Assessment of Antiretroviral Therapy Monitoring Laboratory Services Quality in Governmental Hospitals at Addis Ababa, Ethiopia.
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Date
2011-06
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Addis Abeba University
Abstract
Background: - Despite the fact that Ethiopia is accelerating its ARTprogram, little is known about the quality of ART monitoring laboratoryservices in health facilities.
Objective: - To assess the quality of ART monitoring laboratory services inpublic hospitals of Addis Ababa with emphasis on client satisfaction,providers’ views, functional & structural status of the ART monitoringlaboratory service.
Methods: - Hospital based, descriptive cross sectional study was conducted from October to November 2010. In this study both quantitative andqualitative design forms were used. A total of 422 clients were considered forexit interview about their satisfaction towards ART monitoring laboratoryservices using structured questionnaire. To assess the structural and functional aspects of ART monitoring laboratories, observation checklist wasused. In-depth interview of providers were conducted to assess their viewson quality of ART monitoring laboratory services. Data were coded andentered using EPI info 2002 (Centers for Disease Control and PreventionAtlanta, GA) and analyzed using SPSS version 15 software (SPSS INC,Chicago, IL, USA). Satisfaction score was calculated by giving a value of onefor very satisfied. A value of two was assigned for response of satisfied; threefor neutral response. Values of four and five were given for dissatisfied andvery dissatisfied responses respectively. The mean, median and mode scoresfor the overall satisfaction were calculated. Median of the summary score ofsatisfaction was used to classify as satisfied and none satisfied since thedistribution of summary scores was skewed. Bivariate and multivariatelogistic regression models were also used to examine the effect of selectedvariables on patients’ satisfaction with ART monitoring laboratory services byusing Odds Ratio (OR) with a 95% Confidence Interval (CI). P-Value less than0.05 were taken as statistically significant. Variables that were found with astatistically significant association (p<0.05) at univariate logistic analysiswere entered and analyzed by multiple logistic regression analysis.
Results: - A total response rate of 406 (96.2%) from 422 sample size wasobtained. Among those 255(62.8%) were females. The overall satisfactionrate was 47.5%. The major determinants for none satisfaction were lack ofspace in blood drawing room to put client personal thing (AOR= 3.377, 95%CI 1.511-7.550, P=0.00), lack of information regarding bruises followingblood drawing (AOR= 2.029; CI 1.162-3.542, P=0.01 ),waiting time to get laboratory results (AOR= 4.096; CI 1.769-9.485, P=0.00), needle stick whileattempting to draw blood (AOR=7.769, 95% CI 1.280-47.166, P=0.02),waiting time to get blood drawing service (AOR= 7.643, 95% CI2.62722.236,P=0.00). None of the hospital laboratory had guideline for disposalof damagedor expired laboratory reagents. Equipmenm aintenance wasone ofthemajor problemsfound inalmost allpublichospital of thecity providingARTservicesduringin-depthinterviewofproviders.
Conclusion:-Theoverall satisfactionlevelof clientswithART monitoringlaboratoryservices was 47.5%.Accessibilityand availability of latrines,abilityofphlebotomistto answerquestionsraisedby clientsandcomfort ofchairsinblooddrawingroomwereconsideredthemost significantfactors forlowsatisfactionlevels.Equipmentmaintenancewasa major challengeinrendering ART monitoring laboratory services in public hospitals.
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Keywords
Antiretroviral Therapy ,Laboratory Services,Quality