An Assessment of Client Satisfaction with Services at a Model Primary Health Care Centre in Ogun State; Nigeria

BACKGROUND: Assessing patient satisfaction with health care is increasingly becoming an integral component of quality monitoring in health care systems. However; studies that have been conducted in this environment often show that clients' perceptions of quality of care from public sector providers are generally low. Timeliness; which refers to obtaining needed care and minimizing unnecessary delays in getting that care; may impact considerably on patients' satisfaction. This study w as designed toexamine how the consumers of services at a model primary health centre in Ogun State; Nigeria; viewed their health-seeking experience; relating this to the level of organization.and timeliness of health services provision. OBJECTIVES: This study sought to assess the satisfaction of clients with services at a model PHC centre at Pakoto; Ogun State; Nigeria. METHODS: The Pakoto model primary health care centre is an outstation of the Lagos University Teaching Hospital (LUTH) Idi-Araba; Lagos State. The study was carried out on weekday mornings at the model PHC clinic during the month of June; 2006. Methods of data collection employed were a general observation of clinic activities; and the administration of a modified client flow analysis chart to clients as they exited the health facility. RESULTS: The peak time of arrival of clients was between 9.00 and 11.00 a.m. when the majority (58.5) of clients arrived; the majority of clients (84) exited the facility oetween 11:00 a.m. and 1:00 p.m. The highest proportion of clients (33.1) spent 3-4 hours accessing services at the model PHC facility. Good staff attitude topped the list of aspects of service liked most by clients (36); while the aspect of service liked least by respondents was lack of timeliness of services (43). Suggestions for improvement of services included increase in the number of staff and staff training (30) and early arrival of staff to work (13). CONCLUSION: The study concludes that timeliness of services at the primary health care level impacts positively upon the perception of quality of services rendered to clients

A double-blind placebo-controlled study to assess the effect of cisapride (PREPULSID) on milk feed tolerance in preterm infants -32 weeks gestation

Thirty-six premature infants with a mean birth weight of 1250 g and a gestation age of 28 weeks were enrolled in a randomised double-blind placebo controlled study to assess the effect of Cisapride on milk feed tolerance. Cisapride or placebo was given orally at a dose of 0.2 mg/kg/dose four times daily from the time feeds were commenced up to one week after full feeds (150 ml/kg/day) were attained. All infants were fed expressed breast milk (EBM) or Premature Enfalac every 2 hours and graded up by 1 ml every 2 hours via nasogastric tube (NGT). Six parameters were assessed during the study period to determine feed intolerance. Milk feed intolerance was defined as 2 major or 1 major plus 2 minor criteria. The major criteria included gastric aspirates 2 ml/kg or 30% of volume given at the last feed and bile-stained aspirates. The minor criteria included vomiting, abdominal distention, blood in stools, and reducing substances in stools 2%. The possible risks of cholestasis and the development of ECG changes were also evaluated in the treated group. Milk feed intolerance did not occur in the Cisapride group (0/18, 0%), but was present in 49% (7/18) of the placebo group (p+0.003). Cisapride significantly reduced the volume of gastric aspirates (p=0.025) and vomiting episodes (p=0.011) in the treated infants. No infant who received Cisapride developed cholestatic jaundice clinically nor manifested any abnormal ECG findings. We conclude that Cisapride is effective in improving milk feed intolerance in premature infants -32 weeks gestation and no evidence of cholestasis nor ECG changes were observed after treatments.(Author)

Recombinant human erythropoietin in anemia of prematurity.

OBJECTIVE: To evaluate safety and efficacy of recombinant human erythropoietin (r-HuEPO)in reducing the need for red cell transfusions in anemia of prematurity. METHODS: forty -two preterm infants (gestational age <32 weeks) were randomly assigned to a "treatment" group (r-HuEPO 400 units/kg every alternate day * 10 doses) or "no treatment" (control) group. All infants on enteral feeds received oral iron 3 mg/kg/day, graded up to 6 mg/kg/day. RESULTS: Higher reticulocyte counts in week 2 and 3 and higher hemoglobin levels in week 4 were noted after treatment with r-HuEPO. Despite stumulated erythropoiesis, the frequency of transfusions could not be reduced with r-HuEPO therapy.Overall, Phlebotomy losses, frequency and volume of redcell transfusions were significantly more in neonates with birthweight <1000 grams compared with those with birthweight >1000 grams (p<0.05). Associated side effects of r-HuEPO such as neutropenia,sepsis, hypertension or increased risk of late death did not occur. CONCLUSION:r-HuEPO therapy was safe without any side effects.Inability of r-HuEPO therapy to minimize red cell transfusions for anemia of prematurity may be explained by a relatively strict red-cell transfusion policy and the desired degree of treatment effect.