Niger J Paediatr 2019; 46 (3):129 – 132
ORIGINAL
Eki-Udoko FE
CC
– BY
Parental satisfaction with quality
Atimati AO
of malaria diagnostic service at
University of Benin Teaching
Hospital, Benin City, Edo State
DOI:http://dx.doi.org/10.4314/njp.v46i3.2
Accepted: 22nd July 2019
Abstract :
Background: Parents
evaluation for malaria (60%) were
determine where and when to
of
the opinion that the clinicians
Eki-Udoko FE (
)
access care for their children. As-
made proper malaria diagnosis and
Atimati AO
sessing parental satisfaction with
22.3% felt that a combination of
Department of Child Health
the
quality diagnostic services
the
clinician and laboratory ser-
University of Benin Teaching
offered for an endemic disease
vices made the correct diagnosis.
Hospital
like malaria in a health system is
While the least properly diagnosed
P.M.B 1111,
more likely to determine compli-
malaria was the pharmacy (1.5%)
Benin-City, Nigeria
ance with treatment and future
and self (2.3%) respectively. This
Email: ekiudokofidelis@yahoo.com
usage of such medical services.
study noted that of all the socio
This study specifically aimed to
demographic
variables
only
assess parental satisfaction with
mother level of education was
the
quality of malaria diagnostic
found to significantly influenced
service at the University of Benin
the
level of satisfaction with the
Teaching Hospital (UBTH).
quality of malaria diagnostic ser-
Methods: The
study is
a descrip-
vices offered at CHER in UBTH
tive
survey. A structured ques-
(p< 0.05).
tionnaire with a five point Likert
Conclusion:
parent satisfaction
scale was used for data collection
with the quality of malaria diagno-
from parents of children on
sis by the clinician was high in this
evaluation for malaria. A mean
study. However, areas with least
score of 3.0 and above was used
level of satisfaction such as wait-
as
an acceptable response for high
ing
time and work ethics should be
level of satisfaction. The maximal
reviewed for improvement to en-
allowable score was 5.
hance patient believe in the sys-
Results: parents
of children
on
tem.
Introduction
mated to be 132 billion Naira, in form of treatment
costs, prevention, and loss of man-hours. Direct loss to
7
Patient’s satisfaction is the patient’s perception of care
the economy of the country from malaria is put at GBP
received compared with the care expected . Evaluating
1
(Great Britain Pounds) 530 million. Malaria reduces
to
what extent patients are satisfied with health services
Nigeria’s Gross Domestic Product by one per cent annu-
ally.
7
is
clinically relevant. Satisfied patients are more likely to
comply with treatment , take an active role in their own
2
care , and continue using medical services. They are
3
Correct diagnosis and effective treatment are among the
also more likely to stay with the health care provider
main strategies in the fight against malaria. A diagnosis
(where there are some choices) and maintain a specific
of
malaria based on clinical symptoms alone has very
system. The reverse is the case when patients are not
2
low specificity and contributes to an increase in non-
satisfied with the health care services.
malaria morbidity and mortality. It can also lead to the
Malaria is one of the gravest health threats in sub-
misuse of anti-malarial drugs, increased costs to the
health services and patient dissatisfaction.
8
Saharan Africa. Efforts to control or curtail the spread of
4
malaria infection have posed serious economic chal-
The World Health Organization recommends prompt
lenges to affected countries.
malaria diagnosis either by microscopy or malaria rapid
diagnostic test (RDT) in all patients with suspected ma-
laria before treatment is administered. Microscopy re-
9
Globally, about 207 million episodes of clinical malaria
occurred in 2013, two-thirds of which occurred in sub-
5
mains the mainstay of malaria diagnosis in most large
Saharan Africa. Most of the deaths from malaria are
6
health clinics and hospitals but the quality of micros-
among children aged below five years (U-5s).
6
copy-based diagnosis is frequently inadequate due to
Nigeria is one of the most malaria endemic countries in
lack of expertise. Malaria rapid diagnostic tests (RDTs),
Africa. The financial loss due to malaria annually is esti-
which detect malaria parasite antigens in human blood,
130
permit a reliable detection of malaria infections particu-
cerning correct diagnosis of malaria while the third seg-
larly in remote areas with limited access to quality mi-
ment is on the factors that determined the satisfaction
crocopy services. Provision of quality malaria diagnos-
9
level of the respondents.
