Waterlogging, health and healthcare access in southwest Bangladesh

Waterlogging, a type of stagnant flooding, is becoming more prevalent in southwest Bangladesh. It is expected to worsen due to the expansion of shrimp farming and climate change, which will contribute to environmental degradation. However, the impact of waterlogging on health, health service utilisation and household health expenditure remains poorly understood. We conducted a quantitative study between August and September 2022 in Tala, a disaster-prone sub-district in southwest Satkhira. Data were collected from 596 randomly selected households. A total of 1266 adults were surveyed, of whom 768 reported a recent illness. Of these adults, 213 reported seeking formal healthcare for their initial visit. Information about households’ exposure to waterlogging in the past 12 months was also collected. Bivariate analyses were used to test the association between the outcome variables (reporting illness, utilisation of formal healthcare, and out-of-pocket expenditure) and the following other variables: age, gender, education, whether the respondent was the head of the household, type of illness, household wealth index, household size, and experience of waterlogging in the past 12 months. Two probit models were fitted for illness reporting and formal healthcare utilisation. Waterlogging experience was significantly associated with illness reporting [Coef: 0.47; CI 0.14,0.80], p = 0.006). However, it was not significantly associated with healthcare utilisation among the 768 adults who reported any illness [Coef: -0.11; CI -0.51,0.029], p = 0.600). Bivariate analyses of the association between healthcare expenditure and waterlogging revealed no significant association (p = 0.635). Significant associations were found between illness reporting and household wealth (wealthiest/poorest) and age (older/younger). In contrast, gender (male/female) and household size (larger/smaller) were negatively associated with illness reporting. Of the 768 adults who reported illness, a negative association was observed for education (compared to higher education) and a positive association was observed for wealth (average wealthy and poorest) and chronic illness (compared to acute illness). These findings highlight the need to consider the detrimental health impacts of waterlogging when improving Bangladesh’s healthcare system.