社会经济决定因素与女性对社区诊所的认知及就诊情况的关联:来自2011年孟加拉国人口与健康调查的证据

Associations of socioeconomic determinants with community clinic awareness and visitation among women: evidence from Bangladesh Demographic and Health Survey-2011.

作者信息

Sarker Mohammad Abul Bashar, Harun-Or-Rashid Md, Reyer Joshua A, Hirosawa Tomoya, Yoshida Yoshitoku, Islam Mohammod Monirul, Siddique Md Ruhul Furkan, Hossain Shaila, Sakamoto Junichi, Hamajima Nobuyuki

机构信息

Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65, Tsurumai-Cho, Showa-ku, Nagoya, 466-8550, Japan.

National Control Laboratory, Institute of Public Health (IPH), Dhaka, Bangladesh.

出版信息

BMC Res Notes. 2015 Oct 21;8:590. doi: 10.1186/s13104-015-1374-7.

Abstract

BACKGROUND

Although Bangladesh has achieved tremendous success in health care over the last four decades, it still lagged behind in the areas of maternal and child malnutrition and primary health care (PHC). To increase access to PHC, the Bangladesh government established approximately 18,000 community clinics (CCs). The purpose of this study was to examine the associations of socioeconomic determinants of women aged 12-49 years with the CCs awareness and visitation.

METHODS

We analyzed secondary data provided by Bangladesh Demographic and Health Survey-2011. A two-stage cluster sampling was used to collect the data. A total of 18,222 ever married women aged 12-49 years were identified from selected households and 17,842 were interviewed. The main outcome measures of our study were awareness and visitation of CCs. Bivariate logistic regression was used to calculate odds ratio (OR) and 95% confidence interval (CI) to examine the associations between the awareness and visiting CCs with socioeconomic determinants.

RESULTS

Low prevalence of awareness about CC (18 %) was observed among studied women and only 17 % of them visited CCs. Significant associations (P < 0.05) with CCs awareness and visitation were observed among aged 20-29 years (adjusted OR = 1.18; 95% CI = 1.03-1.35 and adjusted OR = 1.49; 95% CI = 1.05-2.11), primary education (adjusted OR = 1.20; 95% CI = 1.08-1.34 and adjusted OR = 1.37; 95% CI = 1.05-1.78), and poorest family (adjusted OR = 1.21; 95% CI = 1.03-1.42 and adjusted OR = 2.36; 95% CI = 1.56-3.55, respectively), after controlling potential confounders.

CONCLUSIONS

Awareness and visitation of CCs were found to be positively associated with lower economic conditions, young age, and primary education. Awareness and access to CCs might be increased through community activities that involve health care workers. The government should also lower barriers to PHC access through CCs by providing adequate logistics, such as human resources and equipment.

摘要

背景

尽管孟加拉国在过去四十年的医疗保健方面取得了巨大成功,但在孕产妇和儿童营养不良以及初级卫生保健(PHC)领域仍落后。为了增加初级卫生保健的可及性,孟加拉国政府设立了约18000个社区诊所(CCs)。本研究的目的是调查12至49岁女性的社会经济决定因素与对社区诊所的认知及就诊情况之间的关联。

方法

我们分析了《2011年孟加拉国人口与健康调查》提供的二手数据。采用两阶段整群抽样收集数据。从选定家庭中确定了总共18222名年龄在12至49岁的曾婚女性,其中17842人接受了访谈。我们研究的主要结局指标是对社区诊所的认知和就诊情况。采用双变量逻辑回归计算比值比(OR)和95%置信区间(CI),以检验对社区诊所的认知和就诊情况与社会经济决定因素之间的关联。

结果

在研究的女性中观察到对社区诊所的认知率较低(18%),只有17%的女性去过社区诊所。在控制潜在混杂因素后,发现年龄在20至29岁之间(调整后的OR = 1.18;95% CI = 1.03 - 1.35和调整后的OR = 1.49;95% CI = 1.05 - 2.11)、接受过小学教育(调整后的OR = 1.20;95% CI = 1.08 - 1.34和调整后的OR = 1.37;95% CI = 1.05 - 1.78)以及家庭最贫困(调整后的OR分别为1.21;95% CI = 1.03 - 1.42和调整后的OR = 2.36;95% CI = 1.56 - 3.55)与对社区诊所的认知和就诊情况存在显著关联(P < 0.05)。

结论

发现对社区诊所的认知和就诊情况与较低的经济状况、年轻年龄和小学教育呈正相关。可以通过涉及医护人员的社区活动来提高对社区诊所的认知和就诊机会。政府还应通过提供充足的后勤保障,如人力资源和设备,降低通过社区诊所获得初级卫生保健的障碍。

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