Prevalence and correlates of health care utilization for non-communicable diseases in Bangladesh.

BACKGROUND

Non-communicable diseases (NCDs) bring double burden of diseases for Bangladesh where public health system is facing challenges to tackle it. Previous studies investigating healthcare utilization by the patients with NCDs lack nationally representative data. The present study examined healthcare utilization and factors associated with utilizing different types of health facilities (public/private/medicine shop /others/multiple providers). This study further tried to find out the linkage between utilizing different types of health facilities and the receipt of at least one lifestyle behaviour or more, and patient-related medication non-adherence.

METHODS

We analysed nationally representative cross-sectional STEPwise approach to NCD risk factor surveillance (STEPS) Survey 2018 in Bangladesh. Following Andersen's conceptual framework and applying multinomial logistic regression, we examined multiple types of healthcare utilization to estimate and identify predictors associated with the types of healthcare facilities accessed. Further relationships with the receipt of at least one lifestyle behaviour or more, and patient-related medication non-adherence were investigated using binary logistic regression.

RESULTS

The majority of the participants used private facilities (41.0%) for curative care. For accessing medicine for NCDs, participants mostly used medicine shop (81.2%). In the fully adjusted model comparing public facilities vs. medicine shop respondents with no formal education (vs. university education or higher) were more likely to use medicine shop (adjusted relative risk ratio (aRRR):3.9; confidence interval (CI):1.1,13.5). While comparing public facilities vs. other healthcare options (village doctor, alternative medicine practitioner (Homeo, Ayurveda, Unani) and traditional healer), respondents from rural area (vs. urban) more likely to utilize other healthcare options (aRRR: 3.5; CI: 1.8,6.8).

CONCLUSION

The study findings are crucial for Bangladesh's ongoing effort to strengthen NCDs care. Further elucidation of the factors influencing the decision between types of health facility use could be provided by future mixed-method studies.