Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA.
National Institute of Public Health, Cuernavaca, Mexico.
Diabetes Res Clin Pract. 2020 Nov;169:108417. doi: 10.1016/j.diabres.2020.108417. Epub 2020 Sep 4.
We aimed to evaluate the readiness and predictors of diabetes service capability at the level of primary care in Bangladesh as an illustrative instance of readiness for diabetes care in low- and middle-income countries (LMICs).
We used data from the 2014 Bangladesh Health Facility Survey (BHFS), a cross-sectional, nationally representative survey (n = 1596 health facilities). We constructed a diabetes-specific readiness index to assess diabetes service readiness in facilities with outpatient capability and used multivariable regression analysis to evaluate contextual predictors of diabetes service readiness.
Three-hundred and forty-five facilities with outpatient and diabetes service capability were included. Mean readiness for diabetes service capability on a scale of 0-100 was 24.9 (95%CI: 20.8-28.9) and was lowest in rural settings, districts with high social deprivation, and public facilities, where diabetes diagnostic equipment and medications were largely unavailable. Facility type was the strongest, independent predictor of diabetes service readiness.
Diabetes service readiness in outpatient facilities in Bangladesh was low, particularly in public facilities, rural settings, and districts with high social deprivation. .These findings could inform policies aimed at improving diabetes care in areas of high unmet need and may serve as a model to assess diabetes service readiness in other LMICs.
我们旨在评估孟加拉国基层医疗层面的糖尿病服务能力准备情况及其预测因素，以此为例说明中低收入国家（LMICs）进行糖尿病护理的准备情况。
我们使用了 2014 年孟加拉国卫生设施调查（BHFS）的数据，这是一项具有全国代表性的横断面调查（n=1596 个卫生设施）。我们构建了一个糖尿病特定的准备指数，以评估具有门诊能力的医疗机构的糖尿病服务准备情况，并使用多变量回归分析评估糖尿病服务准备情况的背景预测因素。
共纳入 345 家具有门诊和糖尿病服务能力的医疗机构。0-100 分制下的糖尿病服务能力准备程度平均得分为 24.9（95%CI：20.8-28.9），在农村地区、社会贫困程度高的地区以及公共医疗机构得分最低，这些地方的糖尿病诊断设备和药物基本无法获得。医疗机构类型是糖尿病服务准备情况的最强独立预测因素。
孟加拉国门诊医疗机构的糖尿病服务准备情况较低，特别是在公共医疗机构、农村地区和社会贫困程度高的地区。这些发现可以为旨在改善高未满足需求地区糖尿病护理的政策提供信息，并可能成为评估其他 LMICs 糖尿病服务准备情况的模型。
