Missed attendance among 2 to 6 year olds at maternal and child health clinics in Petaling district, Selangor : a mixed methods study

Abstract

Missed attendance at healthcare facility is when someone does not attend their planned appointment without any prior notice. Missed attendance among children at primary care is common globally. Based on the National Health and Morbidity Survey (NHMS) in 2016, missed attendance rate among children at primary care clinics was high. This may increase under 5 children morbidity and mortality. However, limited studies were done on missed attendance among children at healthcare services especially primary care. In Malaysia, only one study has been conducted investigating this problem. Thus, the objective of this research is to explore, understand and determine the factors of missed attendance among 2 to 6 year- old children at Maternal and Child Health (MCH) clinics in Petaling district, Selangor. A convergent parallel mixed method was applied in this study. Petaling district was chosen as the study location because it has the highest number of children aged 2 to 6 years old in the state. For quantitative phase, a cross sectional study was performed using a self administered questionnaire involving 309 randomly selected parents/guardians of 2 to 6 year-old children with clinic appointment at two selected MCH clinics between February until April 2019. As for qualitative phase, seven, in depth interviews among selected parents/guardians and four focus group discussions with healthcare providers were performed. Quantitative analysis revealed 74.9% missed attendance among children seen at two selected MCH clinics in Petaling district, Selangor during the study period. Factors associated to missed attendance at MCH clinics were low family income (AOR 4.654, 95% CI 2.482-8.726), lack of information among parents/guardians (AOR 2.797, 95% CI 1.106-7.070) parents/guardians with suspected depression (AOR 3.567, 95% CI 1.207-10.543), parents/guardians with 5 to 6 year-old children (AOR 2.455, 95% CI 1.238- 4.869) and healthcare providers poor explanation to parents/guardians (AOR 2.584, 95% CI 1.157-5.771). From qualitative analysis, three themes were derived from in depth interviews which were Parents/Guardians’ poor attitude towards missed attendance, Parents/Guardians’ negative influence of social network views and parents/guardians’ unpleasant experience at MCH clinics. Another similar three themes were derived from focus group discussions which were parents/guardians’ poor health seeking attitude, parents/guardians common malpractice in society and parents/guardians unfavourable experience at MCH clinics. Combination of both quantitative and qualitative findings provide information to understand missed attendance among 2 to 6 year- old children at MCH clinics in Petaling district, Selangor. The findings from this study can be a basis to develop new policies, strategies for interventions and strengthening of child healthcare programs in the country.