Socioeconomic inequalities persist in utilisation of health services in urban slum and rural areas in Dhaka, Bangladesh

Background: Research on health services (HS) helps to improve delivery of care to different population groups. The population of highly urbanized areas in developing countries face socioeconomic inequalities in access and use of HS. We have assessed the recent use of different types of HS among residents of urban slum and rural areas in Dhaka, Bangladesh. Methods: Baseline data from a current cohort study in Dhaka were used. Logistic regression was applied to estimate effects of socioeconomic determinants on four dependent variables (yes/no): recent use of governmental and private health services, pharmacies and qualified medical doctors (MBBS). Results: A total of 57.5% of the sample consulted any type of HS recently; however, more than one third of the respondents were unsatisfied with governmental and private HS. 78.4% of the respondents would choose pharmacies in case of a minor and governmental HS in case of a serious disease. In the logistic regression model better educated respondents reported significantly less frequent use of self-medication (pharmacies) and more frequent use of MBBS as well as private and governmental HS. Urban slum dwellers and male respondents used pharmacies more often than rural residents (1.65; 95% CI 1.24–2.20) and female respondents (1.53; 95% CI 1.12–2.10), respectively. As expected, respondents with no or very low income reported the use of pharmacy more often (2.03; 95% CI 1.24–3.32) than respondents with high income; higher income was associated with use of more expensive private and MBBS HS. Conclusions: Education, residential status, income but also location of residence and access to health services remain the key factors influencing choice and use of HS. Lower costs and shorter waiting time lead to extensive use of pharmacies rather than qualified providers. It is essential to continue health education as well as implement better accessible and need-based HS in urban as well as rural areas.