Client satisfaction with integrated community case management program in Wakiso District, Uganda, October 2012: A cross sectional survey

Abstract

Background: Malaria, pneumonia and diarrhea are the leading causes of death in children un- der five years of age in Uganda. In a bid to im- prove access to prompt and effective treatment of these diseases, Malaria Consortium in part- nership with United Nations International Chil- dren’s Emergency Fund (UNICEF) introduced In- tegrated Community Case Management (ICCM) in eight central districts of Uganda. There is cur- rently limited information about client satisfac-tion 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 meth- ods and a modified SERVQUAL tool was con- ducted 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 re- ceived. Logistic regression models were also used. Results: Among 454 respondents, 80% of the care givers of children under five were sat- isfied with ICCM program. The overall gap (−0.332) between expectations and perceptions was significant, (t = −4.89, p-value 0.0081) mea- ning that despite the high level of client satis- faction, 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 dimen- sions except for reliability which had a score of −0.49 (p-value 0.0005). The multivariable logistic regression model showed that primary educa- tion (OR 2.8, 95% CI 1.12 - 6.80) and being a Mus- lim (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 sig- nificant difference between perceptions and ex- pectations for all the dimensions except for re- liability dimension. The DHO and implementing partners should ensure a systematic approach for gathering, aggregating, analysing and repor- ting data to map and identify key gaps in treat- ment coverage.