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The Relationship between Poverty and Healthcare Seeking among Patients Hospitalized with Acute Febrile Illnesses in Chittagong, Bangladesh

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  • M Trent Herdman
  • Richard James Maude
  • Md Safiqul Chowdhury
  • Hugh W F Kingston
  • Atthanee Jeeyapant
  • Rasheda Samad
  • Rezaul Karim
  • Arjen M Dondorp
  • Md Amir Hossain

Abstract

Delays in seeking appropriate healthcare can increase the case fatality of acute febrile illnesses, and circuitous routes of care-seeking can have a catastrophic financial impact upon patients in low-income settings. To investigate the relationship between poverty and pre-hospital delays for patients with acute febrile illnesses, we recruited a cross-sectional, convenience sample of 527 acutely ill adults and children aged over 6 months, with a documented fever ≥38.0°C and symptoms of up to 14 days’ duration, presenting to a tertiary referral hospital in Chittagong, Bangladesh, over the course of one year from September 2011 to September 2012. Participants were classified according to the socioeconomic status of their households, defined by the Oxford Poverty and Human Development Initiative’s multidimensional poverty index (MPI). 51% of participants were classified as multidimensionally poor (MPI>0.33). Median time from onset of any symptoms to arrival at hospital was 22 hours longer for MPI poor adults compared to non-poor adults (123 vs. 101 hours) rising to a difference of 26 hours with adjustment in a multivariate regression model (95% confidence interval 7 to 46 hours; P = 0.009). There was no difference in delays for children from poor and non-poor households (97 vs. 119 hours; P = 0.394). Case fatality was 5.9% vs. 0.8% in poor and non-poor individuals respectively (P = 0.001)—5.1% vs. 0.0% for poor and non-poor adults (P = 0.010) and 6.4% vs. 1.8% for poor and non-poor children (P = 0.083). Deaths were attributed to central nervous system infection (11), malaria (3), urinary tract infection (2), gastrointestinal infection (1) and undifferentiated sepsis (1). Both poor and non-poor households relied predominantly upon the (often informal) private sector for medical advice before reaching the referral hospital, but MPI poor participants were less likely to have consulted a qualified doctor. Poor participants were more likely to attribute delays in decision-making and travel to a lack of money (P

Suggested Citation

  • M Trent Herdman & Richard James Maude & Md Safiqul Chowdhury & Hugh W F Kingston & Atthanee Jeeyapant & Rasheda Samad & Rezaul Karim & Arjen M Dondorp & Md Amir Hossain, 2016. "The Relationship between Poverty and Healthcare Seeking among Patients Hospitalized with Acute Febrile Illnesses in Chittagong, Bangladesh," PLOS ONE, Public Library of Science, vol. 11(4), pages 1-21, April.
    • Handle: RePEc:plo:pone00:0152965
    DOI: 10.1371/journal.pone.0152965
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    References listed on IDEAS

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    1. Sabina Alkire, Maria Emma Santos, 2010. "Acute Multidimensional Poverty: A New Index for Developing Countries," OPHI Working Papers 38, Queen Elizabeth House, University of Oxford.
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    6. Chaudhury, Nazmul & Hammer, Jeffrey S., 2003. "Ghost doctors - absenteeism in Bangladeshi health facilities," Policy Research Working Paper Series 3065, The World Bank.
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