School of Public Health and Community Medicine

New study highlights complex landscape of chronic health challenges faced by slum-dwellers in Bangladesh

Bangladesh slum image

Shown in a new study published in scientific journal PLOS ONE and contributed to by Rubana Islam doctoral student at the SPHCM with a focus on non-communicable diseases, urban slum-dwellers in low and middle-income countries face a high rate of chronic health challenges, inequitable access to healthcare, and catastrophic healthcare expenses.

“The global Sustainable Development agenda recognizes urban slums as a priority focus in achieving key UN Sustainable Development Goals given their growing presence in low and middle-income cities, and the health threats they pose in the absence of investments in basic services, infrastructure, and social and economic opportunity,” says Islam.

“This study highlights the inter-slum variations in healthcare-seeking behaviour for chronic conditions and related catastrophic health expenses.”

Comparing survey data regarding healthcare-seeking behaviour from adults living in two Bangladeshi slum settlements, Tongi and Sylhet, the study’s findings could play a vital role in designing a context-sensitive system of urban healthcare; a key advancement in the fight to improve universal health coverage.

As the researchers found, wealth and occupational profile often influence the form that chronic illness takes; in poorer households of the two settlements, chronic illnesses were more likely to be connective tissue problems related to manual labour, whereas in sedentary, higher caste households, diabetes and circulatory diseases were more prevalent.

Another divide was found with regards to gender, with women being more likely than men to seek healthcare from private clinics rather than public facilities or drug shops, potentially due to issues of respect and privacy.

The study also determines proximity and availability to be primary influencing factors in the type of healthcare that slum-dwellers choose.

“Even though residents were relatively better-off in Tongi,” says Islam, “they relied 77% more on drug shops and pharmacies than Sylhet, instead of on qualified health providers.”

Reasons cited for this choice were of proximity, followed by the availability of effective treatment. For many Tongi factory workers, the appeal of drugstores and pharmacies lay in their convenient opening hours and provision of “quick-fix medicine” that minimised days off work. In both slum settings, greater wealth increased the likelihood of going to providers other than drug shops, with the biggest increase being for private clinics.

“Proximity and business hours of health facilities heavily influence where slum dwellers seek care from,” says Rubana Islam. “These needs of the working poor must be prioritized when planning health services.”

Perhaps the most striking finding of the study was the rate of catastrophic healthcare expenditure, which Islam says was “reported by 28% of households in Tongi and 21% households in Sylhet.”

Though this research was undertaken some years ago, these findings could hold particularly poignant implications for healthcare in the time of COVID-19.

Islam highlights that, “in general, people with chronic health conditions are expected to have more adverse outcomes and complications when infected by COVID-19 than those who do not suffer from chronic health conditions. It is thus essential for slum dwellers with chronic conditions to seek healthcare from health facilities equipped to advise and manage the complications.”

Photo by Mumtahina Rahman from Pexels

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Rubana Islam