Abstract
Background: Malaria, pneumonia and diarrhea are the leading causes of death in children under five years of age in Uganda. In a bid to improve access to prompt and effective treatment of these diseases, Malaria Consortium in partnership with United Nations International Children’s Emergency Fund (UNICEF) introduced Integrated Community Case Management (ICCM) in eight central districts of Uganda. There is currently limited information about client satisfaction with this program. The main objective of the study was to assess client satisfaction with the ICCM program in Wakiso district. Methods: A cross-sectional study using quantitative methods and a modified SERVQUAL tool was conducted and 454 care givers of children under five years of age were interviewed. Differences in mean scores between expected and perceived services were analyzed using paired t-tests and chi-square tests. A negative score implied that clients were not satisfied with the care they received. Logistic regression models were also used. Results: Among 454 respondents, 80% of the care givers of children under five were satisfied with ICCM program. The overall gap (－0.332) between expectations and perceptions was significant, (t = －4.89, p-value 0.0081) meaning that despite the high level of client satisfaction, there still existed a quality gap in services provided under ICCM. Furthermore, there were no significant differences in the expectation and perception scores among the different dimensions except for reliability which had a score of －0.49 (p-value 0.0005). The multivariable logistic regression model showed that primary education (OR 2.8, 95% CI 1.12-6.80) and being a Muslim (OR 2.9, 95% CI 1.40-6.34) were significantly associated with client satisfaction. Conclusion: Overall, 80% of the clients were satisfied with ICCM services despite the overall quality gap in ICCM services and there was no statistical significant difference between perceptions and expectations for all the dimensions except for reliability dimension. The DHO and implementing partners should ensure a systematic approach for gathering, aggregating, analysing and reporting data to map and identify key gaps in treatment coverage.
Highlights
About 12 million deaths occur annually in children under five years of agein developing countries [1] and 70% of these deaths are due to the common childhood illnesses and in most cases, a combination of these conditions [2]
There was no procedure for selecting certain age during the interview but care takers of the children who had used Integrated Community Case Management (ICCM) services were interviewed irrespective of age
Many of the respondents 264 (58%) got to know ICCM services because the village health team member had visited them in their homes
Summary
About 12 million deaths occur annually in children under five years of agein developing countries [1] and 70% of these deaths are due to the common childhood illnesses (diarrhea, pneumonia, measles, malaria, malnutrition) and in most cases, a combination of these conditions [2]. The main causes of death of children worldwide are neonatal disorders, diarrhea, pneumonia and malaria, HIV/AIDS accounts for at least 10% in some African countries [3]. The 2008 world malaria annual report estimation for total malaria deaths in Uganda was at 43,490, ranking it third in the world behind Nigeria and the Democratic Republic of Congo [6] This death toll exceeds that of HIV/AIDS [6]. Pneumonia and diarrhea are the leading causes of death in children under five years of age in Uganda. The overall gap (−0.332) between expectations and perceptions was significant, (t = −4.89, p-value 0.0081) meaning that despite the high level of client satisfaction, there still existed a quality gap in services provided under ICCM. There were no significant differences in the expectation and perception scores among the different dimensions except for reliability which had a score of
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