tic
services in hospital settings entails a process which
include proper filling of investigations forms, making
Data analysis
payments, collection of blood samples, preparation of
slides, reading of blood film, adequate reporting and
The
data was analyzed using the SPSS (statistical pack-
disclosure of results. This process involves different
age
for the social sciences) software version 20. Con-
cadre of staff and can be fraught with lapses which may
tinuous variables were summarized using means while
affect the perception and level of satisfaction of patients
categorical variables were summarized using propor-
and
their caregivers. This may in turn impart on the trust
tions. The mean Likert scale score or weighted average
of
the patients on the health delivery system and compli-
was
used to categorize the satisfaction level as satisfied
ance
with prescribed medications.
when
the score is ≥ the mean score while the value be-
low
the mean score was taken as dissatisfied. The mean
Many
programmes have been formulated in the past and
rating score for each item was calculated by multiplying
the
world is constantly researching into how best possi-
the
number of answers or responses in each category by
ble
(malaria vaccine and other malaria control tools), it
its
rating value (1 to 5), obtaining a sum and dividing by
is
to control and if possible eradicate this public menace.
the
total number of responses for that item; that is over-
Very
little is known about the patients’ parent percep-
all
rate of satisfaction by Likert scale was calculated as
tion
and satisfaction with the quality of diagnostic ser-
(No.
of excellent rating ×5) + (No. of very good rating
vices offered them at the tertiary hospitals.
×4)
+ (No. of good rating ×3) + (No. of fair rating
kitem.
10
While the health team is working tirelessly to curtail this
Chi square statistical test of significance was
problem of malaria, very little is known about how the
used to test association between categorical variables at
end-user (patients/parent) feels about the whole process
a
p-value of 0.05 at 95% confidence interval.
of
making a diagnosis and their perception about the
Ethical approval was obtained from the Ethics and Re-
quality of malaria diagnostic services offered at our hos-
search Committee of the University of Benin Teaching
pitals
Hospital, Benin City. Informed written consent was got-
ten from the parents of the patients.
This study is therefore aimed at assessing the perception
and
satisfaction among patients’ parent on the quality of
malaria diagnostic services offered at the children emer-
gency unit (CHER) in UBTH.
Results
Socio-demographic characteristics of respondents.
One hundred and thirty parents comprising of 57 males
Methods
(44%) and 73 females (56%) were recruited for the
study. The mean age of the respondents was 35.81 ±
This
is a descriptive cross-sectional study carried out
6.352 years with a range of 24 to 46years.The respon-
between October and November 2016 among parents of
dents were sub-divided into four age groups. Respon-
patients managed at CHER in UBTH. University of Be-
dents below 30 years were 28 (21.5%), those between
nin Teaching Hospital (UBTH) is a 700-bed tertiary
ages 30-34 years, were 33(25.4%), while those between
health care facility situated along the Lagos-Benin ex-
35-39 years, were 24(18.5%) those above 40 years were
pressway in Egor Local Government Area (LGA) in
45(34.6%).The minimum age of respondents was 24
Benin City. It serves as a referral centre for other areas
years while the maximum was 46 years. The mean age
of
Edo State as well as the neighboring States of Delta,
was 35.810 with a standard deviation of 6.352.
Kogi, Ondo and parts of Anambra States.
Majority of the respondents were married 115 (88.46%),
About 2400 children are sent for malaria parasite inves-
single parents were 8 (6.15%)while those that were co-
tigation annually in the CHER of UBTH.
habiting 7 (5.39%) respectively. Most of the respondents
Mothers who brought their under five children to the
had secondary education 70 (53.85%), while 53 (40.77)
Children Emergency Room were consecutively recruited
had tertiary education and 7 (5.39) had primary levels of
for
the study after consent was obtained. The tool for
education respectively. Majority of the respondents 105
data
collection was a close-ended interviewer adminis-
(80.77%) earned less than 1 million naira per annual,
tered questionnaire which was designed by the research-
while 10 (7.70%) earned between 1-1.4 million naira, 13
ers and validated. A 5-point Likert scale and the
(10.00%) earned between 1.5-2 million naira and only 3
weighted average were used to categorize satisfaction
(2.31%) of the respondents earned above 2 million naira
level of the parents in this study.
per annum. See Table 1
The questionnaire is composed of three parts; the first
segment contains information on the biodata of the re-
spondents including the educational status, father’s oc-
cupation
and income per annum. The second part con-
tains
information on the perception of the parent con-
130
Table 1: Socio-demographic
characteristics of
respondents
respondents, 12 (7.7%) believed that the proper diagno-
Characteristic
Frequency
Percentage
sis was made by the medical laboratory services, while
35
(22.3%) were of the opinion that a combined diagno-
Age group (years)*
sis by the doctors and medical laboratory was correct.
