Abstract
IMPORTANCE: Inequities in pediatric health care services persist in Bangladesh, with critical disparities between public and private hospitals, particularly for children younger than 5 years. These disparities hinder progress toward equitable health care access and quality outcomes. OBJECTIVE: To evaluate the availability and quality of health care workforce and service coverage for children younger than 5 years in public and private hospitals in Bangladesh to identify gaps in infrastructure, workforce distribution, and adherence to pediatric care standards. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was conducted from October 13, 2023, to May 24, 2024. Data collection included facility assessments, structured questionnaires, and direct observations using World Health Organization (WHO)-adapted tools. The study covered both private and public hospitals across 6 subdistricts in Bangladesh, representing a mix of urban and rural populations. Senior hospital staff and administrators were surveyed. Inclusion criteria were general inpatient and outpatient pediatric care delivered in hospitals. Diagnostic centers and specialized facilities were excluded. EXPOSURES: Availability of pediatric infrastructure, workforce, essential medications, and adherence to clinical guidelines assessed against WHO standards. MAIN OUTCOMES AND MEASURES: The primary outcomes included the presence of pediatric-specific departments, neonatal care facilities, and trained personnel and adherence to WHO care standards. Data were analyzed using descriptive statistics and χ2 tests to highlight disparities. RESULTS: The study sample included 102 private and 7 public hospitals. A significantly higher proportion of public hospitals compared with private hospitals had pediatric inpatient departments (100% vs 39.2%), newborn wards (100% vs 12.8%), and trained nurses (100% vs 32.4%). Only private hospitals in the sample had neonatal intensive care units (6.9% vs 0%). Pediatricians were available for extended consultations at a greater proportion of public hospitals compared with private hospitals (71.4% vs 26.5%). CONCLUSIONS AND RELEVANCE: These findings show substantial disparities in the availability of pediatric health care services between public and private hospitals in Bangladesh. Addressing these disparities through workforce investment and infrastructure improvements is crucial for equitable child health care and better health outcomes.