Barriers in access to healthcare services for individuals with disorders of sex differentiation in Bangladesh: an analysis of regional representative cross-sectional data

Abstract

Background: Worldwide people in disorder of sex development (DSD) faces multiple barriers while seeking their social rights, particularly healthcare services. We aimed to explore the healthcare opportunities available to them, using patterns of healthcare utilization and difficulties faced by DSD population in accessing healthcare services in Bangladesh. Methods: Data from a total of 945 DSD population and 71 medical staff were analyzed, collected from three major divisions (Dhaka, Chittagong, and Rajshahi) in Bangladesh during the period of January to December of 2017. A structured questionnaire was used to collect data via face-to-face interviews. Descriptive statistic was used to determine the frequencies of the visit by the DSD population in healthcare facilities as well as to analyze difficulties experienced by the DSD population in getting healthcare services. Multivariate regression analysis was used to explore the association between perceived barriers in getting healthcare services and failures of the DSD population to receive the healthcare services. Results: Present data revealed that around 80% of DSD population sought healthcare services from government healthcare facilities, where the overall success rate in getting healthcare services was less than 50%. The DSD population reported a number of reasons for failures in getting healthcare services, including non-friendly interaction by non-clinical hospital's staff, non-friendly interaction by physicians, public fright as general people do not want to mingle with a DSD person, undesirable excess public interest in DSD individuals, and limitation of the treatment opportunities of hospitals to merely male or female patients. Among the stated reasons, the most frequently reported reason was non-friendly interaction by physicians (50.27%), followed by undesirable excess public interest in DSD individuals (50.16%).

Data-Driven Evaluation and Optimisation of Livelihood Improvement Efficiency

“…These efforts will eventually lead the local government to increase its efforts in public service work and improve the efficiency of livelihood improvement. (5) In addition, we found no significant correlation between regional population size and LIE, a result that differs from the findings of some previous studies [55][56][57][58]. However, we can draw an important conclusion.…”

“…Cao et al found empirically that the total population of a region was negatively associated with the efficiency of health services [56]. Khan et al argue that this negative correlation is mainly because, as the population size of a region increases, it negatively affects the equity and fairness of public services, and, by extension, service efficiency [57]. Mainardi et al further refined their analysis of the impact of total population size by arguing that increasing the population size of a region in education services will promote the efficiency of those services but will reduce the efficiency of healthcare services [58].…”

“…(2) Population size (PS): An increase in population size may lead to the inequitable distribution of public service resources but may also increase the efficiency of government service delivery owing to the agglomeration effect of population. Based on previous research findings [ [55][56][57][58], it is speculated that the total population is a possible influence; however, based on the existing research literature, inconsistent conclusions have been reached, and further validation is needed to determine how this affects LIE. This study uses the total population of the region to represent the population size.…”