Department of Population, Family, and Reproductive Health, Johns Hopkins University, 615 N, Wolfe St, Baltimore, Md 21205, USA.
Int J Equity Health. 2010 Apr 3;9:9. doi: 10.1186/1475-9276-9-9.
There has been an increasing availability and accessibility of modern health services in rural Bangladesh over the past decades. However, previous studies on the socioeconomic differentials in the utilization of these services were based on a limited number of factors, focusing either on preventive or on curative modern health services. These studies failed to collect data from remote rural areas of the different regions to examine the socioeconomic differentials in health-seeking behavior.
Data from 3,498 randomly selected currently married women from three strata of households within 128 purposively chosen remote villages in three divisions of Bangladesh were collected in 2006. This study used bivariate and multivariate logistic analyses to examine both curative and preventive health-seeking behaviors in seven areas of maternal and child health care: antenatal care, postnatal care, child delivery care, mother's receipt of Vitamin A postpartum, newborn baby care, care during recent child fever/cough episodes, and maternal coverageby tetanus toxoid (TT).
A principal finding was that a household's relative poverty status, as reflected by wealth quintiles, was a major determinant in health-seeking behavior. Mothers in the highest wealth quintile were significantly more likely to use modern trained providers for antenatal care, birth attendance, post natal care and child health care than those in the poorest quintile (chi2, p < 0.01). The differentials were less pronounced for other factors examined, such as education, age, and the relative decision-making power of a woman, in both bivariate and multivariate analyses.
Within rural areas of Bangladesh, where overall poverty is greater and access to health care more difficult, wealth differentials in utilization remain pronounced. Those programs with high international visibility and dedicated funding (e.g., Immunization and Vitamin A delivery) have higher overall prevalence and a more equitable distribution of beneficiaries than the use of modern trained providers for basic essential health care services. Implications of these findings and recommendations are provided.
在过去几十年中，孟加拉国农村地区现代卫生服务的可及性和可获得性日益提高。然而，先前关于这些服务利用的社会经济差异的研究基于有限数量的因素，要么侧重于预防服务，要么侧重于治疗性现代卫生服务。这些研究未能从不同地区的偏远农村收集数据，以检查卫生服务需求行为的社会经济差异。
2006 年，从孟加拉国三个分区的 128 个有目的选择的偏远村庄的 128 个家庭的三个阶层中随机选择了 3498 名已婚妇女，收集了数据。本研究使用二变量和多变量逻辑分析方法，检查了母婴保健七个领域的治疗和预防卫生服务需求行为：产前护理、产后护理、分娩护理、产妇产后接受维生素 A、新生儿护理、最近儿童发热/咳嗽期间的护理以及破伤风类毒素（TT）覆盖的产妇。
一个主要发现是，家庭的相对贫困状况，如财富五分位数所反映的那样，是卫生服务需求行为的主要决定因素。与最贫穷五分位数的母亲相比，最高五分位数的母亲更有可能接受现代培训的提供者进行产前护理、分娩护理、产后护理和儿童保健（chi2，p<0.01）。在二变量和多变量分析中，其他因素，如教育、年龄和妇女的相对决策权，差异不太明显。
在孟加拉国农村地区，总体贫困程度更高，获得医疗保健的机会更困难，利用方面的贫富差距仍然明显。那些具有较高国际知名度和专用资金的方案（例如免疫接种和维生素 A 输送）比现代培训提供者提供基本基本保健服务的使用具有更高的总体普及率和更公平的受益者分布。提供了这些发现和建议的含义。
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