Predictors of Patient Dissatisfaction with Services for Prevention of Mother-To-Child Transmission of HIV in Dar es Salaam, Tanzania

Identifying the determinants of patient satisfaction in the context of antenatal care in Kenya, Tanzania, and Malawi using service provision assessment data

Background

Antenatal care (ANC) is a service that can reduce the incidence of maternal and neonatal deaths when provided by skilled healthcare workers. Patient satisfaction is an important health system responsiveness goal which has been shown to influence adherence to healthcare interventions. This study aims to assess the determinants of pregnant women’s satisfaction with ANC across Kenya, Tanzania, and Malawi using nationally representative Service Provision Assessment data.

Methods

Patient satisfaction was conceptualised mainly based on Donabedian’s theory of healthcare quality with patient characteristics, structure, and process as the major determinants. Bivariate and multivariate analyses were conducted to identify the potential determinants.

Results

Findings show that satisfaction was negatively associated with women’s age (AOR: 0.95; 95% CI: 0.92–0.99) and having a secondary (AOR: 0.39; 95% CI: 0.17–0.87) or tertiary education (AOR: 0.41; 95% CI: 0.17–0.99) in Kenya. Women on their first pregnancy were more likely to report satisfaction in Tanzania (AOR: 1.62; 95% CI: 1.00–2.62) while women were less likely to report being satisfied in their second trimester in Malawi (AOR: 0.31; 95% CI: 0.09–0.97). The important structural and process factors for patient satisfaction included: private versus public run facilities in Kenya (AOR: 2.05; 95% CI: 1.22–3.43) and Malawi (AOR: 1.85; 95% CI: 0.99–3.43); level of provider training, that is, specialist versus enrolled nurse in Tanzania (AOR: 0.35; 95% CI: 0.13–0.93) or clinical technician in Malawi (AOR: 0.08; 95% CI: 0.01–0.36); and shorter waiting times across all countries.

Conclusion

Findings highlight the importance of professional proficiency and efficient service delivery in determining pregnant women’s satisfaction with ANC. Future studies should incorporate both patient characteristics and institutional factors at health facilities into their conceptualisation of patient satisfaction.

Gap analysis between expectations and perceptions of pregnant women attending Prevention of Maternal to Child Transmission of HIV services in a private referral hospital in northern Tanzania: A cross-sectional descriptive study

Objective

Pregnant women satisfaction with the Prevention of Mother-To-Child HIV Transmission services is an essential parameter in the determination of the quality of care and performance. This study aimed to measure the gap between pregnant women expectations of PMTCT services and perceptions of the actual PMTCT services and the relationship between their service gap scores and socio-demographic characteristics.

Methods

A cross-sectional descriptive study design was conducted from August to September 2020 on a sample of 105 participants. A pre-tested SERVIQUAL questionnaire was used to collect data and paired sample t-test, independent one-sample t-test, and one–way ANOVA was used to compare mean service gap scores. A p-value of < 0.05 was considered statistically significant.

Results

The overall mean gap score was (+ 0.31) indicating pregnant women perceived value of the quality of care of PMTCT services. The gap score in the 5 service dimensions was as follows: empathy (+0.49), tangibles (+0.43), assurance (+0.22), responsiveness (+0.20), and reliability (+0.19). Marital status (p-value 0.031) was the only social demographic characteristic associated with pregnant women service gap scores.

Conclusion

Overall, pregnant women perceptions of PMTCT services provided in the RCH clinic at KCMC were meet. Marital status was associated with the overall pregnant women service gap scores and perceived quality of care with PMTCT services. Pregnant women who were married had small service gap scores compared to either divorced or widowed or cohabiting women.

Patient Satisfaction with Antiretroviral Therapy Service and Associated Factors at Jimma Town Public Health Facilities, Southwest, Ethiopia

Background

HIV/AIDS is the greatest and most urgent public health problem that the world is facing today. Antiretroviral therapy (ART) is the treatment option for people infected by the HIV virus and helps them to lead longer and healthier lives and improve their quality of life. This study aimed to measure level of satisfaction and associated factors among patients receiving ART services in ART Clinics at Jimma Town Public Health Facilities, Southwest, Ethiopia.

