An analysis of structure, organization and delivery of ICU care in Bangladesh

Authors

  • Mohammad Omar Faruq Professor of Critical Care Medicine, Chief Consultant, General ICU and Emergency. United Hospital Ltd , Dhaka 1212, Bangladesh
  • ARM Nooruzzaman Consultant , ICU , Bangladesh Specialized Hospital, Dhaka , Dhaka 1207,Bangladesh
  • Rownak Jahan Tamanna Consultant cardiologist and intensivist, Uttara Crescent Hospital, Dhaka 1230, Bangladesh
  • AK Qumrul Huda Professor, ICU, Dept. of Anesthesia, BSM Medical University, Dhaka, 1000, Bangladesh
  • Amina Sultana Junior Consultant, General ICU, United Hospital Ltd, Dhaka 1212, Bangladesh
  • Uzzwal Kumar Mallick Registrar and in Charge, ICU, National Institute of Neuro science hospital, Dhaka1207, Bangladesh
  • Mohammad Asaduzzaman Consultant, ICU, Green life Hospital, Dhaka1205, Bangladesh
  • Md Motiul Islam Associate Consultant and head of ICU, Asgar Ali hospital, Dhaka 1204, Bangladesh
  • Tarikul Hamid Associate Consultant, ICU, Asgar Ali Hospital, Dhaka 1205 , Bangladesh
  • Mohammad Rabiul Halim Consultant, ICU, Dhaka Medical Hospital, Dhaka 1000, Bangladesh
  • Mohammed Arafat Hossain Rubayet Consultant ICU, Dhanmondi clinic, Dhaka1205, Bangl
  • Rawshan Arra Khanam Consultant Pulmonologist, Ingenious Health care Ltd, Dhaka 1207, Bangladesh
  • Samira Humaira Habib Principal research officer and Associate Professor, Health Economics Unit, Diabetic Association of Bangladesh, Dhaka 1000, Bangladesh
  • Ashiq Haider Choudhury Research Assistant, United Hospital Ltd, Dhaka1212, Bangladesh
  • Md Tahsin Salam Associate Consultant ICU and HDU, Ibn Sina Hospital, Dhaka 1209, Bangladesh
  • Mohammad Rashed Mahmud Consultant, ICU, Oasis Hospital, Sylhet 3100, Bangladesh
  • Ridwan Naim Faruq Lecturer, Ibrahim Medical College, Dhaka 1000, Bangladesh

DOI:

https://doi.org/10.3329/bccj.v7i1.40761

Keywords:

Bangladesh; ICU; Intensive care; Critical care.

Abstract

Background : This study is a sub analysis of data submitted on behalf of Bangladesh to an international study (2013-2014) involving Asian ICUs and merits comparison with prior study done in Bangladesh in 2007 which had similar objective.

Objective : To assess structure, organization and delivery of ICU care in ICUs of Bangladesh with attention to hospital organizational characteristics, ICU organizational characteristics, staffing etc.

Method : Prospective cohort study involving ICUs of 51 hospitals of Bangladesh done in 2013-2014. The hospitals in our study were divided into three groups : clinics/hospitals less than 50 beds (n =18), clinics/hospitals more than 50 beds(n=24) and Govt. hospitals/academic hospitals/ medical colleges hospitals (n=9).

Results : Most respondent hospitals were from Dhaka (77.4%). Only 17.6% hospitals were university affiliated. The average number of hospital beds were 225. The average number of ICU beds were 14. 19.6 % hospitals had infection control committees. Basic life support training was required for doctors and nurses in 31.4 % and 27.5 % hospitals respectively. Small clinics/ hospitals (less than 50 bed capacity [n=18]) had significantly less government funding (p < 0.0001), were less attached to university hospital (p < 0.0001), had fewer referral centers (p < 0.001), had less total hospital beds (p < 0.004) and were less in case of ICU beds : hospital beds percentage (p < 0.003). 28 ICUs had no single room. Govt. hospitals/academic hospitals/Medical colleges had relatively more ICU beds .(12.33% - p < 0.004). 60.8% ICUs were operated as open units. Open units were more likely present in hospitals/clinics more than 50 beds. Multivariable analysis showed that the presence of 1:1 nursing staff was much lower in private hospitals. Funding sources and types of hospitals were independently associated with lower percentage of ICU beds (p < 0.002) and (p < 0.0001) respectfully. University affiliations was more likely associated with closed ICU (p < 0.002). Presence of MD CCM qualified intensivists are more in government funded hospitals (p < 0.003) than those of private hospitals

Conclusions : Our study demonstrates considerable variation in the organization and staffing among Bangladeshi ICUs. Compared to 2007 study it shows increased trend in number of closed units( 39% vs 15%) and percentage of ICU beds relative to number of hospital beds (6.5% vs 4.8%) .

Bangladesh Crit Care J March 2019; 7(1): 3-11

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Published

2019-03-27

How to Cite

Faruq, M. O., Nooruzzaman, A., Tamanna, R. J., Huda, A. Q., Sultana, A., Mallick, U. K., Asaduzzaman, M., Islam, M. M., Hamid, T., Halim, M. R., Rubayet, M. A. H., Khanam, R. A., Habib, S. H., Choudhury, A. H., Salam, M. T., Mahmud, M. R., & Faruq, R. N. (2019). An analysis of structure, organization and delivery of ICU care in Bangladesh. Bangladesh Critical Care Journal, 7(1), 3–11. https://doi.org/10.3329/bccj.v7i1.40761

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Original Articles