Client satisfaction among pregnant women attending health delivery institutions is an important measure to assess quality of health care [
Over the last decade, there has been an increasing effort to address the discrepancies between the delivery of health care and client needs [
Different studies from health delivery institutions show that client care satisfaction levels range from 69% to 83% [
A facility based cross-sectional study was conducted from December 17, 2013, to January 27, 2014, in thirteen public health facilities of Gamo Gofa Zone. The capital town of the zone, Arba Minch, is located about 500 km southwest of Addis Ababa. In 2013 the population of the zone was 1.847.264 people; of them 440, 449 were women in reproductive age. The zone has two town administrations and 15 woredas (districts) with three hospitals and 63 health centers which provide delivery services.
Using the results from previous studies with client satisfaction of 83%, the sample size was calculated using Epi Info Version 7 with the following assumptions: 80% power, 95% confidence level, odd ratio 2, design effect of 1.5, and 5% nonresponse rate. The estimated sample size was thus 435 women.
We randomly selected 13 health institutions for the study from a sampling frame of 66 health institutions in Gamo Gofa Zone. The total number of delivering mothers in each health institution was calculated based on proportional to the number of deliveries attended at the health institutions in the last three months. Finally data was collected from every other woman who delivered in those health facilities till the required sample size was reached.
Data was collected using a survey instrument adopted from the Donabedian quality assessment framework [
The Statistical Package for Social Sciences version 16.0 (SPSS Inc., Chicago, IL, USA) was used for data management and analysis. We used descriptive statistics and binary logistic regression for this work.
It is the satisfaction of mothers gained during service delivery. It is the care level gained that increases the likelihood of future utilization maternal health service.
A five-point Likert scale ((1) very unsatisfied, (2) unsatisfied, (3) neutral, (4) satisfied, and (5) very satisfied) was used. For the overall satisfaction level, those who will be satisfied in greater than or equal to 75% of the items were categorized as satisfied and those who were satisfied in less than 75% of the items were categorized as unsatisfied [
Approach focuses on the rights of women to have access to quality care for themselves as individuals and as mothers and for their infantsand all health providers consider respectful care and support women’s emotional, psychological, and social well-being during child birth [
Before the study was conducted, ethical clearance was obtained from Institutional Research Ethical Review Committee of Arba Minch University. After getting ethical clearance, written permission was obtained from Zonal Health Department and from the woreda health offices. Informed verbal consent from each study participant was obtained after explaining the purpose of the study. Individuals were given the right to participate on voluntary basis and if they did not volunteer to continue from the beginning or at any stage of the interview, they were given the right to withdraw from the study without any consequences. Privacy and strict confidentiality were maintained during the interview process. The information that was collected from this research was kept confidential and stored in files, which did not have participant name on it, but a code number assigned to it, and it was not revealed to anyone except the principal investigator.
A total of four hundred thirty (430) postnatal mothers participated in this study, 181 (42.1%) from three hospitals and 249 (57.9%) from ten health centers. More than half of the respondents (246) (57.2%), were Gamo by ethnicity, 262 (60.9%) were Protestant by religion, and 220 (51.2%) were between 25 and 34 years. The mean age was 25.1 years (SD, 5.0). Almost all 414 (96.3%) were married, and half (219) (50.9%) lived in urban areas. The average monthly income was 898 ETB (Table
Sociodemographic characteristic of respondents in public health facility of Gamo Gofa Zone, southwest Ethiopia, May 2014.
Variable | Frequency ( |
Percent (%) |
---|---|---|
Age | ||
15–24 | 186 | 43.3 |
25–34 | 220 | 51.2 |
34–44 | 24 | 5.6 |
Residence | ||
Urban | 219 | 50.9 |
Rural | 211 | 49.1 |
Religion | ||
Protestant | 262 | 60.9 |
Orthodox | 148 | 34.4 |
Muslim | 20 | 4.7 |
Education | ||
Illiterate | 121 | 28.1 |
Primary | 124 | 28.8 |
Secondary | 122 | 43.1 |
Above secondary | 63 | 13.7 |
Occupation | ||
Housewife | 262 | 60.9 |
Government employed | 45 | 10.5 |
Merchant | 44 | 10.2 |
Daily labourer | 42 | 9.8 |
Other | 37 | 8.6 |
Monthly income | ||
<500 ETB | 70 | 16.8 |
500–1500 ETB | 252 | 58.6 |
>1500 ETB | 108 | 25.5 |
Ethnicity | ||
Gamo | 246 | 57.2 |
Gofa | 75 | 17.4 |
Other | 64 | 14.3 |
Delivery took place | ||
Hospitals | 181 | 42.1 |
Health centers | 249 | 57.9 |
For 385 (91.6%) the age at first pregnancy was above 18 years, 225 (52.5%) were gravida of 2–5, and about half of the respondents (49.5%) were para of 2–5. For most of the mothers, 238 (55.3%), the labor lasted up to 12 hours. 59.3% of the mothers did not have previous health facility delivery experience, but 402 (93.5%) of them had visited health facilities for ANC for the recent pregnancy, and 333 (77.4%) came to the health institution without referral for the current delivery (Table
Obstetric characteristics of respondents in Gamo Gofa Zone, southwest Ethiopia, May 2014.
