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IJE Advance Access published online on September 22, 2006
International Journal of Epidemiology, doi:10.1093/ije/dyl167
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Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2006; all rights reserved.
Accepted July 5, 2006

Original paper

Childhood diarrhoea management practices in Bangladesh: private sector dominance and continued inequities in care

Charles P. Larson 1 *, Unnati Rani Saha 2, Rafiqul Islam 2, and Nikhil Roy 2

1 International Centre for Diarrheal Disease Research, Dhaka, Bangladesh; Department of Pediatrics and Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
2 International Centre for Diarrheal Disease Research, Dhaka, Bangladesh

* To whom correspondence should be addressed.
Charles P. Larson, E-mail: clarson{at}icddrb.org


  Abstract

Background Monitoring for disparities in health and services received based upon gender, income, and geography should continue as renewed efforts to reduce under-five mortality are made in response to millennium development goal #4. The purpose of this survey was to provide a nationally representative description of current childhood diarrhoea management practices and disparities in Bangladesh.

Methods A nationally representative, cross-sectional, cluster-sample survey was carried out in randomly selected rural and urban populations across Bangladesh. The survey was completed over an 8 month period between November 2003 and June 2004.

Results A total of 7308 children with a prevalent diarrhoeal illness episode within 560 clusters were identified and enrolled in the survey. In 61% of the cases help was sought from a health care provider, with over 90% practicing in the private sector. Caretaker practice disparities favouring males and higher income households were identified. Significant trends (P < 0.001) favouring higher income households were found for having sought help from any provider or a licensed doctor and for treating their child with oral rehydration solution or an antibiotic. Female children in urban households were less likely to be seen by a licensed allopath, adj OR 0.73 (95% CI 0.57, 0.94). Among rural households gender disparities were limited to females being less likely to receive an antibiotic, adj OR 0.74 (95% CI 0.65, 0.86).

Conclusion Households seeking help from a health provider overwhelmingly utilize the private sector in Bangladesh. Gender inequities in the utilization of licensed providers and purchase of antibiotics, favouring males were identified. Findings suggest that higher income, urban households tend to practice greater gender discrimination. In order to better understand health dynamics in urban populations, in particular slum-dwellers, there is a need to disaggregate survey data by household location.

Keywords: Diarrhoea; treatment; equity; disparities; gender; ORS; antibiotics; providers.
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