Socio-demographic and clinical characteristics
Mean age of the pregnant women in the study was 29.0 years ± standard deviation (SD) of 5.2 years. The mean age of mothers of children under 5 years of age was 30.0 ± 5.2 years. The predominant age group between both maternal groups in the study was women aged 25–34 years of age (69.5% of all participants). Majority of the respondents (60.9%) were within the lower upper socio-economic class. Most respondents (90.8%) were married and living in their matrimonial homes. Slightly above half (51.6%) of the respondents attained secondary education. Almost eighty percent of the respondents have had more than one child (Table 1).
Table 1
Socio-demographic and clinical characteristics of the respondents
Variables | Number (n) | Percentage (%) |
Respondents group | | |
Pregnant women | 818 | 59.6 |
Mothers of Children Under 5 years of age | 555 | 40.4 |
Age group (years) | | |
< 24 | 207 | 15.1 |
25–34 | 954 | 69.5 |
35+ | 212 | 15.4 |
Socio economic status | | |
Lower class | 202 | 14.8 |
Lower middle class | 219 | 16.0 |
Lower upper class | 833 | 60.9 |
Upper class | 115 | 8.4 |
Marital status | | |
Never married | 42 | 3.1 |
Married | 1261 | 91.8 |
Separated/Widowed | 70 | 5.1 |
Education | | |
No formal education | 97 | 7.1 |
Primary | 81 | 5.9 |
Secondary | 709 | 51.6 |
Tertiary | 486 | 35.4 |
Religion | | |
Christianity | 567 | 41.3 |
Islam | 784 | 57.1 |
Traditional worshipper | 22 | 1.6 |
Respondents number of children | | |
Pregnant with first child | 275 | 20.0 |
Has more than one child | 1098 | 80.0 |
Patients’ satisfaction with malaria care
Table 2 shows the summary of respondents’ satisfaction with malaria care for each item on the eighteen-domain questionnaire. The lowest level of satisfaction (41.4%, mean score 3.06 ± 1.2) among pregnant women was reported on item 4 (Sometimes doctors make me wonder if their diagnosis is correct) and 45.1% (mean 3.16 ± 1.3) among mothers of children under 5 years of age. Highest level of satisfaction 65.2% (mean 4.37 ± 0.7) among pregnant was found for item 1 (doctors/health staff are good at explaining the reason for malaria test/s). However, among mothers of children under 5 years of age, highest level of satisfaction 88.7% (mean 4.39 ± 0.9) was noted for item 18 (I am able to get malaria treatment whenever I need it).
Satisfaction level of the 7 domains derived from the raw scale is presented in Table 3. General satisfaction to malaria care was 79.5% with mean score 3.91 ± 0.5 among pregnant women and 78.8% (mean 3.87 ± 0.5) for mothers of children less than 5 years old. For other measures of satisfaction, pregnant women and mothers reported the following: satisfaction with technical quality 63.2% (mean 3.55 ± 0.3) and 64.6% (mean 3.57 ± 0.3) respectively; Interpersonal manner, 90.0% (mean 3.91 ± 0.4) and 83.8% (mean 4.02 ± 0.3), respectively; satisfaction to communication, 78.5% (mean 3.89 ± 0.5) and 80% (mean 3.97 ± 0.6), respectively; satisfaction to financial aspect of care, was 72.5% (mean 3.81 ± 0.5) and 71.9% (mean 3.79 ± 0.6), respectively; satisfaction to time spent with doctor, 69.4% (mean 3.72 ± 0.5) and 73.2% (mean 3.82 ± 0.5), respectively; and satisfaction to accessibility and convenience, 68.7% (mean 3.93 ± 0.6) and 78.1% (mean 4.03 ± 0.4), respectively (Table 3).
