Background
Methodology
Study design and settings
Study sample and sampling technique
Inclusion/exclusion criteria
Data collection team and training
Participants’ consent
Quality assurance of data collection
Data collection instrument
Outcome measures
Statistical analysis
Data storage and management
Results
Characteristics of healthcare facilities
Characteristics | Category | Number of healthcare facilities n (%) |
---|---|---|
Management type | ||
Public | 98 (77.8) | |
Private/Non-government organisations (NGOs) | 28 (22.2) | |
Facility types | ||
Upazila health complex (UHC) | 9 (7.1) | |
Private/NGO facilities | 28 (22.2) | |
Union-level public facilities (ULFs) | 36 (28.6) | |
Community clinic (CC) | 53 (42.1) | |
Type of service provided | ||
Outdoor patients (OPT) only | 95 (75.4) | |
Indoor patients (IPT) only | 4 (3.2) | |
Both OPT & IPT | 27 (21.4) | |
Districts | ||
Cumilla | 56 (44.4) | |
Jhenaidah | 17 (13.5) | |
Rajshahi | 28 (22.2) | |
Sylhet | 25 (19.8) | |
Service in years (operation) | ||
≤ 16 years | 49 (38.9) | |
17–30 years | 51 (40.5) | |
> 30 years | 26 (20.6) | |
Length of service in years, mean and standard deviation | 21.4 (13.1) | |
Daily service available | ||
≤ 6 h | 96 (76.2) | |
> 6 h | 30 (23.8) |
General service readiness
General readiness | Upazila health complex, n (%) | Union-level public facilities, n (%) | Community clinic, n (%) | Private facilities, n (%) | Total n (%) | P-value |
---|---|---|---|---|---|---|
Overall | 9 (7.1) | 36 (28.6) | 53 (42.1) | 28 (22.2) | 126 (100) | |
Basic amenities | ||||||
Power | 9 (100) | 34 (94.4) | 49 (92.5) | 28 (100) | 120 (95.2) | |
Improved water source | 9 (100) | 29 (80.6) | 35 (66.0) | 28 (100) | 101 (80.2) | |
Room with privacy | 9 (100) | 28 (77.8) | 28 (52.8) | 28 (52.8) | 89 (70.6) | |
Adequate sanitation facilities | 8 (88.9) | 30 (83.3) | 38 (71.7) | 28 (100) | 104 (82.5) | |
Telephone facilities | 9 (100) | 28 (77.8) | 42 (79.2) | 28 (100) | 107 (84.9) | |
Computer and internet access | 9 (100) | 24 (66.7) | 40 (75.5) | 25 (89.3) | 98 (77.8) | |
Emergency transportation (ambulance) | 7 (77.8) | 0 | 0 | 6 (21.4) | 13 (10.3) | |
Mean (± SD) | 95.2 (± 8.7) | 68.7 (± 31.4) | 62.5 (± 30.1) | 80.5 (± 31.2) | 71.6 (± 28.1) | 0.224 |
Basic equipment and supplies | ||||||
Blood pressure apparatus | 9 (100) | 36 (100) | 47 (88.7) | 28 (100) | 120 (95.2) | |
Stethoscope | 9 (100) | 36 (100) | 47 (88.7) | 28 (100) | 120 (95.2) | |
