Health, illness and healthcare-seeking behaviour of the street dwellers of Dhaka City, Bangladesh: qualitative exploratory study

Abstract

ObjectiveThis study explored the illness experiences and healthcare-seeking behaviour of a cross-section of street dwellers of Dhaka City for designing a customised intervention.DesignA qualitative exploratory study of a sample of street dwellers of Dhaka City.SettingSamples were taken from three purposively selected spots of Dhaka City with a high concentration of the target population.ParticipantsFifteen in-depth interviews and six informal group discussions with 40 street dwellers (≥18 years), and key informant interviews with service providers (n=6) and policymakers (n=3) were conducted during January–June 2019 to elicit necessary data.Primary outcome measuresQualitative narrative of illness experiences of the sampled street dwellers, relevant healthcare-seeking behaviour and experiences of interactions with health systems.ResultsWe focused on three main themes, namely, reported illnesses, relevant healthcare-seeking behaviour and health system experiences of the street dwellers. Findings reveal that most of the street dwellers suffered from fever and respiratory illnesses in the last 6 months; however, a majority did not visit formal facilities. They preferred visiting retail drug shops for advice and treatment or waited for self-recovery. Formal facilities were visited only when treatment from drug shops failed to cure them or they suffered serious illnesses or traumatic injury. The reproductive-age women did not seek pregnancy care and most deliveries took place in the street dwellings. Lack of awareness, financial constraints and fear of visiting formal facilities were some of the reasons mentioned. Those who visited formal facilities faced barriers like the cost of medicines and diagnostic tests, long waiting time and opportunity cost.ConclusionsThe street dwellers lacked access to formal health systems for needed services as the latter lags far behind to outreach this extremely vulnerable population. What they need is explicit targeting with a customised package of services based on their illness profile, at a time and place convenient to them with minimum or no cost implications.

Perceived Susceptibility and Responses to Ill-health Risks among Children of the Street in Addis Ababa, Ethiopia

“…The finding of our study about the epidemiological experiences of the street children is consistent to other related studies. Related studies (Eshita, 2018;Nazrin et al, 2020;Uddin et al, 2009;Ali & de Muynck, 2005), for instance, found that most of the street children were suffering from different types of diseases, including skin diseases, accidental injuries, hepatitis, fever, respiratory diseases, sexually transmitted infections, and warm infestations. Chowdhury et al (2017) associated street children's exposure to various skin disease and other communicable infections with their overall living conditions such as overcrowded living situations, unhealthy sleeping area, irregular bath, and less changing of clothes.…”

The magnitude and predictors of self-medication amongst street dwellers in Ethiopia: a multicentre study

“…Indeed, previous studies have indicated that, for disadvantaged people such as street dwellers, the first point of access to healthcare services is commonly at drug-retail outlets rather than at healthcare facilities. 32 – 34 Additionally, as previous observations indicated, in Ethiopia, most community drug-retail outlets do not follow regulations for dispensing medications, which allows and supports people in accessing drugs easily without a prescription, thus increasing the rate of self-medication use. 28 , 35 The prevalence of self-medication use in our study was comparable to that in a study conducted amongst college students in urban areas of the Amhara region, which is unsurprising as urban living is associated with self-medication practices.…”

“…8 As street dwellers are highly affected by low socioeconomic conditions and poor personal and environmental hygiene, they are the most disadvantaged and marginalized communities in urban areas. 9 Furthermore, given their overall low levels of living standards and the financial and time constraints linked to their livelihoods, street dwellers have limited access to conventional healthcare services or formal clinics for family planning and reproductive health services, 10 and are therefore extremely likely to self-medicate. Self- medication is the use of medication for self-treatment without visiting a healthcare provider for a prescription or diagnosis or to monitor the course of therapy.…”

Mulheres negras em situação de rua

“…As populações marginalizadas são aquelas que são socialmente excluídas com base em idade, raça, etnia, sexo, estado de deficiência, situação de migração geográfica, resultando na privação de receber serviços, incluindo serviços de saúde (...) 15…”