Missed opportunities for reproductive and child health services of clients in urban NGO clinics of Bangladesh.
OBJECTIVE
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.
Khatun
Jahanara
J
Health Systems and Infectious Diseases Division, ICDDR, B, Mohakhali, Dhaka 1212, Bangladesh. jahanara1957@yahoo.com
Roy
Nikhil Chandra
NC
D000328:Adult; D001459:Bangladesh; D002662:Child Health Services / Q000592:standards / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D020380:Needs Assessment; D009938:Organizations; D015397:Program Evaluation; D034121:Reproductive Health Services / Q000592:standards / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D019037:Urban Health Services / Q000592:standards / Q000706:statistics & numerical data*