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

An assessment of the quality of care for children in eighteen randomly selected district and sub-district hospitals in Bangladesh.
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DOI:
10.1186/1471-2431-12-197
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发表时间:
2012-12-26
期刊:
影响因子:
2.4
通讯作者:
El Arifeen S
El Arifeen S
中科院分区:
医学3区
文献类型:
--
作者:
Hoque DM;Rahman M;Billah SM;Savic M;Karim AQ;Chowdhury EK;Hossain A;Musa SA;Kumar H;Malhotra S;Matin Z;Raina N;Weber MW;El Arifeen S

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优质的医院护理对于确保满足重病儿童的需求、避免儿童死亡非常重要。然而,发展中国家儿童的医院护理质量往往很差。作为改善儿童医院护理的国家路线图的第一步,我们评估了孟加拉国地区和分区级医院为五岁以下儿童提供的护理质量的基线情况。使用改编的世界卫生组织 (WHO) 医院评估工具和标准,对 18 家随机选择的区 (n=6) 和分区 (n=12) 医院进行了评估。由训练有素的评估人员组成的团队使用直接病例观察、记录审查、访谈和管理信息系统(MIS)数据来评估临床病例管理和监测的质量;基础设施、流程和医院管理;必要的医院和实验室支持、药品和设备。调查结果表明,这些医院提供的整体护理质量很差。没有一家医院拥有有效的分诊系统来优先考虑最需要立即护理的儿童。实验室支持和基本设备缺乏。只有一所医院拥有儿科护理的所有基本药物。不到三分之一的医院拥有备用电源,不到一半的医院拥有有效的安全饮用水安排。人们发现,对于流行疾病来说,临床病例管理并不理想,新生儿护理质量也是如此。需要采取行动提高孟加拉国医院环境中儿科护理的质量,特别需要投资改善新生儿护理。
Quality 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. Using 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. Findings 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. Action is needed to improve the quality of paediatric care in hospital settings in Bangladesh, with a particular need to invest in improving newborn care.
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