<30
28
21.5
However, 2 (1.5%) believed that the pharmacy services
30
– 34
33
25.4
made the proper diagnosis of malaria while 3 (2.3%)
35
– 39
24
18.5
≥
40
45
34.6
were of the opinion that they made the proper diagnosis
Gender
of
malaria in their children respectively. See table 2
Male
57
44
Female
73
56
Table 2: Respondent’s
perception of
the proper
diagno-
Marital status
sis of malaria
Married
115
88.4
Perceived to be diagnosed properly
Frequency
Percentage
Single
8
6.2
by
Co-habiting
7
5.4
Clinician
78
60.0
Maternal educational status
Lab
Technician
12
9.2
Primary
7
5.4
Pharmacy
2
1.5
Secondary
70
53.8
Self
3
2.3
Tertiary
53
40.8
Combined
35
26.9
Father’s annual income (naira)
Total
130
100
< 1 million
105
80.77
1 –
1.499 million
10
7.70
Factors associated with Respondents’ perception of
1.5
– 1.99 million
13
10
proper diagnosis of malaria
≥ 2
million
3
2.31
*Mean age (SD) = 35.81 (6.352)
There is a statistically a significant difference( p<0.05)
in
gender, mother level of education, age group, waiting
Respondent’s perception of the proper diagnosis of
time, work ethics factors and the perception of proper
malaria
diagnosis of malaria by respondents. However, father
income and marital status of respondents were not statis-
In
the table 2below, most of the respondents had the
tically significant (p >0.05) factors that determine re-
perception
that the diagnosis of malaria in their children
spondents perception of proper diagnosis of malaria in
was proper done by the doctors 78 (60.0%). Of the other
their children.
Table 3: Factors
associated with
Respondents’ perception of
proper diagnosis
of malaria
Factors
Clinician
Lab
Tech
Combined
Others
c
2
p-value
Gender
Male
37(47.4)
8(66.7)
12(34.3)
0(0.0)
8.150
0.043*
Female
41(52.6)
4(33.3)
23(65.7)
5(100.0)
Marital Status
Single
4(5.1)
2(16.7)
2(5.7)
0(0.0)
7.577
0.271
Married
67(85.9)
10(83.3)
33(94.3)
5(100.0)
Co-Habiting
7(9.0)
0(0.0)
0(0.0)
0(0.0)
Mothers LOE
Primary
3(3.8)
2(16.7)
2(5.7)
0(0.0)
14.358
0.073
Secondary
48(61.5)
4(33.3)
13(37.1)
5(100.0)
Tertiary
27(34.6)
6(50.0)
20(57.1)
0(0.0)
Income per annum
<N1m
65(83.3)
10(83.3)
25(71.4)
5(100.0)
9.239
0.416
N1m
- N1.4m
6(7.7)
0(0.0)
4(11.4)
0(0.0)
N1.5m - N2m
7(9.0)
2(16.7)
4(11.4)
0(0.0)
Above N2m
0(0.0)
0(0.0)
2(5.7)
0(0.0)
Age group
Below 30yrs
9(11.5)
6(50.0)
10(28.6)
3(60.0)
19.943
0.018*
30
- 34yrs
19(24.4)
2(16.7)
10(28.6)
2(40.0)
35
- 39yrs
16(20.5)
2(16.7)
6(17.1)
0(0.0)
40yrs and above
34(43.6)
2(16.7)
9(25.7)
0(0.0)
Waiting Time
30
mins
6(7.7)
2(16.7)
5(14.3)
2(40.0)
14.063
0.029*
30
- 60mins
28(35.9)
4(33.3)
20(57.1)
0(0.0)
60
mins
44(56.4)
6(50.0)
10(28.6)
3(60.0)
Work ethics
Less Concerned
4(5.1)
2(16.7)
5(14.3)
3(60.0)
25.376
<0.0001*
Concerned
40(51.3)
2(16.7)
22(62.9)
2(40.0)
Very
concerned
34(43.6)
8(66.7)
8(22.9)
0(0.0)
*p =
<0.05
131
Respondents’ level of satisfaction with quality of ma-
ability
of laboratory malaria results; willingness to con-
laria
diagnostic services
duct
laboratory investigation; punctuality of service pro-
vider and staff language to communicate
The
table below shows clearly respondents were satis-
fied
with the ease to access the diagnosis service; avail-
Table 4: Respondents’
level of
satisfaction with
quality of
malaria diagnostic
services
Respondents’ Level Of Satisfaction
1
2
3
4
5
x
SD
Remark
Easy to access the service
2
17
53
37
21
3.45
0.96
Positive
Waiting time for lab. Service
3
30
61
26
10
3.08
0.91
Neutral
Health worker professionalism
0
41
40
35
14
3.17
1
Neutral
Encourage to ask any information
16
29
;34
33
18
3.06
1.24
Neutral
Availability of lab malaria result
2
23
37
27
41
3.63
1.15
Positive
Willingnes to conduct lab invest.