Methods

Facility-based, cross-sectional study was employed from March to April, 2018 among 383 clients attending ART in three public health facilities of Jimma town. Data was collected using exit interviewer administrated pre-test structured, coded and entered using Epi-data version 3.5.1 and then exported and analyzed using SPSS version 20 software. Variables having p < 0.25 at bivariate analysis were fitted to multivariate analysis. OR, P-value and 95% CI were computed to show the association of variables (p < 0.05).

Results

A total of 383 clients involved in the study. The majority of the study participants, 253 (66.1%), were females and 163 (42.6%) were in 28-37 age category. The overall satisfaction rate for ART service provision was 89.6%. Patients were satisfied with the availability of ARV drugs, measures taken by health care providers to keep confidentiality and location of the clinic in the facility, 97.9%, 93.2% and 96.3%, respectively. The findings of this study revealed statistically significant associations between the patients' satisfaction and duration of stay on ART and waiting time to get service (p<0.05). Those patients who stayed 36-60 months on ART treatment were 82.5% less likely to be satisfied than those who stayed less than 12 months on ART treatment (AOR=0.175, 95% CI: 0.04-0.771).

Conclusion

Overall, most respondents were satisfied with ART services provision. Factors like duration of stay on ART and waiting time to get service should be taken into consideration to improve the patient's satisfaction.

Clients' Satisfaction with Services for Prevention of Mother-to-Child Transmission of HIV in Public Health Facilities in Diredawa City, Eastern Ethiopia

Background

Ethiopia has a very high burden of HIV infection among children, contracted from their mothers, and nearly two-thirds of pregnant women do not receive prevention of mother-to-child transmission (PMTCT) services. Ensuring clients’ satisfaction with PMTCT services is one of the bases to scale up service utilization and mitigate MTCT of HIV. However, in Ethiopia, particularly in the study area, evidence related to clients’ satisfaction with PMTCT services is scanty.

Methods

A facility-based cross-sectional study was conducted among women attending antenatal care in Diredawa city. Systematic random sampling was used to select 517 study participants. Interviewer-administered structured and pretested questionnaires were used to collect data. Statistical significance was regarded as P≤0.05 with a 95% CI.

Results

Client satisfaction with PMTCT services was 82.2% (95% CI 66.4%–94.3). Receiving the service from a hospital (AOR 2.34; 95% CI 1.5, 3.98), no formal education (AOR 2.53, 95% CI 1.52–4.2), primary education (AOR 2.17 95% CI 1.17–4.04), receiving pre- and post-HIV test counseling from the same provider (AOR 4.93, 95% CI 2.98–7.17), gestational age above first trimester (AOR 1.74, 95% CI 1.12–2.71), and waiting time ≤15 minutes (AOR 2.31, 95% CI 1.28–4.16) were positively associated with client satisfaction with PMTCT services.

Conclusion

Client satisfaction with PMTCT services is relatively high. Receiving the service from a hospital, no formal education or only primary education, gestational age above first trimester, getting pre- and post-HIV test counseling from the same provider, and waiting time ≤15 minutes to receive services were factors associated with client satisfaction. A greater number of skilled PMTCT-service providers would improve service quality and hasten its delivery. Furthermore, providing mentoring and supportive supervision of health centers with PMTCT programs and keeping the same provider in posttest counseling is also mandatory.

An Exploration of Barriers and Enablers of Retention in a Program to Reduce Vertical Transmission of HIV at Health Centers in Zimbabwe

Background

Poor retention in the prevention of women in prevention of vertical transmission programs remains a formidable common setback in elimination of HIV/AIDS. It creates new problems such as poor health outcomes and increased incidence of vertical transmission of HIV. There is a dearth of qualitative information to explain poor retention of women in prevention of mother-to-child transmission (PMTCT) programs in Zimbabwe. The purpose of the study was to explore the enablers and barriers of retention of women in PMTCT programs.

Methods

This was a basic qualitative study conducted at four health centers in Zimbabwe. Four audiotaped focus group discussions were conducted with 34 pregnant or breastfeeding women coming for PMTCT services at the health centers. Descriptive statistics was used for sample demographics. Transcripts were analyzed through latent content analysis based on the Graneheim and Lundman method.

