|Year : 2015 | Volume
| Issue : 4 | Page : 441-446
Patients' perception of the quality of malaria treatment in primary health care centers of Jos and Environs
NS Jimam1, S David1, NZ Galam2, BN Joseph1, OS Buoye1
1 Department of Clinical Pharmacy and Pharmacy Practice, University of Jos, Jos, Plateau, Nigeria
2 Department of Human Physiology, University of Jos, Jos, Plateau, Nigeria
|Date of Web Publication||14-Jul-2015|
N S Jimam
Department of Clinical Pharmacy and Pharmacy Practice, University of Jos, Jos, Plateau
Source of Support: None, Conflict of Interest: None
Background: Though the fight against malaria continued to be on the increased, the disease still remains a major public health problem in many developing countries, especially in the rural areas. The extent of drug use and its effect is affected among other things by the pattern in which these drugs are prescribed by the health workers. Patients' assessment of the quality of care depends on their ability to judge whether health care providers are adhering to the defined standard of care, hence it is necessary to assess the views of patients regarding the quality of care they received from the primary health care (PHC) centers. Aim: This study aimed at evaluating consumer's perception of the quality of malaria treatment in PHC centers of Jos and environs. Materials and Methods: Nine PHC centers were selected by multi-stage random sampling, five from Jos North and four from Jos South Local Government Areas of Plateau State. Patients of both sexes within the age range of 18 years and above who visited the PHC centers for malaria treatment were considered eligible to participate in the survey, provided that they were able to understand and respond to the interview questions. A semi-structured interviewer questionnaire which was adapted from previous health survey studies was administered to all the 249 eligible participants. The data collected were analyzed using the Statistical Package for Social Sciences (SPSS) version 20.0 software programmer. Results: The result showed that there were no consistently significant differences (P > 0.05) regarding patient satisfaction between male and female patients across selected items in the various domains, that is, irrespective of respondents' sex, their perception of the quality of health services rendered by PHCs was similar. Conclusion: It was therefore concluded that there was similar satisfaction level between the male and the female, though some key health services were not readily available in the PHC; most services that were available were readily accessible.
Keywords: Malaria, patients, perception, primary health care, quality of treatment
|How to cite this article:|
Jimam N S, David S, Galam N Z, Joseph B N, Buoye O S. Patients' perception of the quality of malaria treatment in primary health care centers of Jos and Environs. Med J DY Patil Univ 2015;8:441-6
|How to cite this URL:|
Jimam N S, David S, Galam N Z, Joseph B N, Buoye O S. Patients' perception of the quality of malaria treatment in primary health care centers of Jos and Environs. Med J DY Patil Univ [serial online] 2015 [cited 2020 Aug 4];8:441-6. Available from: http://www.mjdrdypu.org/text.asp?2015/8/4/441/160782
| Introduction|| |
Malaria is a major public health problem in Nigeria; it remains one of the leading causes of morbidity and mortality worldwide with pregnant women and their unborn children being more vulnerable.  According to the 2013 world malaria reports, it was estimated that 3.4 billion people were at risk of malaria globally with an estimated malaria cases of 207 million globally in 2012 and 627,000 deaths indicating a decreased in the episode compared to the 2012 report.  165 million of the malaria cases (about 80%) occurred in Africa, and 562,000 of the deaths (about 90%) occurred in Africa and 82% of the deaths occurring in under 5-years children.  According to the report, there was insufficiently consistent data to assess the trends of the malaria incidence in Nigeria for that year. It has been reported that Nigeria is responsible for 25% of malaria burden in Africa. 
The primary health care (PHC) is the entry point into the Nigerian healthcare sector and is aimed at providing healthcare services to the grass root; though the use of primary health facilities for malaria management is low. It is estimated that only about 20% of malaria episodes are treated in the health centers.  It is paramount to prescribe these drugs correctly to the few that come in contact with the health centers; the extent of drug use and its effect is affected by the pattern in which these drugs are prescribed by the health workers, especially in primary care.  Others include the availability of appropriate drugs, affordability, health education, and treatment seeking behavior among others, can also affect the quality of treatment.  Lack of appreciate knowledge on the disease and its management may result in inappropriate medications, as is the case in many health facilities of developing countries, including Nigeria.  For instance, it has been reported that acute febrile illness is the most common cause of hospital visitation and death in African children.  Majority of these illnesses are due to malaria or invasive bacterial disease, but differentiating between these causes is often difficult and can result in missed diagnoses and inappropriate treatment.  To ensure quality in the treatment of malaria, diagnosis should go beyond the presumptive diagnosis to the laboratory confirmation. , Assessment of the quality of malaria treatment services provided by health workers is needed to identify and correct problems associated with quality of malaria treatment services.
