Changing health-seeking behaviour in Matlab, Bangladesh: do development interventions matter?
Changing health-seeking behaviour in Matlab, Bangladesh: do development interventions matter?
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DOI：
10.1093/heapol/czg037
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发表时间：
2003-09-01
影响因子：
3.2
通讯作者：
Bhuiya, A
中科院分区：
文献类型：
--
作者：
Ahmed, SM;Adams, AM;Bhuiya, A
人们普遍认为，对穷人的社会经济发展干预措施将提高他们的物质和社会能力，以防止健康不良，并寻求适当和及时的护理。本文利用1995年和1999年作为孟加拉国Matlab的BRAC-ICDDR，B联合研究项目的一部分进行的调查的横截面数据，探讨了随着时间的推移寻求健康的行为模式，假设接触综合社会经济发展活动将提高寻求保健和使用合格的医疗服务的性别平等。虽然有初步证据表明，在受益于发展干预措施的家庭中，在治疗选择方面两性更加平等，但对合格医疗的偏好并不明显。调查结果显示，在4年的时间里，自我治疗的显着和普遍的上升，这是由于1998年的一场大洪水的经济影响，以及由于社区卫生工作者在Matlab的密度更大的健康意识。同样值得注意的是，大量依赖非正式和往往不合格的从业人员（超过20%），如药剂师和流动药品销售商。使用逻辑回归确定与寻求医疗保健类型相关的因素。自我保健与女性、缺乏低成本保健服务和相对较短的疾病有关。另一方面，男性性别、地理位置、较高的社会经济地位和长期严重疾病对医疗保健有积极的预测作用。本文最后强调，必须加强地方能力，以确定是否自我治疗的指示，自我治疗适当，或在寻求医疗保健的情况下，判断供应商的能力，并评估治疗费用是否合理。还建议向所有保健提供者提供药学培训。
It is generally assumed that socioeconomic development interventions for the poor will enhance their material and social capacities to prevent ill health and to seek appropriate and timely care. Using cross-sectional data from surveys undertaken in 1995 and 1999 as part of the BRAC-ICDDR,B Joint Research Project in Matlab, Bangladesh, this paper explores patterns of health-seeking behaviour over time, with the hypothesis that exposure to integrated socioeconomic development activities will enhance gender equity in care-seeking and the use of qualified medical care. While there is tentative evidence of greater gender equity in treatment choice among households benefiting from development interventions, a preference for qualified medical care is not apparent. Findings reveal a striking and generalized rise in self-treatment over the 4-year period that is attributed to the economic repercussions of a major flood in 1998, and greater heath awareness due to the density of community health workers in Matlab. Also noteworthy is the substantial reliance on informal and often unqualified practitioners (over 20%) such as pharmacists and itinerant drug sellers. Factors associated with the type of health care sought were identified using logistic regression. Self-care is associated with female gender, the absence of low cost health services and illnesses of relatively short duration. Medical care, on the other hand, is positively predicted by male gender, geographic location, greater socioeconomic status and serious illness of long duration. The paper concludes by emphasizing the importance of enhancing local capacities to determine whether self-treatment is indicated, to self-treat appropriately, or in cases where health care is sought, to judge provider competence and evaluate whether treatment costs are justified. The provision of pharmaceutical training to the full spectrum of health care providers is also recommended.