Islam Md Tauhidul, Bruce Mieghan, Alam Khurshid
Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia.
School of Veterinary Medicine and Centre for Biosecurity and One Health, Harry Butler Institute, Murdoch University, Perth, WA, 6150, Australia.
BMC Health Serv Res. 2025 May 21;25(1):736. doi: 10.1186/s12913-025-12906-3.
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.
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.
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).
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.
非传染性疾病给孟加拉国带来了双重疾病负担，该国的公共卫生系统在应对这一问题上面临挑战。以往关于非传染性疾病患者医疗服务利用情况的研究缺乏全国代表性数据。本研究考察了医疗服务利用情况以及与使用不同类型卫生设施（公立/私立/药店/其他/多个提供者）相关的因素。本研究还试图找出使用不同类型卫生设施与接受至少一种或更多生活方式行为以及患者相关用药不依从之间的联系。
我们分析了2018年孟加拉国具有全国代表性的非传染性疾病风险因素监测逐步调查（STEPS）横断面调查数据。遵循安德森的概念框架并应用多项逻辑回归，我们考察了多种类型的医疗服务利用情况，以估计和识别与所使用的卫生设施类型相关的预测因素。使用二元逻辑回归进一步研究了与接受至少一种或更多生活方式行为以及患者相关用药不依从之间的关系。
大多数参与者在治疗护理时使用私立设施（41.0%）。在获取非传染性疾病药物方面，参与者大多使用药店（81.2%）。在比较公立设施与药店的完全调整模型中，未受过正规教育（与大学教育或更高学历相比）的受访者更有可能使用药店（调整后相对风险比（aRRR）：3.9；置信区间（CI）：1.1，13.5）。在比较公立设施与其他医疗选择（乡村医生、替代医学从业者（顺势疗法、阿育吠陀、尤那尼）和传统治疗师）时，农村地区的受访者（与城市地区相比）更有可能使用其他医疗选择（aRRR：3.5；CI：1.8，6.8）。
研究结果对于孟加拉国当前加强非传染性疾病护理的努力至关重要。未来的混合方法研究可以进一步阐明影响卫生设施使用类型决策的因素。
