Background
Methods
Study design and settings
Sample size and sampling of health facilities
Data collection
Data analyses
Results
Characteristics of healthcare facilities
General service readiness
Variable | Rajshahi (N = 61) | Sylhet (N = 62) | ||||||
---|---|---|---|---|---|---|---|---|
Pharmacy | Community clinic | Primary care facilities | Higher care facilities | Pharmacy | Community clinic | Primary care facilities | Higher care facilities | |
General characteristics | ||||||||
Number of facilities [n (% of total)] | 12 (19.4) | 12 (19.4) | 15 (24.2) | 22 (35.5) | 12 (19.7) | 13 (21.3) | 15 (24.6) | 22 (36.1) |
Public facilities [n (%)] | 0 (0.0) | 12 (100.0) | 12 (80.0) | 4 (18.2) | 0 (0.0) | 13 (100.0) | 12 (80.0) | 4 (18.2) |
Area [n (%)] | ||||||||
Rural | 6 (50.0) | 12 (100.0) | 13 (86.7) | 10 (45.5) | 6 (50.0) | 13 (100.0) | 13 (86.7) | 11 (50.0) |
Urban | 6 (50.0) | 0 (0.0) | 2 (13.3) | 12 (54.5) | 6 (50.0) | 0 (0.0) | 2 (13.3) | 11 (50.0) |
Duration of service, in years [Mean (SD)] | 4 (2.9) | 13 (3.3) | 28 (15.1) | 16 (16.1) | 9 (10.4) | 10 (5.6) | 28 (14.1) | 20 (17.4) |
Basic amenities | ||||||||
Power [n (%)] | 4 (33.3) | 5 (41.7) | 12 (80.0) | 20 (90.9) | 7 (58.3) | 0 (0.0) | 4 (26.7) | 18 (81.8) |
Improved water source within 500 m of facility [n (%)] | 11 (91.7) | 12 (100.0) | 15 (100.0) | 22 (100.0) | 9 (75.0) | 10 (76.9) | 14 (93.3) | 22 (100.0) |
Room with auditory and visual privacy for patient consultations [n (%)] | 1 (8.3) | 9 (75.0) | 11 (73.3) | 22 (100.0) | 4 (33.3) | 12 (92.3) | 12 (80.0) | 21 (95.5) |
Access to adequate sanitation facilities for clients [n (%)] | 1 (8.3) | 12 (100.0) | 15 (100.0) | 22 (100.0) | 3 (25.0) | 12 (92.3) | 15 (100.0) | 22 (100.0) |
Communication equipment (phone or SW radio) [n (%)] | 12 (100.0) | 0 (0.0) | 6 (40.0) | 22 (100.0) | 10 (83.3) | 1 (7.7) | 4 (26.7) | 20 (90.9) |
Facility has access to computer [n (%)] | 0 (0.0) | 11 (91.7) | 11 (73.3) | 18 (81.8) | 3 (25.0) | 11 (84.6) | 10 (66.7) | 17 (77.3) |
Emergency transportation [n (%)] | 3 (25.0) | 12 (100.0) | 5 (33.3) | 9 (40.9) | 1 (8.3) | 10 (76.9) | 4 (26.7) | 15 (68.2) |
Domain score (Mean availability of items as percentage) [Mean (SE)] | 38.1 (15.5) | 72.6 (14.5) | 71.4 (9.9) | 87.7 (8.2) | 44.0 (10.7) | 61.5 (15.1) | 60.0 (12.4) | 87.7 (4.6) |
Basic equipment | ||||||||
Adult scale [n (%)] | 3 (25.0) | 11 (91.7) | 15 (100.0) | 21 (95.5) | 2 (16.7) | 12 (92.3) | 9 (60.0) | 19 (86.4) |
Child scale [n (%)] | 0 (0.0) | 4 (33.3) | 10 (66.7) | 16 (72.7) | 0 (0.0) | 6 (46.2) | 11 (73.3) | 19 (86.4) |
