The association between family structure, reports of illness and health care demand for children: evidence from rural Bangladesh.

Access to health care in lesser-developed countries is often quite limited, especially in rural areas. However, less is known about how different factors, such as household structure, parental income and parental education, modify such access to care. This study uses individual-level data from rural Bangladesh during and following a period of major flooding to examine factors associated with reports of illness and demand for doctors in households with children less than 10 years of age. Using information about the number of children who were reported sick and also those who were taken to a doctor, a model was estimated for such reports and decisions to visit a doctor. Overall, 74% of households reported an illness in a child during the study period. The likelihood of reports was significantly greater for boys (36%) than girls (31%). In most analyses, there was no association between parental education and reports of child illness after adjusting for village- and household-level heterogeneity. However, in analyses limited to female children, greater education of the household head was associated with lower odds of such a report (odds ratio [OR] 0.95, 95% confidence interval [CI] 0.91-1.00). Parental education and income were also related to household decisions to seek medical care, though results once again differed based on the sex of the child. There was a particularly strong effect between maternal education level and demand for medical care for boys (OR 1.13; CI 1.01-1.27), though not for girls (OR 0.96; CI 0.84-1.09). Overall, the likelihood of a doctor's visit for a sick child was positively related to household income and at the highest levels of income was a virtual certainty.