Waterlogging, Health and Healthcare Access in Southwest Bangladesh

Lucie Clech , Manuela De Allegri, Lucas Franceschin , Muhammed Nazmul Islam, Mollah M. Shamsul Kabir , DM Rezoan Kobir, Malabika Sarker, Valery Ridde

Waterlogging, a form of stagnant flooding, is increasingly affecting southwest Bangladesh and is expected to intensify with the expansion of shrimp farming and climate change, contributing to environmental degradation. However, its impacts on health, health service utilisation and household health expenditures remain 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. 1266 adults were surveyed, from which 768 reported recent illness. Of these 768 adults, 213 reported formal health care utilisation for their first visit. Information about household’s exposure to waterlogging in the past 12 months was also collected from the households. Bivariate analyses were used to test the association between the outcome variables (illness report, formal health care utilisation, and out-of-pocket expenditure) and other variables (age, gender, education, being the head of the household, type of illness, wealth index of the household, household size and experience of waterlogging in the past 12 months). Two probit models followed for illness report and formal health care utilisation. Of these 1266 adults, 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 health care utilisation for the 768 adults reporting any illness [Coef: -0.11; CI -0.51,0.029], p=0.600). Bivariate analyses for the association of healthcare expenditure and waterlogging present no significant association (p=0.635). Considering significant associations, household wealth (wealthiest/poorest) and age (older/younger), were positively associated with illness reporting. In contrast, gender (males/females) and household size (larger/smaller) were negatively associated with illness reporting. For formal health service utilisation, on the 768 adults reporting illness, a negative association was observed for education (compared to higher education), and a positive association for wealth (average wealthy/poorest) and for chronic illness (/acute). These findings highlight the need to account for the detrimental health impacts of waterlogging when strengthening Bangladesh's health system.