Adult scale | 7 (77.8) | 19 (52.8) | 38 (71.7) | 25 (89.3) | 89 (70.6) | |
Infant scale | 8 (88.9) | 23 (63.9) | 34 (64.2) | 24 (85.7) | 89 (70.6) | |
Thermometer | 9 (100) | 30 (83.3) | 50 (94.3) | 28 (100.0) | 117 (92.9) | |
Light source | 9 (100) | 13 (36.1) | 11 (20.8) | 25 (89.3) | 58 (46.0) | |
Mean (± SD) | 94.5 (± 9.3) | 72.7 (± 26.1) | 71.4 (± 27.3) | 94.1 (± 6.6) | 78.4 (± 19.7) | 0.130 |
Standard precautions | ||||||
Sterilization equipment | 8 (88.9) | 30 (83.3) | 27 (50.9) | 27 (96.4) | 92 (73.0) | |
Safe disposal of sharps and infectious wastes | 9 (100.0) | 18 (50.0) | 22 (41.5) | 24 (85.7) | 73 (57.9) | |
Waste receptacle | 8 (88.9) | 27 (75.0) | 38 (71.7) | 28 (100.0) | 101 (80.2) | |
Hand‐washing soap and water or alcohol-based hand rub | 9 (100.0) | 30 (83.3) | 44 (83.0) | 28 (100.0) | 111 (88.1) | |
Mean (± SD) | 94.5 (± 6.4) | 72.9 (± 15.8) | 61.8(± 19.0) | 95.5 (± 6.8) | 74.8 (± 12.8) | 0.009 |
Diagnostic facility | ||||||
Hemoglobin | 9 (100.0) | 0 | 14 (26.4) | 25 (89.3) | 48 (38.1) | |
Blood glucose | 8 (88.9) | 0 | 33 (62.3) | 27 (96.4) | 68 (54.0) | |
Urine dipstick – protein | 4 (44.4) | 0 | 2 (3.8) | 23 (82.1) | 29 (23.0) | |
Urine dipstick – glucose | 6 (66.7) | 0 | 2 (3.8) | 21 (75.0) | 29 (23.0) | |
Malaria diagnostic capacity | 5 (55.6) | 0 | 0 | 12 (42.9) | 17 (13.5) | |
TB microscopy | 8 (88.9) | 0 | 0 | 15 (53.6) | 23 (18.3) | |
Syphilis RDT | 4 (44.4) | 0 | 0 | 11 (39.3) | 15 (11.9) | |
Urine pregnancy test | 6 (66.7) | 18 (50.0) | 0 | 25 (89.3) | 49 (38.9) | |
Mean (± SD) | 69.8 (± 22.9) | 0 (± 0.0) | 13.8 (± 23.4) | 68.4 (± 23.0) | 26.0 (± 15.1) | < 0.001 |
Essential medicines | ||||||
Amitriptyline | 0 | 0 | 0 | 0 | 0 | |
Amoxicillin | 9 (100.0) | 35 (97.2) | 48 (90.6) | 4 (14.3) | 96 (76.2) | |
Atenolol | 7 (77.8) | 0 | 0 | 0 | 7 (5.6) | |
Captopril | 0 | 0 | 0 | 0 | 0 | |
Ceftriazone | 0 | 0 | 0 | 0 | 0 | |
Ciprofloxacin | 9 (100.0) | 15 (41.7) | 0 | 2 (7.1) | 26 (20.6) | |
Co‐trimoxazole | 7 (77.8) | 32 (88.9) | 39 (73.6) | 3 (10.7) | 81 (64.3) | |
Diazepam | 7 (77.8) | 23 (63.9) | 0 | 3 (10.7) | 33 (26.2) | |
Diclofenac | 9 (100.0) | 10 (27.8) | 0 | 3 (10.7) | 22 (17.5) | |
Glibenclamide | 0 | 0 | 0 | 0 | 0 | |
Omeprazole | 8 (88.9) | 16 (44.4) | 0 | 7 (25.0) | 31 (24.6) | |
Paracetamol | 9 (100.0) | 35 (97.2) | 49 (92.5) | 7 (25.0) | 100 (79.4) | |
Simvastatin | 0 | 0 | 0 | 0 | 0 | |
