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Mutaganzwa C, Wibecan L, Iyer HS, Nahimana E, Manzi A, Biziyaremye F, Nyishime M, Nkikabahizi F, Hirschhorn LR, Magge H. Advancing the health of women and newborns: predictors of patient satisfaction among women attending antenatal and maternity care in rural Rwanda. Int J Qual Health Care 2019; 30:793-801. [PMID: 29767725 DOI: 10.1093/intqhc/mzy103] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 04/24/2018] [Indexed: 11/14/2022] Open
Abstract
Objective Identify predictors of patient satisfaction with antenatal care (ANC) and maternity services in rural Rwanda. Design Cross-sectional. Setting Twenty-six health facilities in Southern Kayonza (SK) and Kirehe districts. Participants Sample of women ≥ 16 years old receiving antenatal and delivery care between November and December 2013. Intervention Survey of patient satisfaction with antenatal and delivery care to inform quality improvement (QI) initiatives aimed at reducing neonatal mortality. Main Outcome Measure Overall satisfaction with antenatal and delivery care (reported as excellent or very good). Results In multivariate logistic regression analysis, high perceived quality [odds ratio (OR) = 3.03, 95% confidence intervals (CI): 1.565.88], respect [OR = 4.13, 95% CI: 2.16-7.89], and confidentiality [SK: OR = 7.50, 95% CI: 2.16-26.01], [Kirehe: OR = 1.54, 95% CI: 0.60-3.94] were associated with higher overall satisfaction with ANC, while having ≥1 child compared to none [OR = 0.46, 95% CI: 0.25-0.84] was associated with lower satisfaction. For maternity services, <5 years of school versus ≥5 years [OR = 0.13, 95% CI: 0.026-0.69] and higher cleanliness [OR = 19.23, 95% CI: 2.22-166.83], self-reported quality [OR = 10.52, 95% CI: 1.81-61.22], communication [OR = 8.78, 95%CI: 1.95-39.59], and confidentiality [OR = 8.66, 95% CI: 1.20-62.64] were all positively associated with high satisfaction. Higher comfort [OR: 0.050, 95% CI: 0.0034-0.71] and Kirehe vs. SK district [OR: 0.21, 95% CI: 0.042-1.01] were associated with lower satisfaction. Conclusions Patient-centeredness (including interpersonal relationships), organizational factors, and location are important individual determinants of satisfaction for women seeking maternal care at study facilities. Understanding variation in these factors should inform QI efforts in maternal and newborn health programs.
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Affiliation(s)
- Christine Mutaganzwa
- Partners In Health/Inshuti Mu Buzima, Department of Maternal and Child Health, KG 9 Ave, 46 Nyarutarama, Kigali, Rwanda
| | - Leah Wibecan
- Harvard Medical School, Department of Global Health and Social Medicine, 55 Shattuck Street, Boston, MA, USA.,Harvard T.H. Chan School of Public Health, Department of Epidemiology, 677 Huntington Ave, Boston, MA, USA
| | - Hari S Iyer
- Partners In Health/Inshuti Mu Buzima, Department of Maternal and Child Health, KG 9 Ave, 46 Nyarutarama, Kigali, Rwanda.,Harvard T.H. Chan School of Public Health, Department of Epidemiology, 677 Huntington Ave, Boston, MA, USA.,Brigham and Women's Hospital, Department of Global Health Equity, 75 Francis Street, Boston, MA, USA
| | - Evrard Nahimana
- Partners In Health/Inshuti Mu Buzima, Department of Maternal and Child Health, KG 9 Ave, 46 Nyarutarama, Kigali, Rwanda
| | | | - Francois Biziyaremye
- Partners In Health/Inshuti Mu Buzima, Department of Maternal and Child Health, KG 9 Ave, 46 Nyarutarama, Kigali, Rwanda
| | - Merab Nyishime
- Partners In Health/Inshuti Mu Buzima, Department of Maternal and Child Health, KG 9 Ave, 46 Nyarutarama, Kigali, Rwanda
| | | | - Lisa R Hirschhorn
- Harvard Medical School, Department of Global Health and Social Medicine, 55 Shattuck Street, Boston, MA, USA.,Brigham and Women's Hospital, Department of Global Health Equity, 75 Francis Street, Boston, MA, USA.,Ariadne Laboratories, 405 Park Drive 3E, Boston, MA, USA
| | - Hema Magge
- Partners In Health/Inshuti Mu Buzima, Department of Maternal and Child Health, KG 9 Ave, 46 Nyarutarama, Kigali, Rwanda.,Brigham and Women's Hospital, Department of Global Health Equity, 75 Francis Street, Boston, MA, USA.,Boston Children's Hospital, Division of General Pediatrics, 300 Longwood Ave, Boston, MA, USA
