An assessment of the quality of care for children in eighteen randomly selected district and sub-district hospitals in Bangladesh

Dewan Me Hoque,Ziaul Matin,Aqm Rezaul Karim,Altaf Hossain,Neena Raina,Muntasirur Rahman,Michael Savic,Sudhansh Malhotra,Saj Md Musa,Martin W Weber,Enayet K Chowdhury,Sk Masum Billah,Harish Kumar,Shams El Arifeen

doi:10.1186/1471-2431-12-197

Abstract

BackgroundQuality hospital care is important in ensuring that the needs of severely ill children are met to avert child mortality. However, the quality of hospital care for children in developing countries has often been found poor. As the first step of a country road map for improving hospital care for children, we assessed the baseline situation with respect to the quality of care provided to children under-five years age in district and sub-district level hospitals in Bangladesh.MethodsUsing adapted World Health Organization (WHO) hospital assessment tools and standards, an assessment of 18 randomly selected district (n=6) and sub-district (n=12) hospitals was undertaken. Teams of trained assessors used direct case observation, record review, interviews, and Management Information System (MIS) data to assess the quality of clinical case management and monitoring; infrastructure, processes and hospital administration; essential hospital and laboratory supports, drugs and equipment.ResultsFindings demonstrate that the overall quality of care provided in these hospitals was poor. No hospital had a functioning triage system to prioritise those children most in need of immediate care. Laboratory supports and essential equipment were deficient. Only one hospital had all of the essential drugs for paediatric care. Less than a third of hospitals had a back-up power supply, and just under half had functioning arrangements for safe-drinking water. Clinical case management was found to be sub-optimal for prevalent illnesses, as was the quality of neonatal care.ConclusionAction is needed to improve the quality of paediatric care in hospital settings in Bangladesh, with a particular need to invest in improving newborn care.

Highlights

Quality hospital care is important in ensuring that the needs of severely ill children are met to avert child mortality
Utilisation of hospitals by under-fives Routine hospital Management Information System (MIS) data showed that district hospitals (DHs) generally saw more children (M=17,435) than sub-district hospitals (SDHs) (M=8,728) in 2008
A greater proportion of children were seen in outpatient departments in SDHs (86.3%) as compared to DHs (DHs: 80.8%), while the proportion of children seen in inpatient departments was similar (DHs: 10.3% and SDHs: 9.9%)

Summary

Introduction

Quality hospital care is important in ensuring that the needs of severely ill children are met to avert child mortality. The quality of hospital care for children in developing countries has often been found poor. Quality of care provided to children in hospital settings in low-income countries has generally been found to be poor [1,2,3,4,5,6]. A study of hospital quality for severely ill children across seven developing countries highlighted many of the quality of care issues [6]. The Government of Bangladesh (GoB) adopted the Integrated Management of Childhood Illness (IMCI) in Studies in Ethiopia and Bangladesh have reported that 12-34% of children that come into contact with firstlevel facilities require referral to hospital care for further assessment and treatment [9,10]. It has been estimated that there are approximately 4,400 of first level government facilities in Bangladesh [11]

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Discussion

Conclusion