Abstract
This study provides a comprehensive review of the care-seeking patterns and direct economic burden of injuries from the victims’ perspective in rural Bangladesh using a 2013 household survey covering 1.17 million people. Descriptive statistics and bivariate analyses were used to derive rates and test the association between variables. An analytic model was used to estimate total injury out-of-pocket (OOP) payments and a multivariate probit regression model assessed the relationship between financial distress and injury type. Results show non-fatal injuries occur to 1 in 5 people in our sample per year. With average household size of 4.5 in Bangladesh--every household has an injury every year. Most non-fatally injured patients sought healthcare from drug sellers. Less than half of fatal injuries sought healthcare and half of those with care were hospitalized. Average OOP payments varied significantly (range: $8–$830) by injury type and outcome (fatal vs. non-fatal). Total injury OOP expenditure was $355,795 and $5000 for non-fatal and fatal injuries, respectively, per 100,000 people. The majority of household heads with injuries reported financial distress. This study can inform injury prevention advocates on disparities in healthcare usage, OOP costs and financial distress. Reallocation of resources to the most at risk populations can accelerate reduction of preventable injuries and prevent injury related catastrophic payments and impoverishment.
Highlights
In Bangladesh, the burden of disease from injuries in 2013 was 3031 disability-adjusted-life-years (DALYs) per 100,000 people, which was slightly lower than the global rate, 3456 DALYs per 100,000, and made about 10% of the national disease burden [1]
This study evaluates the direct economic burden of injuries from the perspective of the injury victim during the short-term and excludes indirect costs
Given that the survey’s recall period for non-fatal injuries was 6 months and for fatal injuries was 1 year, we multiply rates for injuries and cost data for non-fatal injuries by two in order to present all results in person-year units
Summary
In Bangladesh, the burden of disease from injuries in 2013 was 3031 disability-adjusted-life-years (DALYs) per 100,000 people, which was slightly lower than the global rate, 3456 DALYs per 100,000, and made about 10% of the national disease burden [1]. To prevent injury related disabilities and deaths prompt access to high quality post-injury healthcare is crucial. There is increasing evidence across low-and-middle-income-countries (LMIC) that there are major barriers to access health facilities and surgical care [2]. Some of these barriers include long distance to facilities, poor roads and lack of suitable transport, few healthcare providers with resources and expertise, fear of healthcare procedures, high direct and indirect costs related to healthcare as well as socioeconomic status [2]. Barriers to access perpetuate patients’ preferences for self-care, faith on traditional healers Public Health 2017, 14, 472; doi:10.3390/ijerph14050472 www.mdpi.com/journal/ijerph
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