Health needs and health-care-seeking behaviour of street-dwellers in Dhaka, Bangladesh.

The study objective was to ascertain the extent to which the need for primary health care services among street-dwellers is being met through existing facilities. This community-based cross-sectional study was conducted in Dhaka city over a 12-month period from June 2007 to May 2008. The study population included ever-married females and males aged 15-49 years. Data for the study were collected through a community survey and exit interviews. Both bivariate and multivariate analyses were done. Seventy-two per cent of female and 48% of male street-dwellers interviewed were sick at the time of data collection. Twenty-one per cent of deliveries were conducted on the street. Eighty-nine per cent of the street-dwellers reported that their children aged less than 5 years had more than one symptom associated with acute respiratory infection during the last 2 weeks. Thirty-seven per cent of the females and 34% of the males interviewed reported that their accompanied children had diarrhoea. A few street-dwellers sought services for their health problems, and most went to the nearest pharmacy and to mobile clinics run by a non-governmental organization at night. Eighty-eight per cent of the female and 88% of the male street-dwellers used open space for their defecation. The street-dwellers are extremely vulnerable in terms of their health needs and health-care-seeking behaviours. There is no health service delivery mechanism targeting this marginalized group of people. Although the health, nutrition and population sector programme of Bangladesh designed programmes to ensure equitable essential services to all, this marginalized group of people was not targeted. The Ministry of Health and Family Welfare and private sectors should, thus, should focus future programmes to meet the needs of this extremely vulnerable group. Mobile and static clinics at night for street-dwellers may be potential programmes. Action research to assess the effectiveness of programmes is essential before large-scale implementation.