Patients' perception of quality of care is critical to community settings; studies have shown that perceived and actual qualities of care are the determinants of health outcomes and consumer's choice of treatment provider. ,
Actual quality of care focuses merely on structural and process measures, relating to professionally defined standard of care, and refers to whether health care services adhere to these standards, while perceived quality of care relates to the views of patients, which are attracting more and more importance. 
This study aimed at evaluating consumer's perception of the quality of malaria treatment in PHC centers of Jos and environs. It is expected that the outcome of this study will help in providing measures that will strengthen the treatment component of malaria control strategy, especially with the use of artemisinin-based combination therapy which is the first-line treatment for malaria in Nigeria.
| Materials and Methods|| |
The study was conducted in Jos Metropolis of plateau state. It is located in the North - Central part of Nigeria, popularly known as the middle belt. Malaria is stable practically everywhere in Plateau state; which could be due to high rainfall pattern in the state. The metropolis consisted of Jos North and South Local Government Areas (LGAs). Jos North Local Government has a total of 24 government-owned PHC health facilities and 21 privately owned health facilities (PSMOH, 2006). The PHC facilities are organized into the political ward system. Jos North LGA has 14 political wards each hosting between 1 and 4 health facilities.
Jos South LGA has a total of 35 PHC facilities organized into 16 political wards with an average of 1-2 PHC per political ward. The present study is focused only on the public primary health centers which are believed to be the main health care providers at the grassroots at affordable prices.
Patients of both sexes within the age range of 18 years and above who visit the PHC centers for malaria treatment were considered eligible to participate in the survey, provided that they were able to understand and respond to the interview questions. Patients were interviewed face to face by trained interviewers in English or Hausa as the case could be.
This was a facility-based cross-sectional descriptive survey. An assessment of the patients' perception of the quality of malaria treatment was made across selected PHC centers in Jos metropolis.
Sampling and sampling method
A multistage sampling technique was employed in selecting a respondent for this study.
Stage 1, selection of wards: In Jos North LGA, 5 political wards were selected randomly from the 14 political wards. These are Tafawa Balewa, Jenta Apata, Jenta Adamu, Dogon Agogo, and Tudun Wada political wards.
In Jos South LGA, 4 political wards were selected randomly from the 16 political wards and these were Gyel B, Giring, Bukuru, and Howlshe.
Stage 2, one PHC center was selected for each political ward by balloting. In Jos North, these were PHCs Township, Jenta Apata, Jenta Adamu, Dogon Agogo and Tudun Wada, respectively, while in Jos South, Bukuru Central, Bukuru Express, Howlshe, and Giring Abattoir PHCs were respectively selected for the study.
Stage 3, selection of participants: All patients attending the selected PHCs with cases of malaria were eligible to participate in the survey; a total of 249 patients were selected for the study.
Ethical approval and consent
Ethical approval for this study was obtained from the Faculty of Pharmaceutical Science, University of Jos research ethical committee. A written consent form was also read out and explained to the respondents. It was when the investigator was satisfied that the respondent understood it, including its implications and had agreed to participate, that s/he was included in the survey.
A semi-structured interviewer questionnaire which was adapted from previous health survey studies published in peer review journals were administered to all the eligible participants.
The data were collected by trained data collectors through face to face interview of the respondents.
Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 20.0 software programmer, IBM Incorporation.
| Result|| |
Demographic characteristic of the patients
Totally, 259 of the patients attending PHCs participated in the study, with the mean age of 36 ± 8.0 years and females constituted 56% of respondents. About 47.4% of the respondents were married. Majority of the respondents' (61%) were students [Table 1].
Patients' satisfaction measure
Perceived access to primary health care services
The result of the study [Table 2] showed that 52.3% of the male respondents agreed that it takes more than 1 h to go to the clinic while only 46.8% of the women agreed with the same time. On the cost of transport, 53% of men agreed that it cost them more than 100 naira (N100) to go to the clinic with about 51% of the women agreeing with that. Seventy-eight percent of women agreed that they were treated by nurses who spoke a language they could understand with 75% of the men also agreed to that.
Men were more positive in their responses to items of the empathy domain compared to women [Table 3]. About 55% of the male respondents agreed that the nurses who treated them introduced themselves with 69% of them stating that the nurse in the clinic was very interested in the patients. On the hand, 61% of women agreed that the nurses in the clinic makes it easy for them discuss about their problems.
Service standard measures
About 51.8% of men agreed that the registration procedures in the clinic were satisfactory; waiting time before examination was reasonable, also 60% of the males said the time they had to wait in the clinic before they were examined was reasonable. Both respondents agreed that health worker that assisted them had a name tag on them which help in improving the quality of service rendered [Table 4].
