Why COVID-19 symptomatic patients did not seek healthcare service in Bangladesh: Evidence from a cross-sectional study

Abstract Background: During an outbreak, the health-seeking behaviour (HSB) of patients plays a vital role to mitigate the disease spread. Poor HSB may significantly increase mortality and complicate contact tracing. In our study, we aimed to assess the status of HSB among the educated young adults of Bangladesh.Methods: A cross-sectional study was conducted online in June-July 2020 when the country was under strict social distancing measures. A snowball sampling method was employed to capture the suspected COVID-19 patients who did not undergo the COVID-19 test. Descriptive and inferential analyses were performed with statistical significance defined as p < 0.05. Results: Among the 390 participants, more male (79.5%) and urban-dwelling residents (80.3%) participated in the study. About 45% of the participants had a bachelor’s degree followed by 25.9% of post-graduation degrees such as master’s and Ph.D. Common symptoms included fever (77.7%), cough (50.5%), headache (46.2%), body pain (36.4%), sore throat (35.6%), anosmia (31.3%), anorexia (13.8%), diarrhea (11.4%) and dyspnea (11.3%). Compared to females, males were more likely to self-medicate. The odds of male participants considering COVID-19 infection as harmless was 3.2 times higher (AOR: 3.2, CI: 1.28-7.98) than the female participants. Smokers were more likely to use government hotlines for support and take drugs at home. Participants from rural areas were 2.5 times more likely to purchase drugs from nearby stores. The most common reasons for not taking the COVID-19 test were limited testing facilities (48%), risk of infection from the test centre (46%), fear of social stigma (19%), belief that COVID-19 will not cause any harm (18%) and fear of forced quarantine (5%). Respondents having higher monthly income were less likely to fear forced quarantine (AOR: 0.27, CI: 0.4-2.02) but more likely to consider the risk of being infected from the test centre (AOR: 1.75, CI: 0.88-3.49). Conclusion: Non-compliance with public health guidelines by educated people in the epidemic reflects the absence of health literacy and distrust in the healthcare system. Along with enhanced infrastructure, improved public health risk communication and health literacy efforts are needed to rebuild public trust in the healthcare system.