Results

Maternal determination, a four-tier support system, and an inspiring health package were enablers to retention in the PMTCT program while uninspired individual engagement, paternalism, and undesirable PMTCT-related events were barriers to retention of women in the PMTCT program.

Conclusions

Reinforcing hope for the women and their children, active management of side effects of antiretroviral medicine, consistent peer support, enhancing confidentiality among community cadres, and commitment from community or religious leaders may improve retention of women in PMTCT programs; for women with HIV during pregnancy, delivery and post-natal care.

Maternal Decision-Making and Uptake of Health Services for the Prevention of Mother-to-Child HIV Transmission: A Secondary Analysis

Objectives We investigated whether a woman's role in household decision-making was associated with receipt of services to prevent mother-to-child HIV transmission (PMTCT). Methods We conducted a secondary analysis of the PEARL study, an evaluation of PMTCT effectiveness in Cameroon, Cote d'Ivoire, South Africa, and Zambia. Our exposure of interest was the women's role (active vs. not active) in decision-making about her healthcare, large household purchases, children's schooling, and children's healthcare (i.e., four domains). Our primary outcomes were self-reported engagement at three steps in PMTCT: maternal antiretroviral use, infant antiretroviral prophylaxis, and infant HIV testing. Associations found to be significant in univariable logistic regression were included in separate multivariable models. Results From 2008 to 2009, 613 HIV-infected women were surveyed and provided information about their decision-making roles. Of these, 272 (44.4%) women reported antiretroviral use; 281 (45.9%) reported infant antiretroviral prophylaxis; and 194 (31.7%) reported infant HIV testing. Women who reported an active role were more likely to utilize infant HIV testing services, across all four measured domains of decision-making (adjusted odds ratios [AORs] 2.00-2.89 all p < .05). However, associations between decision-making and antiretroviral use-for both mother and infant-were generally not significant. An exception was active decision-making in a woman's own healthcare and reported maternal antiretroviral use (AOR 1.69, p < 0.05). Conclusions for Practice Associations between decision-making and PMTCT engagement were inconsistent and may be related to specific characteristics of individual health-seeking behaviors. Interventions seeking to improve PMTCT uptake should consider the type of health-seeking behavior to better optimize health services.

The effect of a community health worker intervention on public satisfaction: evidence from an unregistered outcome in a cluster-randomized controlled trial in Dar es Salaam, Tanzania

BACKGROUND

There is a dearth of evidence on the causal effects of different care delivery approaches on health system satisfaction. A better understanding of public satisfaction with the health system is particularly important within the context of task shifting to community health workers (CHWs). This paper determines the effects of a CHW program focused on maternal health services on public satisfaction with the health system among women who are pregnant or have recently delivered.

METHODS

From January 2013 to April 2014, we carried out a cluster-randomized controlled health system implementation trial of a CHW program. Sixty wards in Dar es Salaam, Tanzania, were randomly allocated to either a maternal health CHW program (36 wards) or the standard of care (24 wards). From May to August 2014, we interviewed a random sample of women who were either currently pregnant or had recently delivered a child. We used five-level Likert scales to assess women's satisfaction with the CHW program and with the public-sector health system in Dar es Salaam.

RESULTS

In total, 2329 women participated in the survey (response rate 90.2%). Households in intervention areas were 2.3 times as likely as households in control areas to have ever received a CHW visit (95% CI 1.8, 3.0). The intervention led to a 16-percentage-point increase in women reporting they were satisfied or very satisfied with the CHW program (95% CI 3, 30) and a 15-percentage-point increase in satisfaction with the public-sector health system (95% CI 3, 27).

CONCLUSIONS

A CHW program for maternal and child health in Tanzania achieved better public satisfaction than the standard CHW program. Policy-makers and implementers who are involved in designing and organizing CHW programs should consider the potential positive impact of the program on public satisfaction.

TRIAL REGISTRATION

ClinicalTrials.gov, EJF22802.

Satisfaction of Patients Attending Public HIV or AIDS Care and Treatment Centers in Kinondoni District, Tanzania

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.