominated slums. Data on health-seeking behaviour and expenditure on a recent illness in the youngest child were collected by interviewing mothers during October 2007 to March 2008.
  
  
  RESULTS
  Of the 175 children, 78.8% had at least one episode of illness during the previous year. Of the total number of episodes, 71% had been treated and 61% of them had incurred OOP expenditure. A significantly lower proportion of episodes of illness in girls had been treated than in boys (P = 0.01) and incurred OOP expenditure (P = 0.05). Private health care was preferred and only 16.5% availed themselves of the government sources. About 89 and 87% of households of boys and girls, respectively, incurred OOP expenditure. A child's gender (female) (P = 0.05), mother's education (P = 0.002) and type of illness (P = 0.002) were significantly associated with total OOP expenditure.
  
  
  CONCLUSIONS
  Further studies are warranted to address the low access to government health care and thereby reduce high OOP expenditure by tribal migrants on low incomes. Efforts are required to increase the ability of communities and health providers to identify and address the issues of gender and equity in health care along with a focus on culture-sensitive service provision.
authors.affiliation: a Department of Anthropology , Sambalpur University , Sambalpur , India.
authors.forename: Suchismita
authors.initials: S
authors.lastname: Mishra
authors.affiliation: a Department of Anthropology , Sambalpur University , Sambalpur , India.
authors.forename: Yadlapalli S
authors.identifier: http://orcid.org/0000-0002-4355-6274
authors.initials: YS
authors.lastname: Kusuma
authors.affiliation: b Health Systems Research Division , Indian Council of Medical Research , New Delhi , India.
authors.forename: Bontha V
authors.identifier: http://orcid.org/0000-0001-5096-2222
authors.initials: BV
authors.lastname: Babu
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005102:Health Expenditures; D006297:Health Services Accessibility; D006801:Humans; D007194:India; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010342:Patient Acceptance of Health Care; D010865:Pilot Projects; D044382:Population Groups; D011795:Surveys and Questionnaires; D014171:Transients and Migrants
keywords: Gender; Health care-seeking behaviour; Migration; Out-of-pocket expenditure; Treatment costs