Yaya Sanni, Bishwajit Ghose, Ekholuenetale Michael, Shah Vaibhav
School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada.
Institute of Nutrition and Food Science, University of Dhaka, Dhaka, Bangladesh.
PLoS One. 2017 Oct 27;12(10):e0187303. doi: 10.1371/journal.pone.0187303. eCollection 2017.
In recent years, Bangladesh government has accomplished the ambitious project of establishing hospitals 18,000 Community Health Clinics in sub-districts across the country. Operating under the affiliation of the government hospitals, these community health clinics aim to provide free healthcare services and to increase health-awareness among the extreme poor communities in the rural areas. However, a great proportion of the people are still not well aware of the services offered by the community health clinics. Thus, it is imperative to identify the factors of awareness regarding the community clinics. Research-based evidence is necessary to improve the efficacy and service coverage of community clinics among key population.
Cross-sectional data of size 11,673 women aged 15 to 49 years living in rural settings across seven divisions were extracted from the latest Bangladesh Demographic and Health Survey 2014. The main outcome measures of our study were awareness and utilization of Community Clinic Services (CCs). Descriptive statistics were used to present the baseline socio-demographic and economic characteristics; Chi-square test and logistic regression were performed to identify the factors associated with awareness of community clinics.
About one-third (36.7%) of the women were aware of community clinics. Geographical location, level of education, household wealth status and frequency of reading newspaper were found to be significantly associated with awareness about community clinic services. Services reported to be obtained in the community clinics include family planning, immunization, tetanus, antenatal care, vitamin A, and health care for children and child growth monitoring. In the multivariate logistic regression, the odds of awareness among participants with primary education [p<0.001, AOR = 1.255, 95%CI = 1.107-1.357], secondary qualification [p<0.001, AOR = 1.370, 95%CI = 1.242-1.510] and tertiary [p<0.001, AOR = 1.526, 95%CI = 1.286-1.809] had approximately 23%, 37% and 53% respectively higher odds of awareness when compared to those with no formal education. Compared to the women living in richest households, odds of awareness were approximately 12.5%, 12.8%, 4.5% and 22.4% respectively higher among women reported in poorer, middle, richer and richest household wealth status when compared to poorest wealth status.
Our findings suggested that policies enhancing improved education could benefit health awareness. Poverty elimination and income generation programs among women are also likely to improve awareness about community health clinics in the target population. Special policy attention is required to address the regional variation of awareness about Community clinics.
近年来，孟加拉国政府完成了一项宏伟工程，即在全国各分区设立了18000家社区卫生诊所。这些社区卫生诊所在政府医院的附属下运营，旨在提供免费医疗服务，并提高农村极端贫困社区的健康意识。然而，很大一部分人仍然不太了解社区卫生诊所提供的服务。因此，必须确定影响对社区诊所认知的因素。基于研究的证据对于提高社区诊所在重点人群中的疗效和服务覆盖范围是必要的。
从最新的2014年孟加拉国人口与健康调查中提取了来自七个分区农村地区的11673名15至49岁女性的横断面数据。我们研究的主要结局指标是社区诊所服务（CCs）的认知度和利用率。描述性统计用于呈现基线社会人口统计学和经济特征；进行卡方检验和逻辑回归以确定与社区诊所认知度相关的因素。
约三分之一（36.7%）的女性知晓社区诊所。发现地理位置、教育程度、家庭财富状况和阅读报纸的频率与社区诊所服务的认知度显著相关。据报告在社区诊所获得的服务包括计划生育、免疫接种、破伤风、产前护理、维生素A以及儿童保健和儿童生长监测。在多变量逻辑回归中，与未接受正规教育的参与者相比，接受小学教育的参与者知晓的几率 [p<0.001，调整后比值比（AOR）=1.255，95%置信区间（CI）=1.107 - 1.357]、接受中学教育的参与者知晓的几率 [p<0.001, AOR = 1.370, 95%CI = 1.242 - 1.510] 和接受高等教育的参与者知晓的几率 [p<0.001, AOR = 1.526, 95%CI = 1.286 - 1.809] 分别高出约23%、37%和53%。与生活在最富裕家庭的女性相比，报告家庭财富状况为较贫困、中等、较富裕和最富裕的女性知晓的几率分别比最贫困财富状况的女性高出约12.5%、12.8%、4.5%和22.4%。
我们的研究结果表明，加强教育水平的政策可能有益于健康意识。消除妇女贫困和创收项目也可能提高目标人群对社区卫生诊所的认知度。需要特别的政策关注来解决对社区诊所认知度的地区差异。