Table 2
Respondents Satisfaction levels for each of the eighteen items
Questions | Total |
No (Strongly disagree and disagree N (%) | Uncertain N (%) | Yes (Strongly agree and agree) N (%) | Mean of responses 1–5 | Standard Deviation |
Q1 - Doctors/health staff are good at explaining the reason for malaria test/s | 96 (9.2) | 135 (12.9) | 699 (77.9) | 4.35 | 0.71 |
Q2 - I think the health facility has everything needed to provide complete care | 24 (2.7) | 49 (5.0) | 850 (92.2) | 4.24 | 0.69 |
Q3 - The malaria intervention I have been receiving is just about perfect | 16 (2.0) | 65(6.7) | 829(91.3) | 4.30 | 0.69 |
Q4 - Sometimes doctors make me wonder if their diagnosis is correct | 382 (43.3) | 189 (21.0) | 320 (35.8) | 3.10 | 1.25 |
Q5 - I feel confident that I can get the malaria intervention/s I need without being set back financially | 45(5.0) | 74 (7.7) | 788 (87.3) | 4.21 | 0.83 |
Q6 - When I go for medical care, they health staff are careful to check everything when treating and examining me | 49(5.6) | 87(9.3) | 776(85.1) | 4.18 | 0.82 |
Q7 - I have to pay for more of my medical care than I can afford | 552(61.4) | 109(11.4) | 252(27.3) | 3.41 | 1.18 |
Q8 - I have easy access to the medical specialists I need | 82 (9.2) | 90 (9.7) | 733(81.1) | 4.10 | 0.94 |
Q9 - When I get care for malaria, people have to wait too long for emergency treatment | 469(53.7) | 127(14.2) | 310(32.1) | 3.21 | 1.24 |
Q10 - Health staff (Doctors/nurses) act too businesslike and impersonal towards me | 53 (59.2) | 155 (16.9) | 213 (23.9) | 3.42 | 1.15 |
Q11 - My doctors/nurse treat me in a very friendly and courteous manner | 694 (75.7) | 89 (10.1) | 125 (14.2) | 4.01 | 1.06 |
Q12 - Those who provide medical care sometimes hurry too much when they treat me for malaria | 607 (67.1) | 115 (13.4) | 183 (19.5) | 3.53 | 1.09 |
Q13 – Doctors sometimes ignore what I tell them | 45 (6.3) | 57 (7.3) | 790 (86.4) | 3.68 | 0.98 |
Q14 - I have some doubts about the ability of the doctor who treat me | 154 (17.7) | 82 (8.9) | 657 (73.4) | 3.66 | 1.07 |
Q15 - Doctors usually spend plenty of time with me | 164(18.0) | 119(13.0) | 624(69) | 3.83 | 1.09 |
Q16 - I find it hard to get an appointment for medical care | 585(66.0) | 94(10.4) | 201(23.6) | 3.54 | 1.20 |
Q17 - I am dissatisfied with some things about the malaria treatment I receive | 620(69.8) | 101(11.2) | 169(19.1) | 3.62 | 1.10 |
Q18 - I am able to get malaria treatment whenever I need it | 70(7.6) | 57(6.2) | 763(86.2) | 4.29 | 0.94 |
According to the instructions for scoring Patient Satisfaction Questionnaire 18 (PSQ-18) [13] |
(i) ‘Agree or strongly agree’ = ‘Satisfaction’ for Items 1, 2, 3, 5, 6, 8, 11, 15 and 18. |
(ii) ‘Disagree or strongly disagree’ = ‘Satisfaction’ for Items 4, 7, 9, 10, 12, 13, 14, 16 and 17. |
(iii) For all 18 items, means can range from 1 (strongly dissatisfied) to 5 (strongly satisfied). The results are coded in such a way that, the closer the means are to ‘5’, the higher the satisfaction level for ALL the items. |
Table 3
Seven Scales of Satisfaction Items in Table 2
SN | Satisfaction Scales (component items are shown in brackets) | Pregnant women | Mothers of under-five years children |
Total means from component items | Means of Satisfaction Scales (average of means deviation from component items) | Standard deviation | % Satisfaction (average of percentages from component items) | Total means from component items | Means of Satisfaction Scales (average of means deviation from component items) | Standard deviation | % Satisfaction (average of percentages from component items) |
