Performance of the lot quality assurance sampling method compared to surveillance for identifying inadequately-performing areas in Matlab, Bangladesh.

This paper compared the performance of the lot quality assurance sampling (LQAS) method in identifying inadequately-performing health work-areas with that of using health and demographic surveillance system (HDSS) data and examined the feasibility of applying the method by field-level programme supervisors. The study was carried out in Matlab, the field site of ICDDR,B, where a HDSS has been in place for over 30 years. The LQAS method was applied in 57 work-areas of community health workers in ICDDR,B-served areas in Matlab during July-September 2002. The performance of the LQAS method in identifying work-areas with adequate and inadequate coverage of various health services was compared with those of the HDSS. The health service-coverage indicators included coverage of DPT, measles, BCG vaccination, and contraceptive use. It was observed that the difference in the proportion of work-areas identified to be inadequately performing using the LQAS method with less than 30 respondents, and the HDSS was not statistically significant. The consistency between the LQAS method and the HDSS in identifying work-areas was greater for adequately-performing areas than inadequately-performing areas. It was also observed that the field managers could be trained to apply the LQAS method in monitoring their performance in reaching the target population.

Childhood diarrhoea management practices in Bangladesh: private sector dominance and continued inequities in care.

BACKGROUND: Monitoring for disparities in health and services received based upon gender, income, and geography should continue as renewed efforts to reduce under-five mortality are made in response to millennium development goal #4. The purpose of this survey was to provide a nationally representative description of current childhood diarrhoea management practices and disparities in Bangladesh. METHODS: A nationally representative, cross-sectional, cluster-sample survey was carried out in randomly selected rural and urban populations across Bangladesh. The survey was completed over an 8 month period between November 2003 and June 2004. RESULTS: A total of 7308 children with a prevalent diarrhoeal illness episode within 560 clusters were identified and enrolled in the survey. In 61% of the cases help was sought from a health care provider, with over 90% practicing in the private sector. Caretaker practice disparities favouring males and higher income households were identified. Significant trends (P < 0.001) favouring higher income households were found for having sought help from any provider or a licensed doctor and for treating their child with oral rehydration solution or an antibiotic. Female children in urban households were less likely to be seen by a licensed allopath, adj OR 0.73 (95% CI 0.57, 0.94). Among rural households gender disparities were limited to females being less likely to receive an antibiotic, adj OR 0.74 (95% CI 0.65, 0.86). CONCLUSION: Households seeking help from a health provider overwhelmingly utilize the private sector in Bangladesh. Gender inequities in the utilization of licensed providers and purchase of antibiotics, favouring males were identified. Findings suggest that higher income, urban households tend to practice greater gender discrimination. In order to better understand health dynamics in urban populations, in particular slum-dwellers, there is a need to disaggregate survey data by household location.

Missed opportunities for reproductive and child health services of clients in urban NGO clinics of Bangladesh.

OBJECTIVES: The study was undertaken to identify the extent of missed opportunities of clients for selected reproductive and child health services, including the reasons and factors contributing to missed opportunities, in NGO clinics in Bangladesh. METHODS: A cross-sectional survey of 6 NGO clinics from 6 randomly-selected municipality areas was conducted for one month during July-August 2000. In total, 1,478 clients were consecutively selected both from fixed and satellite clinics. A structured questionnaire was used for conducting exit-interviews. RESULTS: Missed opportunities among female clients of reproductive age included tetanus toxoid (54%), family planning (26%), postnatal care (16%), reproductive tract infection (15%), and antenatal care (11%). The missed opportunities among children aged less than 5 years were the highest (42%) for acute respiratory infections, followed by diarrhoea (38%) and immunization (22%). Although the clients of clinics had specific health needs, over 50% did not perceive their importance, resulting in missed opportunities. Significantly higher missed opportunities for tetanus toxoid were observed among women aged 26 years and over and also among housewives. Missed opportunity for family-planning method was significantly lower (p < 0.01) among women aged 26 years and over compared to women aged 20-25 years. Missed opportunities for child immunization were significantly higher (p < 0.05) among the children living nearer ( <1 km) to the clinic compared to children who lived >1 km away from the clinic. CONCLUSIONS: The findings suggest that providing a broader range of services alone is not enough to ensure their use. A systematic screening mechanism should be in place for regular appraisal of clients for their missed opportunities. Behavioral change communication needs to be introduced to increase awareness among clients about the availability of additional services.