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Patient and Provider Satisfaction With a Comprehensive Strategy to Improve Prevention of Mother-to-Child HIV Transmission Services in Rural Nigeria. J Acquir Immune Defic Syndr 2017; 72 Suppl 2:S117-23. [PMID: 27355498 PMCID: PMC5113240 DOI: 10.1097/qai.0000000000001058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND High mother-to-child HIV transmission rates in Nigeria are coupled with a critical shortage of trained health personnel, dearth of infrastructure, and low levels of male involvement in HIV care. This study evaluated maternal and provider satisfaction with services for prevention of mother-to-child transmission within the context of an implementation science cluster-randomized trial that included task shifting to lower-cadre workers, male engagement, point-of-care CD4 cell counts, and integrated mother-infant care. METHODS Patient and clinician satisfaction were measured at 6 control and 6 intervention sites using a 5-point Likert scale. Patient satisfaction was assessed at 6 weeks postpartum through a 22-item scale about the provider's ability to explain the health problem, time spent with the clinician, and motivation to follow prescribed treatment. Provider satisfaction was assessed through a 12-item scale about motivation, compensation, and training, with 4 additional questions about the impact of task shifting on job satisfaction to intervention arm providers. RESULTS We measured satisfaction among 340 mothers (intervention n = 160; control n = 180) and 60 providers (intervention n = 36; control n = 24). Total patient satisfaction (maximum 5) was higher in the intervention than control arm [median (interquartile range) = 4.61 (4.22-4.79) vs. 3.84 (3.22-4.22), respectively; P < 0.001]. Provider satisfaction was generally high, and was similar between the intervention and the control arms [median (interquartile range) = 3.60 (3.37-3.91) vs. 3.50 (3.08-4.25), respectively; P = 0.69]. Provider satisfaction dropped when questions on newly acquired provider roles were included [3.47 (3.25-3.72)]. Patient and provider satisfaction were not associated with uptake of antiretroviral therapy or mother-infant retention at 6 and 12 weeks postpartum. CONCLUSIONS Satisfaction was higher among patients at intervention sites, and provider satisfaction decreased when newly assigned roles were factored in. Task shifting should include training and supportive oversight to ensure comfort with assigned tasks.
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Ndayongeje J, Kazaura M. Satisfaction of Patients Attending Public HIV or AIDS Care and Treatment Centers in Kinondoni District, Tanzania. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2017; 37:113-119. [PMID: 28511601 DOI: 10.1177/0272684x17701264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Satisfaction of care and treatment among HIV patients is one of the important elements for adherence. This study aimed to determine levels of satisfaction and associated factors among HIV-infected patients attending public care and treatment centers (CTCs) in Tanzania. The study was cross-sectional using face-to-face interviews. Satisfaction was measured using a total of 30 questions from a domain of six area of CTC service delivery. To assess independent predictors of levels of satisfaction, we used multilevel ordinal logistic regression analysis. We enrolled 434 study participants. Of these, 5% reported low satisfaction, 25% medium satisfaction, and 70% reported high satisfaction. The CTC environment was rated low by 56% of the patients. Predictors of levels of satisfaction were age of patient and health facility level. Low levels of satisfaction with CTC environment and laboratory services underscore the need for improvement of these areas.
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Affiliation(s)
| | - Method Kazaura
- 2 Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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