Variables | Frequency ( |
Percent (%) |
---|---|---|
Age at first marriage | ||
<18 | 116 | 27 |
>18 | 314 | 73 |
Age at first pregnancy | ||
>18 | 74 | 17.2 |
<18 | 356 | 82.8 |
Gravidity | ||
One | 160 | 37.2 |
Two–five | 225 | 52.3 |
>five | 45 | 10.5 |
Parity | ||
One | 181 | 42.1 |
Two–five | 213 | 49.5 |
>five | 36 | 8.4 |
Reason for visit | ||
Planned | 333 | 77.4 |
Referred | 97 | 22.6 |
Status of pregnancy | ||
Wanted | 345 | 81.2 |
Unwanted | 81 | 18.8 |
Mode of delivery | ||
SVD | 355 | 82.6 |
Assisted delivery | 36 | 8.4 |
CS delivery | 39 | 9.1 |
Maternal condition after delivery | ||
Normal | 365 | 84.9 |
With complication | 65 | 15.1 |
Foetal outcome | ||
Live birth | 403 | 93.7 |
Stillbirth | 27 | 6.3 |
Ever had neonatal death | ||
Yes | 30 | 7 |
No | 400 | 93 |
Ever had still birth | ||
Yes | 34 | 93 |
No | 396 | 79 |
Duration of last delivery (hr) | ||
<12 | 238 | 55.5 |
12–24 | 143 | 33.3 |
>24 | 49 | 11.4 |
About three hundred sixty (82.9%) participants travelled for up to one hour, 31 (7.1%) travelled for one to two hours, and 41 (10.1%) travelled for more than two hours to access health institutions to give birth. 158 (36.7%) used ambulance (Figure
Mode of transportation used by clients to reach facilities where they received delivery care service in public facilities of Gamo Gofa Zone, December 17, 2013, to January 27, 2014.
399 (92.8%) of mothers were willing to recommend the facility to a family or a friend. Most of the respondents (355) (82.6%) said there was no shower service, but all of the clients (430) (100%) said toilet has been available in the health institutions.
The proportion of mothers who were satisfied with delivery care was 340 (79.1%), varying from 105 (58%) in hospitals and 235 (94.4%) in health centers (
Proportion of client’s satisfaction levels with major dimensions of care in 13 public health facilities of Gamo Gofa Zone.
In the bivariate analysis educational, occupational, and also institutional related factors were significantly associated with overall satisfaction (Table
Predictors of satisfaction in public health facility of Gamo Gofa Zone, southwest Ethiopia, May 2014 (
Variable | Satisfied | Unsatisfied | COR (95% CI) | AOR (95% CI) |
---|---|---|---|---|
Education | ||||
Illiterate | 86 (20.0%) | 35 (8.6%) | 1 | 1 |
Primary | 106 (24.7%) | 18 (4.2%) | 2.4 (1.27–4.52) |
1.56 (0.68–3.5) |
Secondary | 101 (23.5%) | 21 (4.9%) | 2.4 (1.27–4.52) |
1.65 (0.71–3.87) |
Above secondary | 47 (10.9%) | 16 (3.7%) | 1.12 (0.6–2.34) | 1.01 (0.23–3.40) |
Occupation | ||||
Housewife | 211 (49.1%) | 46 (10.7%) | 1 | 1 |
Government employed | 34 (7.9%) | 11 (2.6%) | 0.68 (0.32–1.43) | 1.33 (0.49–3.55) |
Self-employed | 61 (14.2%) | 24 (5.6%) | 0.56 (0.32–0.98) |
0.85 (0.24–2.99) |
Other | 34 (7.9%) | 9 (2.1%) | 0.83 (0.37–1.84) | 0.77 (0.25–2.29 |
Mode of delivery | ||||
SVD | 286 (67.2%) | 66 (15.3) | 1 | 1 |
Assisted delivery | 19 (4.4%) | 17 (4.0%) | 0.26 (0.12–0.52) |
0.59 (0.26–1.34) |
CS | 32 (7.4%) | 7 (1.6%) | 1.05 (0.45–2.47) | 3.61 (1.44–9.06) |
ANC follow-up | ||||
Yes | 323 (75.1%) | 79 (18.4%) | 1 | 1 |
No | 17 (4%) | 11 (2.6%) | 0.37 (0.17–0.83) |
0.52 (0.21–1.36) |
Payment status | ||||
Paid | 119 (27.7%) | 11 (2.6%) | 0.07 (0.038–0.15) |
0.27 (0.09–0.81) |
Free | 221 (51.4%) | 79 (18.4%) | 1 | 1 |
Distance | ||||
<half an hour | 189 (44.0%) | 40 (9.3%) | 1 | 1 |
>half-one hour | 109 (32.1%) | 24 (5.6%) | 0.36 (0.18–0.71) |
1.81 (0.72–4.56) |
1 hour-two hours | 13 (3.0%) | 9 (2.1%) | 0.8 (0.18–0.79) |
1.98 (0.75–5.16) |
>two hours | 29 (6.7%) | 17 (4.0%) | 19 (0.42–3.34) | 0.73 (0.19–2.72) |
Presence of support person during birth | ||||
Yes | 191 (44.4%) | 8 (1.9%) | 13.14 (6.17–28) |
6.23 (2.75–14.11) |
No | 149 (34.7%) | 82 (19.1%) | 1 | 1 |