Salbutamol | 9 (100.0) | 36 (100.0) | 52 (98.1) | 7 (25.0) | 104 (82.5) | |
Mean (± SD) | 58.7(± 46.2) | 40.1 (± 41.9) | 25.3 (± 41.9) | 9.2 (± 10.0) | 28.4 (± 32.6) | 0.258 |
Readiness index specific to the service for cervical cancer
Services for cervical cancer | Upazila health complex, n (%) | Union-level public facilities, n (%) | Community clinic, n (%) | Private facilities, n (%) | Totaln (%) | P-value |
---|---|---|---|---|---|---|
Overall | 9 (7.1) | 36 (28.6) | 53 (42.1) | 28 (22.2) | 126 (100) | |
Staff and guidelines | ||||||
Guidelines on the diagnosis and treatment of cervical cancer | 0 | 0 | 0 | 0 | 0 | |
At least one trained staff member (within 24 months) | 2 (22.2) | 0 | 0 | 1 (3.6) | 3 (2.4) | |
Mean (± SD) | 11.1 (± 15.7) | N/A | N/A | 1.8 (± 2.5) | 1.2 (± 1.7) | 0.545 |
Basic equipment | ||||||
Speculum | 9 (100) | 24 (66.7) | 0 | 15 (53.6) | 48 (38.1) | |
Mean (± SD) | N/A | N/A | N/A | N/A | N/A | N/A |
Diagnostic facility | ||||||
Acetic Acid | 4 (44.4) | 0 | 0 | 6 (21.4) | 10 (7.9) | |
Cytology | 0 | 0 | 0 | 3 (10.7) | 3 (2.4) | |
Cancer antigen 15.3 (CA 15.3) | 0 | 0 | 0 | 0 | 0 | |
Cancer antigen 125 (CA125) | 0 | 0 | 0 | 0 | 0 | |
Colposcopy | 0 | 0 | 0 | 0 | 0 | |
Mean (± SD) | 5.6 (15.7) | N/A | N/A | 4.0 (± 8.0) | 1.3 (± 2.8) | 0.537 |
Essential medicines | ||||||
Hydrocortisone | 0 | 0 | 0 | 0 | 0 | |
Lorazepam | 0 | 0 | 0 | 0 | 0 | |
Morphin | 0 | 0 | 0 | 0 | 0 | |
Ondanseron | 0 | 0 | 0 | 0 | 0 | |
Pheniramine | 0 | 0 | 0 | 0 | 0 | |
Broad Spectrum Antibiotics | 0 | 0 | 0 | 0 | 0 | |
Mean (± SD) | N/A | N/A | N/A | N/A | N/A | N/A |
Readiness index specific to service for chronic respiratory diseases
Services for chronic respiratory illness | Upazila health complex, n (%) | Union-level public facilities, n (%) | Community clinic, n (%) | Private facilities, n (%) | Total n (%) | P-value |
---|---|---|---|---|---|---|
Overall | 9 (7.1) | 36 (28.6) | 53 (42.1) | 28 (22.2) | 126 (100) | |
Staff and guidelines | ||||||
Guidelines on the diagnosis and treatment | 6 (66.7) | 9 (25.0) | 10 (18.9) | 15 (53.6) | 40 (31.7) | |
At least one trained staff member (within 24 months) | 6 (66.7) | 5 (13.9) | 13 (24.5) | 3 (10.7) | 27 (21.4) | |
Mean (± SD) | 66.7 (± 0) | 19.5 (± 7.8) | 21.7 (± 4.0) | 32.2 (± 30.3) | 26.6 (± 7.3) | 0.099 |
Basic equipment | ||||||
Blood pressure apparatus | 9 (100) | 36 (100) | 47 (88.7) | 28 (100) | 120 (95.2) | |
Stethoscope | 9 (100) | 36 (100) | 47 (88.7) | 28 (100) | 120 (95.2) | |