Thermometer [n (%)] | 10 (83.3) | 12 (100.0) | 13 (86.7) | 22 (100.0) | 10 (83.3) | 12 (92.3) | 12 (80.0) | 21 (95.5) |
Stethoscope [n (%)] | 9 (75.0) | 12 (100.0) | 15 (100.0) | 22 (100.0) | 6 (50.0) | 10 (76.9) | 14 (93.3) | 22 (100.0) |
Blood pressure apparatus [n (%)] | 9 (75.0) | 10 (83.3) | 15 (100.0) | 22 (100.0) | 9 (75.0) | 9 (69.2) | 14 (93.3) | 22 (100.0) |
Domain score (Mean availability of items as percentage) [Mean (SE)] | 51.7 (16.5) | 81.7 (12.5) | 90.7 (6.5) | 93.6 (5.3) | 75.4 (8.6) | 75.4 (8.6) | 80.0 (6.3) | 93.7 (3.1) |
Standard precautions for infection prevention | ||||||||
Safe final disposal of sharps [n (%)] | 6 (50.0) | 11 (91.7) | 15 (100.0) | 22 (100.0) | 6 (50.0) | 13 (100.0) | 12 (80.0) | 21 (95.5) |
Safe final disposal of infectious wastes [n (%)] | 6 (50.0) | 11 (91.7) | 13 (86.7) | 22 (100.0) | 6 (50.0) | 13 (100.0) | 14 (93.3) | 21 (95.5) |
Appropriate storage of sharps waste [n (%)] | 0 (0.0) | 0 (0.0) | 5 (33.3) | 21 (95.5) | 0 (0.0) | 2 (15.4) | 7 (46.7) | 20 (90.9) |
Domain score (Mean availability of items as percentage) [Mean (SE)] | 33.3 (16.7) | 61.1 (30.6) | 73.3 (20.4) | 98.5 (1.5) | 33.3 (16.7) | 71.8 (28.2) | 73.3 (13.9) | 94.0 (1.5) |
Diagnostic capacity | ||||||||
Hemoglobin [n (%)] | 0 (0.0) | 0 (0.0) | 5 (33.3) | 14 (63.6) | 0 (0.0) | 0 (0.0) | 6 (40.0) | 11 (50.0) |
Blood glucose [n (%)] | 6 (50.0) | 0 (0.0) | 4 (26.7) | 15 (68.2) | 4 (33.3) | 0 (0.0) | 5 (33.3) | 18 (81.8) |
Malaria diagnostic capacity [n (%)] | 0 (0.0) | 0 (0.0) | 3 (20.0) | 6 (27.3) | 0 (0.0) | 0 (0.0) | 1 (6.7) | 10 (45.5) |
Urine dipstick- protein, glucose [n (%)] | 0 (0.0) | 0 (0.0) | 5 (33.3) | 15 (68.2) | 0 (0.0) | 0 (0.0) | 6 (40.0) | 10 (45.5) |
Syphilis rapid test [n (%)] | 0 (0.0) | 0 (0.0) | 0 (0.0) | 8 (36.4) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 10 (45.5) |
Domain score (Mean availability of items as percentage) [Mean (SE)] | 10.0 (10.0) | 0.0 (0.0) | 22.7 (6.2) | 52.7 (8.7) | 6.7 (6.7) | 0.0 (0.0) | 24.0 (8.6) | 53.6 (7.1) |
Variable | Rajshahi (N = 61) | Sylhet (N = 62) | ||||||
---|---|---|---|---|---|---|---|---|
Pharmacy | Community clinic | Primary care facilities | Higher care facilities | Pharmacy | Community clinic | Primary care facilities | Higher care facilities | |
Albendazole [n (%)] | 10 (83.3) | 12 (100.0) | 12 (80.0) | 3 (13.6) | 9 (75.0) | 13 (100.0) | 14 (93.3) | 10 (45.5) |
Amoxicillin Cap [n (%)] | 11 (91.7) | 11 (91.7) | 6 (40.0) | 4 (18.2) | 10 (83.3) | 12 (92.3) | 6 (40.0) | 11 (50.0) |
