Health> Vol.5 No.11, November 2013

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

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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.

Cite this paper

Tumuhamye, N. , Rutebemberwa, E. , Kwesiga, D. , Bagonza, J. and Mukose, A. (2013) Client satisfaction with integrated community case management program in Wakiso District, Uganda, October 2012: A cross sectional survey. Health, 5, 1889-1898. doi: 10.4236/health.2013.511255.


[1] WHO (2008) Global burden of disease: 2004 update. Geneva.
[2] Nicoll, A. (2000) Integrated management of childhood illness in resource-poor countries: an initiative from the World Health Organization. Transactions of the Royal Society of Tropical Medicine & Hygiene, 94, 9-11.
[3] Black, R., Morris, S. and Bryce, J. (2003) Where and why are 10 million children dying every year? Lancet, 261, 2226-2234.
[4] Byakika-Kibwika, P., et al. (2010) Update on the efficacy, effectiveness and safety of artemether-lumefantrine combination therapy for treatment of uncomplicated malaria. Journal of Therapeutics and Clinical Risk Management, 2, 11-20.
[5] MOH (2010) Uganda ministry of health: Annual health sector performance report. M.O. Health, Kampala.
[6] Lynch, K.I., et al. (2005) President’s malaria initiative. Rapid Assessment Report, Uganda.
[7] Mulholland, K. (1999) Magnitude of the problem of childhood pneumonia. Lancet, 6736, 590-592.
[8] Reyes, H., Pérez-Cuevas, R., Salmeron, J., Tome, P., Guiscafre, H. and Gutierrez, G. (1997) Infant mortality due to acute respiratory infections: The influence of primary care processes. Health Policy Plan, 12, 214-223.
[9] Kosek, M., Bern, C. and Guerrant, R. (2003) The global burden of diarrhoeal disease, as estimated from studies published between 1992 and 2000. Bulletin of the World Health Organization, 81, 197-204.
[10] WHO (2007) Weekly epidemiological record. 285-296.
[11] Binka, F., et al. (2003) Incidence and risk factors of paediatric rotavirus diarrhoea in northern Ghana. Tropical Medicine & International Health, 8, 840-846.
[12] Parashar, U., Bresse, J. and Glass, R. (2006) Rotavirus and severe childhood diarrhea. Emerging Infectious Diseases, 12, 304-306.
[13] WHO (2008) Global networks for surveillance of rotavirus gastroenteritis. Weekly Epidemiological Report.
[14] MOH (2010) Uganda ministry of health: Integrated community case management of childhood malaria, pneumonia and diarrhoea. Implementation Guidelines, Kampala.
[15] Rutebemberwa, E., et al. (2009) Utilization of public or private health care providers by febrile children after user fee removal in Uganda. Malaria Journal, 14, 45.
[16] Yeka, A., et al. (2011) Malaria in Uganda: Challenges to control on the long road to elimination I. Epidemiology and current control efforts. Acta Tropica, 121, 184-195.
[17] Rutebemberwa, E., et al. (2009) Determinants of delay in care-seeking for febrile children in eastern Uganda. Tropical Medicine & International Health, 14, 472-479.
[18] Uganda Bureau of Statistics (2005) The 2002 Uganda population and housing census. U.B.O. Statistics, Kampala.
[19] Malaria Consortium Uganda (2011) Malaria consortium disease control. Better Health.
[20] Hall, J. and Dornan, M. (1990) Patient sociodemographic characteristics as predictors of satisfaction with medical care: A meta-analysis. Social Science & Medicine, 30, 811-818.
[21] Ferguson, J.M. and Higgins, L.F. (1999) A gap analysis of HOM service quality. Health Marketing Quarterly, 16, 1-15.
[22] Nguyen, V.F., et al. (2011) Determinants of patient satisfaction in ambulatory oncology: A cross sectional study based on the OUT-PATSAT35 questionnaire. BMC Cancer, 11, 526.
[23] Sitzia, J. and Wood, N. (1997) Patient satisfaction: A review of issues and concepts. Social Science and Medicine, 45, 1829-1843.
[24] Van Campen, C., Sixma, H. and Kerssens, J. (1997) Assessing noninstitutionalized asthma and COPD patients’ priorities and perceptions of quality of health care: The development of the QUOTE-CNSLD instrument. Journal of Asthma, 34, 531-538.
[25] Epstein, K., Laine, C. and Farber, N. (1996) Patients’ perceptions of Office Medical Practice: judging quality through the patients eyes. American Journal of Medical Quality, 11, 73-80.
[26] Hansen, P., Peters, D. and Viswanathan, K. (2008) Client perceptions of the quality of primary care services in Afghanistan. International Journal for Quality in Health Care, 20, 384-391.
[27] Andaleeb, S., Siddiqui, N. and Khandakar, S. (2007) Patient satisfaction with health services in Bangladesh. Health Policy Plan, 22, 263-273.
[28] Mendoza, et al. (2001) Client satisfaction and quality of health care in rural Bangladesh. Bulletin of the World Health Organization, 79, 512-517.
[29] Westaway, M.S. and Rheeder, P. (2003) Interpersonal and organizational dimensions of patient satisfaction: The moderating effects of health status. International Journal for Quality in Health Care, 15, 337-344.

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