Social inequity in health awareness and its association with health service utilization in ethnic conflict regions in northeastern Myanmar

Aim: Civil wars, political conflicts, ethnic issues, and stagnant social development have resulted in fragile health systems in northeastern Myanmar. Low health awareness is also one of the leading contributing factors to poor health status in these regions. The present study examines the socioeconomic differentials of health awareness and the association between health awareness and health-seeking behaviors in the ethnic minority regions of northeastern Myanmar. Subject and methods: A multistage-stratified random cluster survey was conducted in the Shan State Special Region 2 (Wa region) and the Eastern Shan State Special Region 4 (SR4) of northeastern Myanmar in 2016. A total of 1572 participants were eventually recruited in the survey. Data were collected on demographics, household, health status, health care, health knowledge and behavior, and health service utilization. Linear and logistic regression models were applied to analyze the associations. Results: Only 3% of women and 4.11% of men were found to have satisfactory levels of health awareness. The coefficients of higher levels of health awareness with higher income, educational attainment, and marital status were 0.05, 4.70, and 3.11 in women and 0.11, 4.24, and 2.85 in men, respectively, with significance. A higher level of health awareness was associated with increased health-seeking behaviors in men (OR: 2.86, 95% CI: 1.24–6.62) and women (OR: 1.22, 95%CI: 0.46–3.22) in these regions. Conclusion: The less educated, low household income earners, the unmarried and farming populations were all at risk for poor health awareness. Future promotion programs should target at the above populations to promote health knowledge dissemination and health service utilization along the China-Myanmar border.