Amoxicillin Syrup/Pediatric suspension [n (%)] | 11 (91.7) | 12 (100.0) | 7 (46.7) | 2 (9.1) | 8 (66.7) | 12 (92.3) | 10 (66.7) | 7 (31.8) |
Antacid [n (%)] | 11 (91.7) | 12 (100.0) | 11 (73.3) | 5 (22.7) | 10 (83.3) | 13 (100.0) | 15 (100.0) | 10 (45.5) |
Benzoic Acid and Salicylic Acid Ointment [n (%)] | 6 (50.0) | 12 (100.0) | 6 (40.0) | 4 (18.2) | 3 (25.0) | 12 (92.3) | 3 (20.0) | 3 (13.6) |
Benzyl Benzoate Lotion Application [n(%)] | 1 (8.3) | 12 (100.0) | 4 (26.7) | 1 (4.5) | 3 (25.0) | 11 (84.6) | 4 (26.7) | 3 (13.6) |
Calcium Lactated Tab [n (%)] | 9 (75.0) | 12 (100.0) | 3 (20.0) | 4 (18.2) | 9 (75.0) | 12 (92.3) | 5 (33.3) | 10 (45.5) |
Chloramphenicol Eye/Ear/Ointment/Drops [n (%)] | 8 (66.7) | 12 (100.0) | 8 (53.3) | 4 (18.2) | 11 (91.7) | 12 (92.3) | 10 (66.7) | 9 (40.9) |
Chlorpheniramine Maleate Tablet [n (%)] | 4 (33.3) | 12 (100.0) | 8 (53.3) | 4 (18.2) | 6 (50.0) | 10 (76.9) | 5 (33.3) | 6 (27.3) |
Cotriomoxazole Tab [n (%)] | 7 (58.3) | 12 (100.0) | 10 (66.7) | 2 (9.1) | 6 (50.0) | 10 (76.9) | 14 (93.3) | 5 (22.7) |
Doxycycline [n (%)] | 12 (100.0) | 12 (100.0) | 7 (46.7) | 3 (13.6) | 10 (83.3) | 12 (92.3) | 11 (73.3) | 10 (45.5) |
Ferrous Sulphate Tablet/ Syrup [n (%)] | 6 (50.0) | 0 (0.0) | 4 (26.7) | 4 (18.2) | 7 (58.3) | 0 (0.0) | 8 (53.3) | 7 (31.8) |
Folic Acid Tablet [n (%)] | 11 (91.7) | 9 (75.0) | 11 (73.3) | 2 (9.1) | 9 (75.0) | 11 (84.6) | 10 (66.7) | 9 (40.9) |
Gentian Violet Topical Solution [n (%)] | 1 (8.3) | 12 (100.0) | 0 (0.0) | 1 (4.5) | 4 (33.3) | 11 (84.6) | 0 (0.0) | 2 (9.1) |
Hyoscine ButyIbromide [n (%)] | 8 (66.7) | 12 (100.0) | 4 (26.7) | 3 (13.6) | 2 (16.7) | 13 (100.0) | 2 (13.3) | 9 (40.9) |
Mebendazole Tablet [n (%)] | 6 (50.0) | 0 (0.0) | 0 (0.0) | 5 (22.7) | 8 (66.7) | 0 (0.0) | 4 (26.7) | 14 (63.6) |
Neomycin Bacitracin skin ointment [n (%)] | 7 (58.3) | 12 (100.0) | 4 (26.7) | 2 (9.1) | 8 (66.7) | 12 (92.3) | 3 (20.0) | 6 (27.3) |
ORS (Oral Rehydration Salt) [n (%)] | 12 (100.0) | 12 (100.0) | 7 (46.7) | 5 (22.7) | 10 (83.3) | 13 (100.0) | 10 (66.7) | 12 (54.5) |
Paracetamol suspension/syrup [n (%)] | 12 (100.0) | 12 (100.0) | 9 (60.0) | 4 (18.2) | 8 (66.7) | 11 (84.6) | 7 (46.7) | 10 (45.5) |
Paracetamol Tab Tablet/Elixir [n (%)] | 11 (91.7) | 12 (100.0) | 11 (73.3) | 5 (22.7) | 10 (83.3) | 12 (92.3) | 15 (100.0) | 14 (63.6) |
Benzathine Penicillin [n (%)] | 2 (16.7) | 0 (0.0) | 1 (6.7) | 1 (4.5) | 3 (25.0) | 0 (0.0) | 1 (6.7) | 4 (18.2) |