1 | General Satisfaction (Items 3 + 17) | 7.81 | 3.91 | 0.47 | 79.5 | 7.73 | 3.87 | 0.54 | 78.80 |
2 | Technical Quality (Items 2 + 4 + 6 + 14) | 14.18 | 3.55 | 0.33 | 63.2 | 14.26 | 3.57 | 0.29 | 64.55 |
3 | Interpersonal Manner (Items 10 + 11) | 7.81 | 3.91 | 0.40 | 89.95 | 8.04 | 4.02 | 0.33 | 83.80 |
4 | Communication (Items 1 + 13) | 7.78 | 3.89 | 0.53 | 78.5 | 7.93 | 3.97 | 0.55 | 80.00 |
5 | Financial Aspects (Items 5 + 7) | 7.61 | 3.81 | 0.53 | 72.45 | 7.58 | 3.79 | 0.55 | 71.95 |
6 | Time Spent With Doctor (Items 12 + 15) | 7.43 | 3.72 | 0.52 | 69.35 | 7.63 | 3.82 | 0.45 | 73.15 |
7 | Accessibility and Convenience (Items 8 + 9 + 16 + 18) | 15.7 | 3.93 | 0.59 | 68.7 | 16.12 | 4.03 | 0.43 | 78.10 |
Association of patients’ satisfaction with malaria care
Table 4 presents the odds ratios for estimates of the ordinal regression association of potential explanatory factors for satisfaction with malaria care among pregnant women. The determination of general satisfaction with malaria care showed that respondents who were pregnant with their first child were significantly less likely to feel generally satisfied with malaria care offered (OR: 0.51, 95% CI: 0.34–0.75) compared to those who had more than one number of children. Low educational status was associated with higher satisfaction for technical quality of care provided. Pregnant women with primary education were found to have significantly higher odds (OR: 3.50, 95% CI: 1.19–10.28) than those with higher education to be satisfied with technical quality of the malaria care provided. Further, significant association was found for both interpersonal manner and communication with marital status. Married pregnant women had higher odds of being satisfied with the doctor’s interpersonal manner (OR: 2.09, 95% CI: 1.03–4.23) and level of communication (OR: 2.26, 95% CI: 1.04–4.91) compared to the never married pregnant women. Respondents currently pregnant with first child were shown to be 48% less likely to be satisfied with the financial aspect of malaria care (OR: 0.52, 95% CI: 0.36–0.76) than women with more than one child. With respect to time spent with doctor, respondents currently pregnant with first child were also shown to be 46% significantly less likely to report satisfaction compared to respondents with more than one child (OR: 0.56, 95% CI: 0.38–0.83). Poorer pregnant women (OR: 2.51; 95% CI: 1.08–5.84) and rich pregnant women (OR: 2.28, 95% CI: 1.12–4.64) had significantly higher odds for satisfaction with accessibility and convenience to malaria care compared to those with richest wealth status.
Table 5 presents ordinal regression results for association of explanatory variables with satisfaction scale for malaria care among mothers of children less than 5 years of age. With respect to general satisfaction scale, mothers of children under 5 years of age with poorest wealth status had much (70%) lower odds (OR: 0.30, 95% CI: 0.10–0.90) of being generally satisfied with malaria care compared to those with richest wealth status. Significant association was also found for respondents’ satisfaction with health worker’s interpersonal manner and communication. Mothers with secondary education were observed to be 51% less likely to be satisfied with the doctors interpersonal manner (OR: 0.49, 95% CI: 0.29–0.83) compared to those with tertiary education. Also, the poorest mothers of children under 5 years of age were shown to be 80% less likely to be satisfied with health care workers level of communication (OR: 0.20; 95% CI: 0.07–0.58) compared to those with richest wealth status.
