Abstract

Patients perception about service quality shapes their confidence with regard to use of the available health care facility. This study assessment of womens account of maternity service during labour and delivery. This is an institution based cross sectional descriptive study. A total of 423 postpartum women were interviewed. Data was analyzed using SPSS version 20 statistical package. The proportion of mothers who are completely satisfied with health care ranges between 2.4 to 21%. Pain control was the poorest source of satisfaction with 82% reporting dissatisfaction. Provider's communication with clients yielded complete satisfaction rates ranging between 0.7 to 26%. Inadequate information about the drug prescribed and explanation of procedures to be done to the client were found to be major causes of dissatisfaction. The complete satisfaction rate with environmental factor of the hospital was between 3.3 to 40.2%. Age of the client, educational status, income of the client and client`s address away from Addis Ababa were found to be the predictors of client accounts of satisfaction. Provider's attitude and communication, as well as longer duration of stay in the ward were independent predictors of client satisfaction. Pain management, client privacy and client provider communication need to be addressed to ensure the satisfaction of maternity clients. The clients need to be involved in the management of their own health problems

CHAPTER ONE

INTRODUCTION

 BACKGROUND TO THE STUDY

The effects of the rising socioeconomic inequalities in healthcare utilization among pregnant women in Nigeria as inherent in other Sub-Saharan African countries have received great attention over the years. According to World Health Organization (WHO) 2006, all pregnant women should at least receive care during early stages of pregnancy within the first three months followed by at least 4 antenatal visits (WHO, 2006). A woman reproductive age has been defined by WHO as those between 15-49 years, and these constitute more than one fifth of the world’s population and are repeatedly exposed to the risk of pregnancy and childbearing.

Maternal health refers to the health of the mother during pregnancy, childbirth and the postpartum period (AbouZahr and Wardlaw, 2004). Maternal healthcare utilization is essential for early discovery of mothers who are exposed to ill health and mortality during pregnancy (WHO, 2006). However, in the developing countries, these problems such as poor access to healthcare, low income etc. are more prevalent due to the current socioeconomic conditions and inaccessibility of health facilities (Okereke, 2012).

Antenatal care encompasses a broad range of clinical procedures and care provided to pregnant women. Ideally, all pregnant women should have proper access to effective antenatal care irrespective of their social, economic, cultural and geographical background. Antenatal care plays a vital role in ensuring a healthy mother and baby during pregnancy and after delivery. Pregnant women are given this care to maximise good health outcomes; low maternal and neonatal mortality, low postpartum anemia, and appropriate birth weight (WHO, 2006; Awusi et al., 2009).

Countries all over the world are campaigning seriously for easy access to healthcare especially among pregnant women. In view of this, deliberate efforts are taken to ensure provision of appropriate content of antenatal care in order to reap admirable maternal health outcomes. In line with Millennium Development Goals (MDGs) 4 & 5, provision of appropriate content of maternity care is an important means of reducing child mortality by two-thirds and reducing the maternal mortality ratio by three-quarters, (Adekanle and Isawumi., 2008).

In a developing country like Nigeria with inadequate healthcare systems, it is generally assumed that socioeconomic gradients in access to healthcare are very high, nevertheless only recently has this been subjected to critical review. However, there is an obvious need to study the social pattern of utilization of healthcare especially by women and pregnant ones in particular. Hence, women’s utilization of maternal healthcare facility during and before labour is an important health issue with regard to the wellbeing and survival of both the mother and child during childbirth (Igberase et al., 2009).

STATEMENT OF PROBLEM

Patient satisfaction is defined as the individual's positive evaluation of distinct dimension of health care (Clone, 1997). Patient satisfaction questionnaires have their origin in two separate developments to improve compliance and assess consumerism. Patients with lower expectations tend to be more satisfied. Demographic characteristics such as age, educational attainment, and socio-economic status are some of the factors considered to influence measured satisfaction ratings (Tnish, 1980) .The reasons for measuring patient satisfaction include describing health care service from the patient's perspective which would subsequently lead to assessment accounts of these patients.

Satisfaction is a multidimensional construct involving interpersonal manner, quality of care, accessibility or convenience, finance of care, consistency, physical environment and availability (loba, 1986). It is not important whether the patient is right or wrong but what is important is how the patient felt (Kakwani, 1997). Patient satisfaction is the result of congruent or incongruent orientation towards a certain health care in the community (Ogunlesi, 2012). Patient with higher satisfaction are more likely to stick to medical recommendations when stating their account of the service received (Okereke, 2012). Patients with higher social class are often more satisfied. Nations have differences in satisfaction levels based on their economic development and health care systems (Owumi, 2013). Professional competence and quality of communication are the key predictors of consumer satisfaction (Simkhada, 2008). More than 200 million women get pregnant annually, and about 15% develop complications that will require skilled obstetric care (Thind, 2008).

In Nigeria, efforts are being made to make health institutions client oriented. However evidence shows contradiction on the patient`s perspective. This study is conducted with the aim of assessment of patients (women) account and its determinants in maternity care at a referral hospital.

Objective of study

The broad objective of the study is to provide an assessment of women’s account of maternity service during labour and delivery in Nigeria. Specifically the study seeks to:

1.     Assess the influence of demographic characteristics of respondents on their account of merternity service delivery

2.     Assess Mothers account  towards level of satisfaction during perinatal care

3.     Determine the Factors significantly associated with mothers’ satisfaction

Significance Of The Study

At the completion of the study, the findings will be of great importance to policy makers, as the study seek to emphasis on the strategies to improve maternity health care service in Nigeria, the study will also be of importance to the researcher in imbibing a rigorous approach towards examining the challenges of maternity health service. The study will also be of importance to researchers who intend to embark on study in similar topic as the study will serve as a reference point to the researcher.

1.6 SCOPE AND LIMITATION OF THE STUDY

The scope of the study covers an assessment of women’s account of maternity service during labour and delivery in Nigeria using university of port hacourt teaching hospital. But in the cause of the study, there were some factors which limited the scope of the study;

(a) Availability of research material: The research material available to the researcher is insufficient, thereby limiting the study.       

(b) Time: The time frame allocated to the study does not enhance wider coverage as the researcher has to combine other academic activities and examinations with the study.

(c) Finance: The finance available for the research work does not allow for wider coverage as resources are very limited as the researcher has other academic bills to cover

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