title: An assessment of the quality of care for children in eighteen randomly selected district and sub-district hospitals in Bangladesh.
abstract: BACKGROUND
  Quality hospital care is important in ensuring that the needs of severely ill children are met to avert child mortality. However, the quality of hospital care for children in developing countries has often been found poor. As the first step of a country road map for improving hospital care for children, we assessed the baseline situation with respect to the quality of care provided to children under-five years age in district and sub-district level hospitals in Bangladesh.
  
  
  METHODS
  Using adapted World Health Organization (WHO) hospital assessment tools and standards, an assessment of 18 randomly selected district (n=6) and sub-district (n=12) hospitals was undertaken. Teams of trained assessors used direct case observation, record review, interviews, and Management Information System (MIS) data to assess the quality of clinical case management and monitoring; infrastructure, processes and hospital administration; essential hospital and laboratory supports, drugs and equipment.
  
  
  RESULTS
  Findings demonstrate that the overall quality of care provided in these hospitals was poor. No hospital had a functioning triage system to prioritise those children most in need of immediate care. Laboratory supports and essential equipment were deficient. Only one hospital had all of the essential drugs for paediatric care. Less than a third of hospitals had a back-up power supply, and just under half had functioning arrangements for safe-drinking water. Clinical case management was found to be sub-optimal for prevalent illnesses, as was the quality of neonatal care.
  
  
  CONCLUSIONS
  Action is needed to improve the quality of paediatric care in hospital settings in Bangladesh, with a particular need to invest in improving newborn care.
authors.affiliation: International Centre for Diarrhoeal Diseases Research, Bangladesh ICDDR,B, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh. emdad@icddrb.org
authors.forename: Dewan M E
authors.initials: DM
authors.lastname: Hoque
authors.forename: Muntasirur
authors.initials: M
authors.lastname: Rahman
authors.forename: Sk Masum
authors.initials: SM
authors.lastname: Billah
authors.forename: Michael
authors.initials: M
authors.lastname: Savic
authors.forename: A Q M Rezaul
authors.initials: AQ
authors.lastname: Karim
authors.forename: Enayet K
authors.initials: EK
authors.lastname: Chowdhury
authors.forename: Altaf
authors.initials: A
authors.lastname: Hossain
authors.forename: S A J Md
authors.initials: SA
authors.lastname: Musa
authors.forename: Harish
authors.initials: H
authors.lastname: Kumar
authors.forename: Sudhansh
authors.initials: S
authors.lastname: Malhotra
authors.forename: Ziaul
authors.initials: Z
authors.lastname: Matin
authors.forename: Neena
authors.initials: N
authors.lastname: Raina
authors.forename: Martin W
authors.initials: MW
authors.lastname: Weber
authors.forename: Shams
authors.initials: S
authors.lastname: El Arifeen
mesh_terms: D001459:Bangladesh; D002662:Child Health Services / Q000458:organization & administration / Q000592:standards*; D002675:Child, Preschool; D006295:Health Resources / Q000592:standards / Q000600:supply & distribution; D006767:Hospitals, District / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D014218:Triage / Q000592:standards; D000078329:Workforce