Assessing the quality of care in sick child services at health facilities in Ethiopia

Abstract

Background: Quality of care depends on system, facility, provider, and client-level factors. We aimed at examining structural and process quality of services for sick children and its association with client satisfaction at health facilities in Ethiopia. Methods: Data from the Ethiopia Service Provision Assessment Plus (SPA+) survey 2014 were used. Measures of quality were assessed based on the Donabedian framework: structure, process, and outcome. A total of 1908 mothers or caretakers were interviewed and their child consultations were observed. Principal component analysis was used to construct quality of care indices including a structural composite score, a process composite score, and a client satisfaction score. Multilevel mixed linear regression was used to analyze the association between structural and process factors with client satisfaction. Result: Among children diagnosed with suspected pneumonia, respiratory rate was counted in 56% and temperature was checked in 77% of the cases. A majority of children (92%) diagnosed with fever had their temperature taken. Only 3% of children with fever were either referred or admitted, and 60% received antibiotics. Among children diagnosed with malaria, 51% were assessed for all three Integrated Management of Childhood Illnesses (IMCI) main symptoms, and 4% were assessed for all three general danger signs. Providers assessed dehydration in 54% of children with diarrhea with dehydration, 17% of these children were admitted or referred to another facility, and Oral Rehydration Solution was prescribed for 67% while none received intravenous fluids. The number of basic amenities in the facility was negatively associated with the clients' satisfaction. Private facilities, when the providers had got training for care of sick children in the past 2 years, had higher client satisfaction. There was no statistical association between structure, process composite indicators and client satisfaction. Conclusion: The assessment of sick children was of low quality, with many missing procedures when comparing with IMCI guidelines. In spite of this, most clients were satisfied with the services they received. Structural and process composite indicators were not associated with client's satisfaction. These findings highlight the need to assess other dimensions of quality of care besides structure and process that may influence client satisfaction.

Health postservice readiness and use of preventive and curative services for suspected childhood pneumonia in Ethiopia: a cross-sectional study

“…However, the general health post readiness had no association with awareness and coverage of pentavalent-3 immunisation, but a negative association with care-seeking for childhood suspected pneumonia and other illnesses. Studies in Haiti and Ethiopia have shown absence of association between readiness of primary healthcare facilities for sick child care and caregivers’ utilisation and satisfaction to the respective services 40 58. The lack of consistent positive association may be linked to the dominating low level of health post preparedness.…”

Appropriateness of Care for Common Childhood Infections at Low-Level Private Health Facilities in a Rural District in Western Uganda

“…Other studies carried out in private and public health facilities in Uganda and other African countries found that 7-24% children testing positive for malaria never received the correct malaria medicine [46,47]. In a study from Nigeria, over 85% of children with watery diarrhea were given unnecessary antibiotics, while in a study from Ethiopia, the assessment, as well as treatment of children for cough, fever, and diarrhea in clinics was of poor quality [48,49]. In our study, it is probable that the health workers were able to diagnose the conditions using the knowledge they had from their professional training since the presentation of the conditions remains the same.…”

Factors associated with the referral of children with severe illnesses at primary care level in Ethiopia: a cross-sectional study

“…This scenario could indicate that Open access many care-seeking sick children were not getting the care they required, at least not at the health post. 35 The lack of essential medicines might be a reason for some referrals of children with non-severe diseases, which otherwise may be treated at the first-level health facility. 32 36 This condition might also impose caregiver for unnecessary social and economic costs incurred by referrals of children with non-severe illnesses.…”