Healthcare Behavior and Expenditure in an Urban Slum in Relation to Birth Experience and Newborn Care

Abstract

Newborn care practices and healthcare seeking are important determinants of neonatal morbidity and mortality in the resource-limited settings of the urban slums. To examine the current patterns of healthcare-seeking behavior and estimate out-of-pocket expenditure for delivery and common neonatal problems in the urban slums of Chandigarh. Community-based cross-sectional survey. Structured questionnaire was used to collect data from the clusters selected by the World Health Organisation (WHO) Expanded Program for Immunization's cluster survey method. Independent t-test, one-way ANOVA and Pearson's Chi-square tests were used to analyze the data. All tests were two-tailed and p < 0.05 was taken as significant. 31.7% of the mothers delivered at home with 4.18 ± 2.16 mean number of antenatal visits and 73.9% used prelacteals. Factors significantly predicting home deliveries were identified. About 44.7% of the neonates had problems after birth, with 40.3% requiring hospitalization. Choice of private healthcare providers governed the care seeking in the majority (61.4%). Out-of-pocket expenditure was significantly high for the private care providers in terms of the cost of delivery and the overall cost of neonatal illness though no gender-based differences were seen. Private sector emerged as the major healthcare provider in the urban slums resulting in higher out-of-pocket expenditure. A comprehensive health strategy comprising of health education, improvement in antenatal practices, institutional deliveries, behavior change communication activities and quality perinatal care is required for these urban slums.