Nigerian Journal of Paediatrics

Parental Satisfaction with Quality of Malaria Diagnostic Service at the University of Benin Teaching Hospital Benin City Edo State

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

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

(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.

is clinically relevant. Satisfied patients are more likely to

comply with treatment , take an active role in their own

care , and continue using medical services. They are

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

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.

Saharan Africa. Efforts to control or curtail the spread of

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-

Globally, about 207 million episodes of clinical malaria

occurred in 2013, two-thirds of which occurred in sub-

mains the mainstay of malaria diagnosis in most large

Saharan Africa. Most of the deaths from malaria are

health clinics and hospitals but the quality of micros-

among children aged below five years (U-5s).

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-

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.

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

21.5

However, 2 (1.5%) believed that the pharmacy services

30 – 34

25.4

made the proper diagnosis of malaria while 3 (2.3%)

35 – 39

18.5

≥ 40

34.6

were of the opinion that they made the proper diagnosis

Gender

of malaria in their children respectively. See table 2

Male

Female

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

6.2

Co-habiting

5.4

Clinician

60.0

Maternal educational status

Lab Technician

9.2

Primary

5.4

Pharmacy

1.5

Secondary

53.8

Self

2.3

Tertiary

40.8

Combined

26.9

Father’s annual income (naira)

Total

130

100

< 1 million

105

80.77

1 – 1.499 million

7.70

Factors associated with Respondents’ perception of

1.5 – 1.99 million

proper diagnosis of malaria

≥ 2 million

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

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)

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)

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

Remark

Easy to access the service

3.45

0.96

Positive

Waiting time for lab. Service

3.08

0.91

Neutral

Health worker professionalism

3.17

Neutral

Encourage to ask any information

;34

3.06

1.24

Neutral

Availability of lab malaria result

3.63

1.15

Positive

Willingnes to conduct lab invest.

3.69

0.96

Positive

Puntuality of service providers

3.38

0.9

Positive

Staff language to communicate

3.22

0.97

Positive

Explanation about lab.result

2.85

0.65

Negative

Explanation about malaria drug

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-

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

dents’ level of satisfaction

is in contrast

with the findings in this study of 22.3%. The difference

Dissatisfied

Satisfied

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

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

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

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-

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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