Burden of Disease on the Urban Poor: A Study of Morbidity and Utilisation of Healthcare among Slum Dwellers in Dhaka City

Abstract

Bangladesh is urbanising rapidly, around one-third of the country’s population comprising 50 million people live in urban areas. Accompanying this rapid pace of urbanisation, there has been a faster growth in the population residing in slums and squatters. Slums and squatters are characterised by crowded living conditions, unhygienic surroundings and lack of basic amenities such as garbage disposal facilities, water and sanitation. Slum residents are especially vulnerable to health risks. The present study is an attempt to explore morbidity patterns and health-seeking behaviour of the urban poor living in slums of Dhaka city. An attempt has also been made to estimate self-reported morbidity, the proportion of individuals seeking care given the reported morbidity, determinants of morbidity and the utilisation of professional care during sickness. The study is based on a household survey conducted in slum and non-slum locations of Dhaka city. A sample of 800 households living in the slum clusters, and another 400 households from non-slum areas were selected for the present study. The findings show that within urban areas, the slum dwellers suffered higher morbidity than non-slum dwellers in each age group, income group and education group. Not only the slum dwellers are likely to suffer from higher morbidity, they are also less likely to receive professional care during sickness. Among the slum households, about a tenth (9.2 percent) of the illnesses did not receive any treatment from any source whatsoever. Of those who received some kind of care, only about a fourth (23.8 percent) consulted qualified doctors, while the largest proportion-three out of every five sick people (61.3 percent) received lay care provided by drug sellers/ pharmacy owners/ traditional healers, herbalists, unqualified allopath/ roadside ‘quacks’, among others, without any professional training, while another 14 percent managed with self-care. But the pattern of health seeking behaviour was quite different in the case of the non-slum households. About three-fourths of the illnesses (72.4 percent) in the non-slum area received treatment from qualified physicians, while a fifth of the illnesses (20 percent) received lay care, and another 7.5 percent managed their illnesses at home (through self-treatment/self-care). The findings imply that patients from non-slum area were 3.06 times more likely to resort to lay care compared to non-slum households, while patients from non-slum area were 3.04 times more likely to resort to professional care. Thus, an overall shift in health-seeking behaviour of the study population was observed for households in non-slum area. Slum residence reduced the odds of seeking any professional care and increased the odds of choosing self-care/lay care. Nutrition and health care is a constant worry for the slum people. And for the vast majority of slum dwellers who live in poverty, attaining the purchasing power to actually buy the food items and consult qualified doctors in case of illness is a far off dream.