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Archived Comments for: Patient satisfaction with antiretroviral services at primary health-care facilities in the Free State, South Africa – a two-year study using four waves of cross-sectional data

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  1. The need for more studies on HIV-positive patients’ satisfaction with care

    N Malangu, University of Limpopo

    28 October 2008

    This study by Wouters et al[1]contributes enormously to characterization of the quality of services as rated by HIV-positive patients in South Africa. In the absence of regular institutional patient satisfaction surveys, studies like this one generate the knowledge that institutional managers could use to improve the quality of service they provide.

    Besides the fact that it has reported data on another province of South Africa, an important addition that this study has provided is the temporal assessment of patient satisfaction during approximately two years. However, although the study indicates that the mean age was 37.5 years, and that 68.1% of patients were female, 17.2% having completed high school, and only 2.5% having attended; the subsequent analyses did not show how the levels of satisfaction varied based on these factors, namely, age, gender, and level of education. Malangu and Mosane [2] reported also that the level of satisfaction was high among female than male patients but not comparison was made with regard to age, and education level.

    Moreover, this study reported that there is a high overall satisfaction with both general services and services provided by nurses in Free-State province; but not defined figure is mentioned in the paper. This makes it a bit difficult to compare the results to other South African studies on the topic. For instance, studies in Pretoria have reported satisfaction levels of 60.7%, and 85% respectively[2-3].

    With regard to the issues identified as causes of dissatisfaction, the study by Wouters et al[1] concurs with findings by the investigators mentioned above; namely that the shortage of staff is responsible for long waiting times. But this is not the only causes of dissatisfaction because others investigators identified insufficient waiting room space, lack of privacy, shortage of medicines, and disrespectful staff attitude as other causes for dissatisfactions [2-5].

    Therefore, there is a need for more studies to cover other provinces of South Africa, and to assess the influence of demographic, and socio-economic factors that affect patient satisfaction with care during antiretroviral treatment so that appropriate interventions could be implemented.


    1. Wouters E, Heunis C, Van Rensburg D, and Meulemans H. Patient satisfaction with antiretroviral services at primary health-care facilities in

    the Free State, South Africa - a two-year study using four waves of cross-sectional data. BMC Health Services Research 2008,8:210.

    2. Malangu N and Mosane T. HIV-positive patients’ satisfaction with service

    provided by a public hospital in Pretoria-South Africa. SA Fam Pract 2008; 50 (2): 72

    3. Malangu N. Views of HIV-infected patients on antiretroviral therapy on the quality of

    service and working relationship with clinic staff in Pretoria, South Africa. XVI HIV/

    AIDS International Conference Scientific Committee, Toronto, Canada, 13-18 August

    2006. Abstract No: CDB1211. Available at:

    4. Malangu N. Human health resources are key to HIV treatment in Africa

    BMJ 2006;333:98 (8 July),

    5. Couper ID, J F M Hugo, J M Tumbo, B M Harvey, N H Malete. Key issues in clinic

    functioning – a case study of two clinics. SAMJ February 2007; 97 (2):125-127.

    Competing interests