Oxygen delivery apparatus | 8 (88.9) | 0 | 0 | 16 (57.1) | 24 (19.0) | |
Spacers for inhalers | 2 (22.2) | 0 | 0 | 6 (21.4) | 8 (6.3) | |
Mean (± SD) | 77.8 (± 37.4) | 50.0 (± 57.7) | 44.4 (± 51.2) | 69.6 (± 38.0) | 53.9 (± 47.9) | 0.837 |
Diagnostic facility | ||||||
Bacteriology including culture and sensitivity | 3 (33.3) | 0 | 0 | 4 (14.3) | 7 (5.6) | |
Chest X ray | 4 (44.4) | 0 | 0 | 13 (46.4) | 17 (13.5) | |
Spirometry test | 0 | 0 | 0 | 0 | 0 | |
Peak flow meter | 0 | 0 | 0 | 0 | 0 | |
Sleep test | 0 | 0 | 0 | 0 | 0 | |
Mean (± SD) | 15.5 (± 21.6) | N/A | N/A | 12.1 (± 20.1) | 4.0 (± 6.3) | 0.267 |
Essential medicines | ||||||
Salbutamol | 9 (100.0) | 36 (100.0) | 52 (98.1) | 7 (25.0) | 104 (82.5) | |
Beclomethasone | 0 | 0 | 0 | 0 | 0 | |
Prednisolone | 0 | 0 | 0 | 0 | 0 | |
Hydrocortisone | 0 | 0 | 0 | 0 | 0 | |
Apinephrine | 0 | 0 | 0 | 0 | 0 | |
Mean (± SD) | 20.0 (± 44.7) | 20.0 (± 44.7) | 19.6 (± 43.9) | 5.0 (± 11.2) | 16.5 (± 36.9) | 0.965 |
Readiness index specific to service for cardiovascular diseases
Services for cardiovascular diseases | Upazila health complex, n (%) | Union-level public facilities, n (%) | Community clinic, n (%) | Private facilities, n (%) | Total n (%) | P-value |
---|---|---|---|---|---|---|
Overall | 9 (7.1) | 36 (28.6) | 53 (42.1) | 28 (22.2) | 126 (100) | |
Staff and guidelines | ||||||
Guidelines on the diagnosis and treatment | 6 (66.7) | 9 (25.0) | 13 (24.5) | 15 (53.6) | 43 (34.1) | |
At least one trained staff member (within 24 months) | 5 (55.6) | 4 (11.1) | 5 (9.4) | 5 (17.9) | 19 (15.1) | |
Mean (± SD) | 61.2 (± 7.8) | 18.1 (± 9.8) | 17.0 (± 10.7) | 35.8 (± 25.2) | 24.6 (± 13.4) | 0.124 |
Basic equipment | ||||||
Blood pressure apparatus | 9 (100) | 36 (100) | 47 (88.7) | 28 (100) | 120 (95.2) | |
Stethoscope | 9 (100) | 36 (100) | 47 (88.7) | 28 (100) | 120 (95.2) | |
Adult scale | 7 (77.8) | 19 (52.8) | 38 (71.7) | 25 (89.3) | 89 (70.6) | |
Thermometer | 9 (100) | 30 (83.3) | 50 (94.3) | 28 (100.0) | 117 (92.9) | |
BMI calculator | 8 (88.9) | 0 | 0 | 8 (28.6) | 16 (12.7) | |
Mean(± SD) | 92.6 (± 9.1) | 66.7 (± 37.8) | 67.9 (± 35.2) | 83.9 (± 27.8) | 72.9 (± 31.7) | 0.708 |
Diagnostic facility | ||||||
Blood lipids | 0 | 0 | 0 | 0 | 0 | |
Electrolytes potassium | 0 | 0 | 0 | 0 | 0 | |
Mean (± SD) | N/A | N/A | N/A | N/A | N/A | N/A |
Essential medicines | ||||||
Atenolol | 7 (77.8) | 0 | 0 | 0 | 7 (5.6) | |
