Kirtipasha Union Health and Family Welfare Centre, Jhalokathi Sadar Upazila, Barishal, Bangladesh.
Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh.
PLoS One. 2021 Mar 4;16(3):e0247700. doi: 10.1371/journal.pone.0247700. eCollection 2021.
Chronic Respiratory Diseases (CRDs) are some of the most prevailing non-communicable diseases (NCDs) worldwide and cause three times higher morbidity and mortality in low- and middle-income countries (LMIC) than in developed nations. In Bangladesh, there is a dearth of data about the quality of CRD management in health facilities. This study aims to describe CRD service availability and readiness at all tiers of health facilities using the World Health Organization's (WHO) Service Availability and Readiness Assessment (SARA) tool.
A cross-sectional study was conducted from December 2017 to June 2018 in a total of 262 health facilities in Bangladesh using the WHO SARA Standard Tool. Surveys were conducted with facility management personnel by trained data collectors using REDCap software. Descriptive statistics for the availability of CRD services were calculated. Composite scores for facility readiness (Readiness Index 'RI') were created which included four domains: staff and guideline, basic equipment, diagnostic capacity, and essential medicines. RI was calculated for each domain as the mean score of items expressed as a percentage. Indices were compared to a cutoff of70% which means that a facility index above 70% is considered 'ready' to manage CRDs at that level. Data analysis was conducted using SPSS Vr 21.0.
It was found, tertiary hospitals were the only hospitals that surpassed the readiness index cutoff of 70%, indicating that they had adequate capacity and were ready to manage CRDs (RI 78.3%). The mean readiness scores for the other hospital tiers in descending order were District Hospitals (DH): 40.6%, Upazila Health Complexes (UHC): 33.3% and Private NGOs: 39.5%).
Only tertiary care hospitals, constituting 3.1% of sampled health facilities, were found ready to manage CRD. Inadequate and unequal supplies of medicine as well as a lack of trained staff, guidelines on the diagnosis and treatment of CRDs, equipment, and diagnostic facilities contributed to low readiness index scores in all other tiers of health facilities.
慢性呼吸道疾病（CRD）是全球最普遍的非传染性疾病（NCD）之一，在中低收入国家（LMIC）的发病率和死亡率比发达国家高三倍。在孟加拉国，关于卫生机构中 CRD 管理质量的数据很少。本研究旨在使用世界卫生组织（WHO）服务可用性和准备情况评估（SARA）工具，描述所有卫生机构层级的 CRD 服务可用性和准备情况。
2017 年 12 月至 2018 年 6 月，在孟加拉国总共 262 家卫生机构中进行了一项横断面研究，使用了世卫组织 SARA 标准工具。培训数据收集员使用 REDCap 软件对设施管理人员进行调查。计算了 CRD 服务可用性的描述性统计数据。为设施准备情况创建了综合准备指数（“RI”），其中包括四个领域：人员和指南、基本设备、诊断能力和基本药物。RI 是每个领域的平均分数，表示为百分比的项目的平均值。将指数与 70%的截止值进行比较，这意味着设施指数高于 70%被认为在该级别具有管理 CRD 的能力。使用 SPSS Vr 21.0 进行数据分析。
结果表明，三级医院是唯一超过准备指数截止值 70%的医院，这表明它们有足够的能力，有能力管理 CRD（RI 为 78.3%）。其他医院层级的平均准备分数依次递减为：地区医院（DH）：40.6%，县卫生综合体（UHC）：33.3%，私营非政府组织（NGO）：39.5%）。
只有三级保健医院，占抽样卫生机构的 3.1%，被认为有能力管理 CRD。所有其他卫生机构层级的药物供应不足且不平等，缺乏经过培训的人员、CRD 的诊断和治疗指南、设备和诊断设施，这导致准备指数得分较低。