Salbutamol syrup [n (%)] | 10 (83.3) | 12 (100.0) | 2 (13.3) | 4 (18.2) | 5 (41.7) | 11 (84.6) | 2 (13.3) | 8 (36.4) |
Salbutamol Tablet/Elixir/Inhaler/Injection [n (%)] | 10 (83.3) | 12 (100.0) | 7 (46.7) | 5 (22.7) | 7 (58.3) | 11 (84.6) | 12 (80.0) | 12 (54.5) |
Vitamin A Cap (200,000 I.U.) [n (%)] | 9 (75.0) | 12 (100.0) | 3 (20.0) | 1 (4.5) | 7 (58.3) | 13 (100.0) | 5 (33.3) | 4 (18.2) |
Vitamin B- Complex Tablet/Multi-vitamin D drops 15 ml [n (%)] | 12 (100.0) | 12 (100.0) | 11 (73.3) | 4 (18.2) | 10 (83.3) | 13 (100.0) | 14 (93.3) | 12 (54.5) |
Zinc [n (%)] | 11 (91.7) | 12 (100.0) | 3 (20.0) | 4 (18.2) | 10 (83.3) | 11 (84.6) | 6 (40.0) | 10 (45.5) |
Domain score (Mean availability of items as percentage) [Mean (SE)] | 69.9 (5.6) | 87.2 (6.4) | 40.8 (4.7) | 15.0 (1.2) | 61.9 (4.4) | 80.2 (5.9) | 50.3 (6.1) | 37.9 (3.0) |
Child immunization service readiness
Variables | Rajshahi division (N = 28) | Sylhet division (N = 31) | ||
---|---|---|---|---|
Facilities with vaccine storage | Facilities without vaccine storage | Facilities with vaccine storage | Facilities without vaccine storage | |
General characteristics | ||||
Number of facilities [n] | 4 | 24 | 5 | 26 |
Public facility [n (%)] | 4 (100.0) | 22 (91.7) | 5 (100.0) | 21 (80.8) |
Area [n (%)] | ||||
Rural | 4 (100.0) | 22 (91.7) | 4 (80.0) | 23 (88.5) |
Urban | 0 (0.0) | 2 (8.3) | 1 (20.0) | 3 (11.5) |
Vaccines and injection supplies are bundled [n (%)] | ||||
No | 0 (0.0) | 0 (0.0) | 0 (0.0) | 4 (15.4) |
Yes, only pick up | 4 (100.0) | 24 (100.0) | 2 (40.0) | 7 (26.9) |
Yes, both | 0 (0.0) | 0 (0.0) | 3 (60.0) | 14 (53.8) |
Service days per month [Mean (SD)] | 7 (5.0) | 4 (7.8) | 21 (7.3) | 2 (2.6) |
Hours of service on a typical day [Mean (SD)] | 4 (2.5) | 5 (0.6) | 6 (0.5) | 6 (0.8) |
Staffs involved in vaccination [Mean (SD)] | 2 (1.0) | 2 (0.4) | 1 (0.5) | 2 (0.6) |
Outreach services available [n (%)] | 4 (100.0) | 0 (0.0) | 4 (80.0) | 0 (0.0) |
Staff and training | ||||
Guidelines for EPI % | 4 (100.0) | 0 (0.0) | 2 (40.0) | 0 (0.0) |
Staff trained in EPI % | 4 (100.0) | 24 (100.0) | 5 (100.0) | 25 (96.2) |
Equipment | ||||
Cold box/vaccine carrier with ice packs [n (%)] | 4 (100.0) | 0 (0.0) | 5 (100.0) | 0 (0.0) |
Refrigerator [n (%)] | 4 (100.0) | 0 (0.0) | 5 (100.0) | 0 (0.0) |
Sharp container [n (%)] | 1 (25.0) | 2 (8.3) | 1 (20.0) | 4 (15.4) |
Single use- standard disposable or auto-disable syringes [n (%)] | 4 (100.0) | 24 (100.0) | 5 (100.0) | 25 (96.2) |