Table 4
Multivariate ordinal logistics regression results for association of explanatory variables with satisfaction scale for malaria care among pregnant women
Satisfaction domain | Factor | OR | 95% CI | P-value |
Lower | Upper |
General satisfaction | Marital status | Separated/Widowed | 1.41 | 0.42 | 4.67 | 0.577 |
Married | 1.65 | 0.80 | 3.42 | 0.177 |
Never married | 1.00 | | | |
Respondents number of children status | Pregnant with one child | 0.51 | 0.34 | 0.75 | 0.001 |
Has more than one child | 1.00 | | | |
Technical Quality | Education | No formal education | 0.70 | 0.32 | 1.50 | 0.357 |
Primary | 3.50 | 1.19 | 10.28 | 0.023 |
Secondary | 1.22 | 0.83 | 1.79 | 0.303 |
Tertiary | 1.00 | | | |
Interpersonal Manner | Marital status | Separated/Widowed | 1.54 | 0.44 | 5.35 | 0.498 |
Married | 2.09 | 1.03 | 4.23 | 0.041 |
Never married | 1.00 | | | |
Communication | Wealth status | Poorest | 1.10 | 0.49 | 2.47 | 0.817 |
Poorer | 2.07 | 0.89 | 4.80 | 0.091 |
Rich | 1.18 | 0.58 | 2.40 | 0.641 |
Richest | 1.00 | | | |
Marital status | Separated/Widowed | 2.38 | 0.63 | 8.93 | 0.2 |
Married | 2.26 | 1.04 | 4.91 | 0.039 |
Never married | 1.00 | | | |
Education | No formal education | 1.01 | 0.45 | 2.24 | 0.987 |
Primary | 1.29 | 0.45 | 3.67 | 0.635 |
Secondary | 1.43 | 0.95 | 2.14 | 0.086 |
Tertiary | 1.00 | | | |
Financial aspect | Wealth status | Poorest | 0.98 | 0.44 | 2.19 | 0.969 |
Poorer | 1.60 | 0.71 | 3.62 | 0.257 |
Rich | 1.89 | 0.94 | 3.82 | 0.075 |
Richest | 1.00 | | | |
Education | No formal education | 0.88 | 0.42 | 1.85 | 0.743 |
Primary | 2.30 | 0.83 | 6.39 | 0.109 |
Secondary | 1.46 | 0.99 | 2.16 | 0.054 |
Tertiary | 1.00 | | | |
Respondents number of children status | Pregnant with one child | 0.52 | 0.36 | 0.76 | 0.001 |
Has more than one child | 1.00 | | | |
Accessibility and convenience | Wealth status | Poorest | 1.74 | 0.77 | 3.95 | 0.184 |
Poorer | 2.51 | 1.08 | 5.84 | 0.033 |
Rich | 2.28 | 1.12 | 4.64 | 0.023 |
Richest | 1.00 | | | |
Marital status | Separated/Widowed | 2.58 | 0.71 | 9.38 | 0.150 |
Married | 2.20 | 1.02 | 4.75 | 0.045 |
Never married | 1.00 | | | |
Time spent with doctor | Education | No formal education | 0.87 | 0.41 | 1.88 | 0.729 |
Primary | 3.26 | 0.99 | 10.75 | 0.052 |
Secondary | 1.06 | 0.70 | 1.59 | 0.786 |
Tertiary | 1.00 | | | |
Respondents number of children status | Pregnant with one child | 0.56 | 0.38 | 0.83 | 0.004 |
Has more than one child | 1.00 | | | |
Table 5
Multivariate ordinal logistics regression results for association of explanatory variables with satisfaction scale for malaria care among mothers of children under 5 years of age
Satisfaction domain | Factor | AOR | 95% CI | P-value |
Lower | Upper |
General Satisfaction | Wealth status | Poorest | 0.30 | 0.10 | 0.90 | 0.031 |
Poorer | 0.93 | 0.37 | 2.37 | 0.884 |
Rich | 1.42 | 0.65 | 3.13 | 0.38 |
Richest | 1.00 | | | . |
Interpersonal Manner | Wealth status | Poorest | 0.39 | 0.13 | 1.14 | 0.086 |
Poorer | 0.90 | 0.35 | 2.30 | 0.823 |
Rich | 0.83 | 0.37 | 1.84 | 0.64 |
Richest | 1.00 | | | . |
Marital status | Separated/Widowed | 11.05 | 0.58 | 208.93 | 0.109 |
Married | 3.40 | 0.79 | 14.60 | 0.1 |
Never married | 1 | | | |
Education | No formal education | 1.01 | 0.23 | 4.42 | 0.994 |
Primary | 0.97 | 0.37 | 2.54 | 0.954 |
Secondary | 0.49 | 0.29 | 0.83 | 0.008 |
Tertiary | 1.00 | | | . |
Communication | Wealth status | Poorest | 0.20 | 0.07 | 0.58 | 0.003 |
Poorer | 0.75 | 0.30 | 1.93 | 0.555 |
Rich | 1.12 | 0.50 | 2.49 | 0.781 |
Richest | 1.00 | | | . |
Accessibility and convenience | Marital status | Separated/Widowed | 1.22 | 0.08 | 18.99 | 0.889 |
Married | 1.01 | 0.27 | 3.77 | 0.989 |
Never married | 1.00 | | | . |
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