Delivery took place | ||||
Hospitals | 105 (58%) | 76 (42%) | 1 | 1 |
Health centers | 235 (94.4%) | 14 (5.6%) | 12.15 (6.57–22.4) |
2.76 (0.99–7.6) |
The present study determined the level of client satisfaction at health delivery institutions in Gamo Gofa Zone, southern Ethiopia. The overall satisfaction level was 79.1%. It is lower than a study conducted in west India (86%) [
The result of this study also showed that the proportion of the women attending health centers was more satisfied compared to women attending hospitals (94% and 58%), respectively. The reason for this more satisfaction might be due to the proximity of the health facility. But this finding did not show the association with satisfaction. It could be due to the vast majority of respondents being satisfied with health institution delivery. This study revealed 10.9% women in the study area complained about courtesy and respect from health workers during the course of labor. This was 20.45% in hospitals compared to health centers, only 4.01%. This prevalence was comparable to study done in Addis Ababa that was 12.4% (14.8,9.4 %) in hospitals and health centres, respectively [
In the current study satisfaction of delivering mothers was predicted by presence of support person during child birth, mode of delivery, and payment status. This was consistent with other studies [
An important finding from this study is that there was a significant association between presence of support person during child birth and client satisfaction, as reported by others [
Also statically significant association was found between the client satisfaction and mode of delivery. Clients delivering with caesarean section are four times more likely to be satisfied than the other modes of deliveries. Other studies done in 1992 by Stadlmayr and colleagues reported no significant association between modes of delivery and satisfaction. The differences between these studies and our results may suggest differences between populations studied or change in maternal perception for caesarean section after they have been saved from complications [
Social desirability bias might have affected the quality of data collected because study subjects might face difficulty in responding to dissatisfaction in the presence of data collectors. But data collection was done in a private room by nonstaff midwives to reduce the bias. The other limitation comes from the institution based nature of the study which makes inferring to all delivering mothers in the study area since most of the deliveries take place at night indicating a need for further study by using a more representative sample and also the nature of the study design temporal relations cannot be drawn. Besides the above shortcomings, the study generated important data that can be used as an input for improvement of maternal health services and with increased satisfaction in the study area.
Nowadays client satisfaction plays a significant role in increasing utilization of women for institution based delivery and also it is necessary to improve quality of health care in reducing maternal morbidity and mortality. The study shows that overall satisfaction level is good, but there is room for improvements; more emphasis should be on giving women friendly care, particularly at hospitals.
The authors have no conflict of interests.
Rahel Tesfaye contributed to conception and design of the study, analysis of data, and writing of the paper. Bernt Lindtjorn took part in the design, data analysis, and writing of the paper. Amare Worku and Wanzahun Godana are involved in the study from the initial inception to the final approval of the paper. In addition, Wanzahun Godana is involved in paper writing and updated it to this standard of the publication.