Extreme heat and child health care practices in drought-prone rural Bangladesh: A mixed-method study

Abstract

Background: Extreme heat is an increasing public health concern in Bangladesh, particularly for children under 5. However, existing peer-reviewed studies have not adequately examined how caregivers in drought-prone rural settings recognise, manage, and seek care for childhood illnesses during extreme heat. Objectives: This study aimed to assess child healthcare practices during extreme heat among children under 5 in drought-prone rural Bangladesh by estimating selected illness prevalence, exploring caregivers’ perceptions and home-based coping practices, and identifying reasons influencing care-seeking. Methods: A mixed-methods study was conducted in Niamatpur Upazila, Naogaon District. The quantitative component used secondary data of 239 children under 5 from the BRAC Health Program surveillance project dataset and was analyzed descriptively using STATA/MP 17.0. The qualitative component included 12 in-depth interviews and 2 focus group discussions with total 27 primary caregivers, all mothers, selected through purposive sampling. Qualitative data were collected using semi-structured guidelines and vignette-based scenarios, and were analyzed thematically. Results: Fever was the most commonly reported illness (43.9%), followed by cold/cough (33.5%), heat-related illnesses (6.7%), diarrhea (6.3%), and acute respiratory illness (2.5%). Qualitative findings showed that caregivers understood extreme heat through bodily discomfort and recognised children’s heat-related illness through crying, irritability, sweating, thirst, reduced movement, and seasonal illness patterns. Home-based cooling and indigenous practices were the first line of care, followed by informal providers and, finally, formal facilities when illness became severe or unresolved. Financial constraints, transport difficulties, distance, uncertainty at facilities, perceived discrimination, and gendered caregiving burden shaped care-seeking decisions. Conclusions: Extreme heat affects child health as both an environmental exposure and a household caregiving stressor. Interventions should strengthen community-level heat-health messages, promote safe home-based practices, engage informal providers and household decision-makers, and improve timely access to respectful formal healthcare in heat-vulnerable rural communities.