title: Caregiver satisfaction with paediatric HIV treatment and care in Nigeria and equity implications for children living with HIV.
abstract: Caregiver satisfaction has the potential to promote equity for children living with HIV, by influencing health-seeking behaviour. We measured dimensions of caregiver satisfaction with paediatric HIV treatment in Nigeria, and discuss its implications for equity by conducting facility-based exit interviews for caregivers of children receiving antiretroviral therapy in 20 purposively selected facilities within 5 geopolitical zones. Descriptive analysis and factor analysis were performed. Due to the hierarchical nature of the data, multilevel regression modelling was performed to investigate relationships between satisfaction factors and socio-demographic variables. Of 1550 caregivers interviewed, 63% (95% CI: 60.6-65.4) reported being very satisfied overall; however, satisfaction varied in some dimensions: only 55.6% (53.1-58.1) of caregivers could talk privately with health workers, 56.9% (54.4-59.3) reported that queues to see health workers were too long, and 89.9% (88.4-91.4) said that some health workers did not treat patients living with HIV with sufficient respect. Based on factor analysis, two underlying factors, labelled Availability and Attitude, were identified. In multilevel regression, the satisfaction with availability of services correlated with formal employment status (p < .01), whereas caregivers receiving care in private facilities were less likely satisfied with both availability (p < .01) and attitude of health workers (p < .05). State and facility levels influenced attitudes of the health workers (p < .01), but not availability of services. We conclude that high levels of overall satisfaction among caregivers masked dissatisfaction with some aspects of services. The two underlying satisfaction factors are part of access typology critical for closing equity gaps in access to HIV treatment between adults and children, and across socio-economic groups.
authors.affiliation: a Health Section , UNICEF , New York , NY , USA.
authors.forename: Dick
authors.initials: D
authors.lastname: Chamla
authors.affiliation: b NASCP, Federal Ministry of Health , Abuja , Nigeria.
authors.forename: Chukwuemeka
authors.initials: C
authors.lastname: Asadu
authors.affiliation: c Faculty of Clinical Sciences , Obafemi Awolowo University , Ile-Ife , Nigeria.
authors.forename: Ebun
authors.initials: E
authors.lastname: Adejuyigbe
authors.affiliation: d Country Office, UNICEF , Abuja , Nigeria.
authors.forename: Abiola
authors.initials: A
authors.lastname: Davies
authors.affiliation: e Department of Paediatrics , Nnamdi Azikiwe University Teaching Hospital , Nnewi Anambra State , Nigeria.
authors.forename: Ebele
authors.initials: E
authors.lastname: Ugochukwu
authors.affiliation: f Department of Paediatrics , ABU Teaching Hospital Zaria , Kaduna State , Nigeria.
authors.forename: Lawal
authors.initials: L
authors.lastname: Umar
authors.affiliation: g World Health Organization , Abuja , Nigeria.
authors.forename: Ilesanmi
authors.initials: I
authors.lastname: Oluwafunke
authors.affiliation: h Paediatrics Department , Aminu Kano Teaching Hospital/Bayero University , Kano State , Nigeria.
authors.forename: Fatimah
authors.initials: F
authors.lastname: Hassan-Hanga
authors.affiliation: e Department of Paediatrics , Nnamdi Azikiwe University Teaching Hospital , Nnewi Anambra State , Nigeria.
authors.forename: Chinyere
authors.initials: C
authors.lastname: Onubogu
authors.affiliation: i Paediatric HIV and Infectious Disease Unit , Federal Medical Centre , Yenagoa Bayelsa State , Nigeria.
authors.forename: Immaculata
authors.initials: I
authors.lastname: Tunde-Oremodu
authors.affiliation: e Department of Paediatrics , Nnamdi Azikiwe University Teaching Hospital , Nnewi Anambra State , Nigeria.
authors.forename: Chinelo
authors.initials: C
authors.lastname: Madubuike
authors.affiliation: e Department of Paediatrics , Nnamdi Azikiwe University Teaching Hospital , Nnewi Anambra State , Nigeria.
authors.forename: Esther
authors.initials: E
authors.lastname: Umeadi
authors.affiliation: e Department of Paediatrics , Nnamdi Azikiwe University Teaching Hospital , Nnewi Anambra State , Nigeria.
authors.forename: Obed
authors.initials: O
authors.lastname: Epundu
authors.affiliation: j Health Service Commission , Lagos state , Nigeria.
authors.forename: Adenike
authors.initials: A
authors.lastname: Omosun
authors.affiliation: f Department of Paediatrics , ABU Teaching Hospital Zaria , Kaduna State , Nigeria.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Anigilaje
authors.affiliation: b NASCP, Federal Ministry of Health , Abuja , Nigeria.
authors.forename: Daniel
authors.initials: D
authors.lastname: Adeyinka
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D017028:Caregivers / Q000523:psychology*; D002648:Child; D005163:Factor Analysis, Statistical; D005260:Female; D015658:HIV Infections / Q000523:psychology / Q000628:therapy*; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009549:Nigeria; D010549:Personal Satisfaction; D011787:Quality of Health Care; D055815:Young Adult
keywords: Caregiver; equity; paediatric HIV; satisfaction