Digoxin | 4 (44.4) | 0 | 0 | 0 | 4 (3.2) | |
Enalapril | 3 (33.3) | 0 | 0 | 0 | 3 (2.4) | |
Furosemide | 4 (44.4) | 0 | 0 | 0 | 4 (3.2) | |
Glyceryl trinitrate | 0 | 0 | 0 | 0 | 0 | |
Isosorbide dinitrate | 0 | 0 | 0 | 0 | 0 | |
Nifedipine | 2 (22.2) | 0 | 0 | 0 | 2 (1.6) | |
Methyldopa | 3 (33.3) | 0 | 0 | 0 | 3 (2.4) | |
Procainamide | 0 | 0 | 0 | 0 | 0 | |
Propranolol | 2 (22.2) | 0 | 0 | 0 | 2 (1.6) | |
Spironolactone | 2 (22.2) | 0 | 0 | 0 | 2 (1.6) | |
Verapamil | 0 | 0 | 0 | 0 | 0 | |
Warfarin | 0 | 0 | 0 | 0 | 0 | |
Mean (± SD) | 23.1 (± 23.8) | N/A | N/A | N/A | 1.7 (± 1.7) | < 0 .001 |
Readiness index specific to service for DM
Services for diabetes mellitus | Upazila health complex, n (%) | Union-level public facilities, n (%) | Community clinic, n (%) | Private facilities, n (%) | Total n (%) | P-value |
---|---|---|---|---|---|---|
Overall | 9 (7.1) | 36 (28.6) | 53 (42.1) | 28 (22.2) | 126 (100) | |
Staff and guidelines | ||||||
Guidelines on the diagnosis and treatment | 6 (66.7) | 6 (16.7) | 15 (28.3) | 15 (53.6) | 42 (33.3) | |
At least one trained staff member (within 24 months) | 7 (77.8) | 4 (11.1) | 10 (18.9) | 6 (21.4) | 27 (21.4) | |
Mean (± SD) | 72.3 (± 7.8) | 13.9 (± 4.0) | 23.6 (± 6.6) | 37.5 (± 22.8) | 27.4 (± 8.4) | 0.027 |
Basic equipment | ||||||
Blood pressure apparatus | 9 (100) | 36 (100) | 47 (88.7) | 28 (100) | 120 (95.2) | |
Stethoscope | 9 (100) | 36 (100) | 47 (88.7) | 28 (100) | 120 (95.2) | |
Weighing scale | 7 (77.8) | 19 (52.8) | 38 (71.7) | 25 (89.3) | 89 (70.6) | |
Height board/stadiometer | 8 (88.9) | 25 (69.4) | 47 (88.7) | 27 (96.4) | 107 (84.9) | |
BMI calculator | 8 (88.9) | 0 | 0 | 8 (28.6) | 16 (12.7) | |
Mean (± SD) | 86.7 (± 5.0) | 24.4 (± 34.0) | 32.1 (± 44.3) | 54.3 (± 35.3) | 38.7 (± 36.0) | 0.684 |
Diagnostic facility | ||||||
Blood glucose (HbA1c/OGTT) | 8 (88.9) | 0 | 33 (62.3) | 27 (96.4) | 68 (54.0) | |
Urine dipstick – protein | 4 (44.4) | 0 | 2 (3.8) | 23 (82.1) | 29 (23.0) | |
Urine dipstick – glucose | 6 (66.7) | 0 | 2 (3.8) | 21 (75.0) | 29 (23.0) | |
Mean (± SD) | 66.7 (± 22.3) | N/A | 23.2 (± 33.6) | 84.5 (± 10.9) | 33.3 (± 17.9) | 0.003 |
Essential medicines | ||||||
Glibenclamide | 0 | 0 | 0 | 0 | 0 | |
Gliclazide | 0 | 0 | 0 | 0 | 0 | |
Insulin | 0 | 0 | 0 | 0 | 0 | |
Metformin | 6 (66.7) | 0 | 0 | 1 (3.6) | 7 (5.6) | |
Mean (± SD) | 16.7 (± 33.4) | N/A | N/A | 0.9 (± 1.8) | 1.4 (± 2.8) | 0.473 |