The item in this domain received a majority of positive responses from women respondents with about 60% of the women agreeing that the clinic building is in good condition. Fifty-seven percent of the woman also agreed that the building was in a good condition, and the clinic and its surroundings are clean. Furthermore, 80.6% agreed that there were benches for clients to sit while waiting to be seen by the health workers. Sixty-five percent of women also agreed that there was clean drinking water for patients with 48% of them agreeing that the clinic has enough consultation rooms while 56% of the men agreed that there are toilets for patients in the clinic [Table 5].
In this domain, the items also received a majority of positive responses from males' respondents. For example, 42.7% of men agreed that the nurses in the facility will call an ambulance if a patient is very sick and that 58.7% of men attested to the fact that nurses in that facility ask patients to return to see how they are doing, with 46.8% of the women agreeing to that fact. Thirty-three percent of the males respondents agreed to the fact that when they are sick they usually visits a traditional healer before they come to clinic with 24.5% of the females also agreeing to that fact [Table 6].
General satisfaction measures (52%)
There were a higher proportion of men who had positive responses on items of this domain when compared to women. 63.9% of men respondents positively agreed that patients are usually pleased with the way they are treated in the clinic with 51.8% agreeing to come back or encouraged relation to visit the clinic when necessary. About 56.2% of the male respondents agreed that staff do inform patients of changes in service, as well as any delays in services from time to time, 67% always get treatment when they come to this clinic [Table 7].
| Discussion|| |
Seeking to understand patients' perspectives is an important step in the efforts to improve the quality of health care. , The patients were satisfied with the staff relationship [Table 3]. A good percentage of the patients also showed satisfying attitudes to the ways they were greeted or welcome by the health care providers and the way they were listened to. This finding is similar to the finding of Abodunrin et al.  However, the result of the study is in contrast to similar studies in Central Africa  where the health workers were found to be so rude as to affect health services utilization.
The level of satisfaction of the patients regarding the time spent at the facility was low; especially the registration procedures of new patients in the clinic [Table 4]. Though, the waiting according to the men was satisfactory, the women said it was not satisfactory. Long waiting time has been reported to be a major reason for patients' dissatisfaction. 
The patients were also satisfied with the infrastructure of the clinics [Table 5]. This result is similar to that of Kano, Northern Nigeria where majority (87%) of the respondents were satisfied with the hospital environment;  though, the result is in contrast with similar studies from Eastern Ethiopia  where the patients were not too satisfied with the cleanliness of the health facility. Regarding consultation rooms, the patients responded that there were inadequate consulting rooms for attending to patients; hence, there is a need for improvement in such basic amenities.
In this study, there were generally no consistently significant differences regarding patients' satisfaction between male and female patients across selected items in the various domains [Table 7]. This is similar to a study conducted in South-East Nigeria.  A similar study have suggested female frequent visit to hospitals could be as a result of greater health needs of females (women and girl child), ranging from pregnancy, occupational health needs, children related illness, abuse and violence effect, communicable and noncommunicable diseases. 
Evidence from developed countries for gender differences in mean satisfaction levels is mixed. Some authors report that women are more satisfied than men with medical care received,  and some report that women are more critical of medical care than in a selected District Municipality of the Eastern Cape of South Africa 97,  whilst a 2005 Canadian study  found almost similar satisfaction levels between male (86%) and female (84%) patients which is similar to the present result of our study. However, a meta-analysis of 110 studies of patient satisfaction, using standard instruments, concluded that there was no average difference in satisfaction with medical care between women and men.  Sanmartin et al.  suggested that user frequency might influence the discrepancies found between male and female patient satisfaction rates and that the type of service being assessed might be a further factor. Wessels et al.  found that among oncology patients, women rated care aspect of services more highly. A Ugandan study found some gender and age difference in patient satisfaction with TB services. 
However, based on the data of this study, the result in [Table 7] shows that of the selected personal characteristics of respondents correlated with their perception of quality of healthcare services provided by PHC, only respondents' sex (P ≤ 0.05) had significant relationship with their general feelings. This implies that irrespective of respondents' sex, their perception of the quality of services rendered by PHCs was similar. Both male and female respondents' view the services from a similar perspective. However, respondents of various marital statuses, age, family background, and educational background were varied in their perception of the quality of care provided by PHCs. The plausible explanation for this trend of result with respect to sex being the only correlate of respondents' perception could be that men may have been indifferent to quality of health services rendered at the PHCs as they rarely patronize PHCs hence, the significance of quality of health at this level may not be of any significant interest to them. 
| Conclusion|| |
From the consumers' perception studies, it can be concluded that there were almost similar satisfaction level between the male and the female though some key health services were not readily available in the PHC, most services that were available were readily accessible.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]