Level of satisfaction with the quality of antenatal care services and its associated factors among pregnant women in Mbale district a mixed methods study.

Abstract

Background: Currently, about 830 women die from pregnancy- or childbirth-related complications around the world every day. With good-quality care, during antenatal care (ANC), the majority of that adverse maternal outcome can be prevented. That is why, in the 2016 Lancet, attention turned from mortality to morbidity, and the provision of high-quality, woman-centered care was acknowledged as a right (Audrey C, Richard, H, 2016). One of the reasons as to why provision of high-quality antenatal woman-centered care was acknowledged as a right is to increase the utilization of ANC services during services, especially given that the number of recommended visits has been increased from 4 to 8. That quality of health care delivery is best assessed by a measure of the extent to which a patient is satisfied with the care received from the health care provider. Health facilities are no longer more just a symbol of humanitarian services; clients are increasingly concerned about health facilities performance with focus on resources, and quality of services delivered by these hospitals. Thus improving the quality of care in current practice focuses more on quality assurance process with the patient as the focus point, that is in the perspective of whether the patient is satisfied with the quality of service or not. Objective: The purpose of this study was to assess the level and associated factors of satisfaction with ANC services among pregnant women seeking maternal health services in Mbale district. Method: A sequential explanatory mixed methods research approach was adopted. The study population was pregnant women attending their subsequent ANC visits, and their sample size was determined using Cochran‟s correction formula. The number of focus group discussions held was determined using the principle of data saturation. Mbale district and Mbale regional referral and teaching hospital were purposively sampled. Health centers in were sampled using cluster and simple random sampling. Simple random sampling was used to sample the women. Structured interviews were used to collect the quantitative data from the pregnant women, while focus group discussions were used to collect qualitative data. Interviewer administered structured questionnaires were used to collect quantitative data, while a focus group discussion guide was used during the group discussions. Statistical Package for the Social Sciences (SPSS) version 20.0 was used for quantitative analysis. Qualitative data was analyzed using thematic analysis Results: Almost three quarters of the pregnant women majority of the women (n = 253, 74%) were satisfied with the quality of antenatal care services provided in Mbale district. Only two process quality attributes significantly affected satisfaction with ANC services. Pregnant women who were satisfied with health care provider‟s examination were twice as likely to be satisfied with the quality of ANC services (aOR = 2.249, 1.010 - 5.010). Women who obtained most of the prescribed medicines from the health facility were also twice as likely to be satisfied with the quality of ANC services (aOR = 2.190, CI = 1.103 - 4.348). No structural ANC quality attribute had a statistically significant association with the level of satisfaction with ANC services among the pregnant women in Mbale district. Only one maternal characteristic significantly affected satisfaction with ANC services; women having upper primary education being twice as likely to be satisfied with ANC (aOR = 2.185, CI = 1.435- 5.971). The findings of the qualitative study showed that majority of the women were satisfied which confirms the quantitative results Conclusion: There was a high level of satisfaction with the quality of ANC services provided in Mbale, among pregnant women; almost 8 out of every 10 of them are satisfied with that quality. That level of satisfaction is influenced to a relatively larger extent by process quality characteristics of ANC, to smaller extent by maternal characteristics and structural characteristics to no extent. Recommendation: There is need for health care service providers to improve on their level of interaction, patient involvement and responsiveness