Demographic events and economic conditions of rural households in Bangladesh

Do healthy people migrate more? A 21-year follow-up of a rural cohort in Bangladesh

Demographers have long suspected that health influences whether a person migrates-a "healthy migrant effect" -but this has rarely been tested for a longer period with high-quality, longitudinal data. This study aimed to assess which measures of health are associated with subsequent migrations among young adults from a rural community in Bangladesh, adjusted for socio-demographic characteristics, and how long these associations persist. The 1996 Matlab Health and Socioeconomic Survey (MHSS) characterized health (by self-reported chronic, and acute morbidity symptoms in the past 12 months and one month, respectively, and self-rated health status) of adults within the Matlab Health and Demographic Surveillance System (HDSS) cohort. Analyses included 3756 (M = 1,496, F = 2260) adults aged 18-34 years (the age when migration peaks) to study the effect of health on migration. Cox Proportional Hazards models were estimated to describe associations between health status and subsequent out-migration in 1996-2017, controlling for age, sex, education, religious affiliation, and household asset quintiles. Discrete-time logistic models were estimated to assess the sustained effects of health status measures on out-migrations. Results reveal that self-reported chronic morbidity, neither acute morbidity nor self-rated health status, inhibited subsequent migration. More reported chronic morbidity symptoms were associated with a lower migration (hazard ratio, HR = 0.82, CI = 0.74-0.92 for one symptom and HR = 0.73, CI = 0.63-0.84 for ≥2 symptoms relative to no symptoms). The differences diminished but persisted over time. Socio-demographic variables inhibiting migration were female sex, older age, and lower-level education. In conclusion, healthy young rural adults were more likely to migrate than their counterparts with symptoms of chronic morbidity, and the effect of chronic morbidity on subsequent migrations waned but not eliminated over time.

"When I suffer from fever, I eat mangos." Determinants of health-seeking beliefs and behaviors of rural older women in Sylhet, Bangladesh

Poverty, poor living conditions, religious values and norms, lack of education, and gender discrimination influence the beliefs and behaviors of rural older women in many low-income countries. This paper aims to report the socio-ecological determinants of health-seeking beliefs and behaviors of rural older women in North-eastern Bangladesh and how these behaviors impact their recognition within the setting. It involved semi-structured interviews with 25 older women and 11 healthcare professionals. The findings revealed various determinants at the personal level (awareness of illness, mistrust toward medical treatment, self-treatment, and religious values and norms), the interpersonal level (isolation in family and communication with clinicians), community level (community perception of aging, neighboring and community organizations), and in the sphere of human rights (care affordability, social safety-net coverage and national policy). Four core determinants (poverty, education, gender and religiosity) were intertwined in shaping beliefs and behaviors.

The World Is Not Mine - Barriers to Healthcare Access for Bangladeshi Rural Elderly Women

Social determinants of health is a core cross-cutting approach of the World Health Organization to reduce health inequalities, and places an emphasis on aged care planning in rural areas of low- and lower-middle income countries including Bangladesh. The complex correlated health and social factors in Bangladesh interplay to shape the healthcare access of rural people. This impact is significant for rural elderly women in particular who have been shown to access healthcare in ways that are described as 'socially determined'. This study aimed to explore how this cohort related their healthcare access to their living circumstances and provided insight into how their healthcare access needs can be addressed. This study was a critical social theoretical exploration from conversational interviews held over three months with 25 elderly women in rural Bangladesh. Two critical social constructs, 'emancipation' of Habermas and 'recognition' of Honneth, were used in the exploration and explanation of the influence of personal circumstances, society and system on rural elderly women's healthcare access. The concept of 'social determinants of healthcare access' is defined from the physical, emotive, symbolic and imaginative experiences of these women. Interviewing the women provided information for exploration of the determinants that characterized their experiences into an overall construct of 'The World is Not Mine'. This construct represented four themes focusing on the exclusion from healthcare, oppressive socioeconomic condition, marginalization in social relationships and personal characteristics that led the women to avoid or delay access to modern healthcare. This study confirms that the rural elderly women require adequate policy responses from the government, and also need multiple support systems to secure adequate access to healthcare. As healthcare services are often a reflection of community values and human rights concerns for the elderly, there is a need of recognition and respect of their voice by the family members, society and the healthcare system in planning and implementation of a prudent aged care policy for rural elderly women in Bangladesh.