Continuous temperature monitoring device in refrigerator [n (%)] | 4 (100.0) | 0 (0.0) | 4 (80.0) | 0 (0.0) |
Energy source and power supply for vaccine refrigerator [n (%)] | 4 (100.0) | 0 (0.0) | 4 (80.0) | 0 (0.0) |
Immunization cards [n (%)] | 4 (100.0) | 22 (91.7) | 4 (80.0) | 18 (69.2) |
Medicines and commodities | ||||
Measles & Rubella vaccine [n (%)] | 4 (100.0) | 4 (16.7) | 5 (100.0) | 1 (3.8) |
Penta (DPT + Hib + HepB) vaccine [n (%)] | 4 (100.0) | 4 (16.7) | 5 (100.0) | 1 (3.8) |
Polio vaccine [n (%)] | 4 (100.0) | 4 (16.7) | 5 (100.0) | 1 (3.8) |
BCG vaccine [n (%)] | 4 (100.0) | 4 (16.7) | 5 (100.0) | 0 (0.0) |
PCV [n (%)] | 4 (100.0) | 3 (12.5) | 3 (60.0) | 1 (3.8) |
IPV [n (%)] | 3 (75.0) | 2 (8.3) | 5 (100.0) | 1 (3.8) |
Stock-outs in the past 3 months | ||||
Measles & Rubella vaccine [n (%)] | 0(0.0) | 0(0.0) | 0(0.0) | 0(0.0) |
Penta (DPT + Hib + HepB) vaccine [n (%)] | 0(0.0) | 0(0.0) | 0(0.0) | 0(0.0) |
Polio vaccine [n (%)] | 0(0.0) | 0(0.0) | 1(20.0) | 0(0.0) |
BCG vaccine [n (%)] | 0(0.0) | 0(0.0) | 0(0.0) | 0(0.0) |
PCV [n (%)] | 0(0.0) | 0(0.0) | 0(0.0) | 0(0.0) |
IPV [n (%)] | 3(75.0) | 0(0.0) | 0(0.0) | 0(0.0) |
Readiness for PCV and IPV introduction
Variables | Rajshahi division (N = 28) | Sylhet division (N = 31) | ||
---|---|---|---|---|
Facilities with vaccine storage | Facilities without vaccine storage | Facilities with vaccine storage | Facilities without vaccine storage | |
Pneumococcal conjugate vaccine (PCV) | ||||
Received official training about PCV [n (%)] | 4 (100.0) | 23 (95.8) | 5 (100.0) | 22 (84.6) |
Total staff trained in PCV [Mean ± SD] | 72 (66.1) | 4 (1.2) | 114 (64.3) | 4 (5.5) |
Antigen availability for PCV training [n (%)] | 0 (0.0) | 11 (45.8) | 2 (40.0) | 11 (42.3) |
Sufficient fund for PCV training [n (%)] | 2 (50.0) | 0 (0.0) | 2 (40.0) | 1 (3.8) |
Availability of PCV poster at the facility [n (%)] | 2 (50.0) | 3 (12.5) | 4 (80.0) | 13 (50.0) |
Availability of PCV guidelines [n (%)] | 3 (75.0) | 0 (0.0) | 4 (80.0) | 0 (0.0) |
Inactivated polio vaccine (IPV) | ||||
Received official training about IPV [n (%)] | 4 (100.0) | 23 (95.8) | 5 (100.0) | 22 (84.6) |
Staff trained in IPV [Mean ± SD] | 72 (67.0) | 4 (1.2) | 114 (64.8) | 3 (4.1) |
Antigen availability for PCV training [n (%)] | 0 (0.0) | 10 (41.7) | 3 (60.0) | 9 (34.6) |
Sufficient fund for IPV training [n (%)] | 1 (25.0) | 0 (0.0) | 3 (60.0) | 1 (3.8) |
Availability of IPV poster at the facility [n (%)] | 0 (0.0) | 0 (0.0) | 0 (0.0) | 11 (42.3) |
Availability of IPV guidelines [n (%)] | – | – | – | – |