Ethnic differentials in parental health seeking for childhood illness in Vietnam

Abstract

Vietnam's sustained investment in primary healthcare since the onset of socialism has lowered infant and childhood mortality rates and improved life expectancy, exceeding progress achieved in other poor countries with comparable levels of income per capita. The recent introduction of user fees for primary healthcare services has generated concern that economic policies may have adversely affected health-seeking behavior and health outcomes of the poor, particularly among impoverished families who are members of socially marginalized minority groups. This paper examines this debate by analyzing parental recall of illness and care-seeking for sick children under the age of 5 years recorded by the 2001-2002 Vietnam National Health Survey. We estimate statistical models of the determinants of parental recall of incidence and response to illness among their children. Ethnic minority parents less frequently reported their children to have been sick than Kinh and Chinese parents. When they recognize an illness episode, minority parents are less likely to seek care -- whether professional consultation or self-prescribed care -- than non-minority parents. Ethnic differentials are evident in all geographic and income levels, although adverse effects of minority status are most pronounced among poor households in remote areas. Regression estimates of the effects of ethnicity and maternal education on health decisions are pronounced even when poverty effects are controlled, suggesting that social equity may have been under-emphasized in Vietnam's early health policy deliberations. Policies extending free healthcare to poor communes affect parental decisions to seek professional care or self-prescribed care among better-off parents without affecting parental decision making among the poor. Early health initiatives for the poor may therefore have failed to offset equity problems confronting impoverished ethnic minority families.

Care seeking for children with fever/cough or diarrhoea in Nepal: equity trends over the last 15 years

“…The inequity displayed in care seeking could be explained by a multitude of factors, one being the cost of seeking care, as has been shown in studies from around the world [26][27][28].…”

Distance decay in delivery care utilisation associated with neonatal mortality. A case referent study in northern Vietnam

“…It is well known that ethnic minorities in Vietnam live in the more remote and isolated areas [26,27] and that there are larger concentrations of poverty in rural areas [28]. Therefore, to further come to terms with possible confounding stratification according to socioeconomic factors was made.…”

Ethnicity, education attainment, media exposure, and prenatal care in Vietnam

“…Some studies have speculated upon the nature of disparities in health care practices among ethnic minorities and majorities in Vietnam (Trinh, Dibley, and Byles 2007;Sepehri et al 2008;Teerawichitchainan and Phillips 2008;Do 2009;Målqvist et al 2011). These studies, consisting largely of local case studies or regional analyses, have found that ethnic minority pregnant women tend to enter prenatal care at later gestation ages, have fewer pregnancy check-ups, lack adequate vaccinations, prefer home delivery, and rely upon traditional birth attendants during delivery.…”

“…The control variables included in our models are measures of the characteristics of individuals, as well as the households and communities within which they reside as suggested in the previous studies on prenatal care utilization and ethnic disparities in Vietnam (Trinh, Dibley, and Byles 2007;Sepehri et al 2008;Teerawichitchainan and Phillips 2008;Do 2009;Teerawichitchainan and Amin 2010;Målqvist et al 2011;Tran et al 2011). These variables, presented in Table 1, include women's age, birth parity, occupation, and household wealth quintile.…”