Clinical and Hospital Level Predictors of Quality of Healthcare for Clients with Epilepsy attending Treatment at Selected Hospitals in Kenya

Abstract

BACKGROUND Quality of Healthcare is the degree to which health services increase the likelihood of desired health outcomes of individuals and populations in the context of prevailing professional knowledge. Despite accounting for 1% of the global disease burden, epilepsy care faces significant challenges, and treatment remains inadequate. This study aimed to determine predictors of quality of care for clients at the selected hospitals in the Nairobi metropolis.

METHODS A mixed methods cross-sectional approach was adopted and quantitative data were collected from 373 sampled epilepsy patients from Mama Lucy, Kiambu, Gatundu, Thika and Machakos Level 5 Hospitals using semi-structured questionnaires. Qualitative data were collected from key informant interviews and focus group discussions in the study sites. Using (SPSS) version 26, quantitative data were analysed using chi-square to determine the distribution of observation between groups, and logistic and multiple linear regression analyses to test for association quality of care and various variables. Qualitative data were analysed into themes using NVIVO.

RESULTS Predictors of high quality included formal employment with 3.372 OR CI (1.423-7.625) P=0.005, similarly, those who did not experience stigma were 1.98 CI (1.123-3.497) P= 0.018 likely to rate care as high quality. Less than one seizure after beginning treatment was another predictor of high-quality rating OR=2.405 CI (1.017-5.684), P= 0.045. Additionally, a shorter waiting time was a predictor of a good rating with OR= 2.692 CI (0.353-0.756) P=0.028. Patients who could afford treatment were also likely to rate care as high-quality OR=1.79 CI (2.427-3.642) P=0.045.

CONCLUSION Key clinical predictors of quality-of-care rating included the time to treatment initiation, type of anti-seizure medication, seizure frequency after treatment onset, and stigma experience. Hospital-related factors influencing care quality included waiting time, service availability, and affordability. Additionally, individuals with formal employment, seizure control, shorter waiting times, and the ability to afford medication were more likely to rate healthcare quality highly.