2
10
44
44
30
3.69
0.96
Positive
Puntuality of service providers
0
19
60
33
18
3.38
0.9
Positive
Staff language to communicate
0
35
45
36
14
3.22
0.97
Positive
Explanation about lab.result
2
32
79
17
0
2.85
0.65
Negative
Explanation about malaria drug
13
29
47
19
22
3.06
1.21
Neutral
Grand mean
n=
130, Mean cut off is 3.0, SD= Standard Deviation. Source: Field survey
2016
Socio- demographic factors associated with respondents’
level
of satisfaction
Discussion
There is a statistically significant difference in the
mother level of education and the level of satisfaction
This study showed that a large percentage of the parents
with the quality of malaria diagnosis. There is no signifi-
were of the perception that the consulting doctor (60%)
cant difference in other socio demographic factors and
made the proper malaria diagnosis of their children. The
the level of satisfaction with the quality of malaria diag-
result from this study is comparable to the 64.7% report
in
a study done in North Western Ethiopia The percep-
11
nosis
tion
that a combination of consulting doctor and the
Table 5: Socio
demographic factors
associated with
respon-
laboratory made a proper diagnosis of malaria of 12.0%
reported in the North Western Ethiopia
11
dents’ level of satisfaction
is
in contrast
with the findings in this study of 22.3%. The difference
c
2
Dissatisfied
Satisfied
p-
value
noticed may have been due to the fact that majority of
Age group
the respondents in this study were literate (may still
Below 30yrs
13(22.4)
13(19.1)
5.502
0.139
want to confirm the diagnosis after consultation with
30
- 39yrs
12(20.7)
21(30.9)
their doctor) as compared to the Ethiopian study were a
40yrs and above
25(43.1)
18(26.5)
very large percentage of the respondents were illiterate.
Gender
In
this study 7.7% felt that the medical laboratory gave
Male
20(34.5)
33(48.5)
2.534
0.111
the proper diagnosis of malaria. This is comparable to
Female
38(65.5)
35(51.5)
the 5% reported by Agajieet al in a study done in the
11
No of Children
North Western Ethiopia.
Below 4
41(70.7)
46(67.6)
0.136
0.713
4
and above
17(29.3)
22(32.4)
This
study reported that 1.5% of respondents were of the
Marital status
opinion that the pharmacy services made a proper diag-
Single
4(6.9)
4(5.9)
0.079
0.961
nosis of malaria. This is comparable to 1.4% reported in
Married
51(87.9)
60(88.2)
the North Western Ethiopia . However, the report of
11
Co-Habiting
3(5.2)
4(5.9)
2.3% of respondents perception that their (self) shown in
Maternal Educational status
this study contrast the 15.3% reported by
Agajie et al in
11
Primary
2(3.4)
5(7.4)
9.750
0.008
*
2014. The difference noticed may have been due to the
Secondary
24(41.4)
44(64.7)
fact that majority of the respondents in this study were
Tertiary
32(55.2)
19(27.9)
literate as compared to the Ethiopian study were a very
Income per annum
large percentage of the respondents were illiterate.
<N1m
44(75.9)
57(83.8)
6.598
0.086
N1m
- N1.499m
8(13.8)
2(2.9)
This study noted that gender, mother level of education,
N1.5m – N1.99m
6(10.3)
7(10.3)
age group, waiting time and work ethics were had statis-
≥N2m
0(0.0)
2(2.9)
tically significantly influenced respondents perception of
malaria diagnosis. These findings are comparable to
*p
= <0.05
those observed in Ethiopia were work ethics and wait-
11
ing time positively influenced the perception of malaria
diagnosis. But gender and mothers level of education
were not among the factors reported to be associated
132
with
perception of proper malaria diagnosis. This may
respondents were literate and perhaps understand what
be
due to the fact that this study had majority of the re-
duty
of care is expected of the health service provider to
spondents been literate as compared to the Ethiopian
her client.
study that majority (85%) illiterate.
Finally, with regards to the socio demographic factors
Conflict of interest: None
that influence the level of satisfaction with the quality of
Funding: None
malaria diagnostic services surprisingly, only mother
level of education was statistically significant in this
study. This is in contrast to the Ethiopian work were,
Acknowledgement
work ethics, professionalism and personnel availability
were the significant factors that really influence the level
We
appreciate Mr. NosaOkunbowa who assisted in the
of
satisfaction with malaria diagnosis. This study may
data analysis of this work
have been different due to the fact that majority of the
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