I.L. Nwaeze1, O.O. Enabor2, T.A.O. Oluwasola2, C.O. Aimakhu2
- Department of Obstetrics & Gynaecology, Delta State University Teaching Hospital, Ogharra, Delta State.
- Department of Obstetrics & Gynaecology, University College Hospital, Ibadan.
Background: Antenatal care is an important health service which detects and sometimes reduces the risk of complications among pregnant women. The quality of care is likely to influence effective utilization and compliance with interventions.
Objectives: This study evaluated clients’ perception of antenatal care quality at the University College Hospital (UCH), Ibadan and determined levels of client satisfaction.
Methods: Women presenting for antenatal care at the study centre were interviewed in a cross-sectional design using a structured questionnaire. Items in the questionnaire included sociodemographic and obstetric variables, assessment of quality of amenities, waiting time and level of satisfaction. Data analysis was done using frequency tables, Chi-square cross tabulations and logistic regression. The p-value was set at P<0.05.
Results: There were 239 participants; 74% percent of the women were aged 25-34 years; majority of the respondents (86%) had tertiary education while 49.4% were skilled workers or professionals. In 57.7% of women, the gestational age was between 13 and 27 weeks while 66.1% were Para 1-4. Amenities and water supply were regarded as unsatisfactory in 60.7% and 61.9% respectively. The clinic services were regarded as good in 81.1% of respondents; the only significant association with patient satisfaction was the desire to register in the same facility in the next pregnancy.
Conclusion: There is a high overall level of satisfaction with antenatal services among pregnant women in UCH. Policy makers and health providers should however address improvement of amenities, reduction of waiting time and ensure that health interventions are available for all clients.
Keywords: Antenatal care, Perception, Satisfaction, Ibadan, Pregnancy
Dr. Enabor O.O
Department of Obstetrics &Gynecology,
University College Hospital,
Ibadan, Oyo State, Nigeria.
Antenatal care (ANC) is an important part of preventive medicine and professionals providing this service can reduce the risk of complications through education, counseling and various interventions. The proportion of Nigerian women that receive antenatal care and those that are delivered by skilled birth attendants has however remained far from acceptable1.
For many years, high standards of care were considered a luxury particularly in developing countries where service coverage was largely inadequate 2, 3. Quality of health care is seen as a factor closely related to effectiveness, compliance and continuity of care particularly for ethical reasons4. Women’s perceptions of antenatal visits significantly influence their assessment of quality of services that are provided5. As a result of this new focus, measurement of customer satisfaction has become equally important in assessing system performance.
Patient satisfaction has traditionally been linked to the quality of services given and the extent to which specific needs are met. Satisfied patients are likely to come back for the services and recommend services to others6. Various factors including attitude of staff, cost of care, time spent at the hospital and doctor communication have been found to influence patient satisfaction in previous studies7-9. The study objective was to ascertain the perception of and satisfaction with the quality of ANC services among pregnant women at the UCH, Ibadan. The study also sought to correlate patient’s satisfaction with future use of maternity services in the institution.
MATERIALS AND METHODS
This cross sectional study was conducted at the antenatal clinic of the UCH, Ibadan, a tertiary institution in South- Western Nigeria. In 2009, clinic attendance was 13,932 (daily average of 82 women) and 8,811(daily average of 55 women) in 2010. There are three antenatal clinics per week, 1 booking and postnatal clinic on Wednesday and Friday respectively. The clinic usually commences with an interactive health talk co-ordinated by a qualified community health nurse which usually lasts for at least 45minutes.
The health talk usually covers various topical issues including nutrition, diet, personal hygiene, danger signs in pregnancy, the labour experience, care of the newborn, exclusive breast feeding and immunization.
Other health issues such as hypertension, diabetes mellitus, malaria, anaemia, HIV/AIDS and family planning are also discussed. Routine services following the health talk include weight and height measurement, blood pressure estimation, urinalysis, haemoglobin estimation and multivitamin supplementation. Thereafter, patients are called individually to see their doctors for clinical examination and treatment.
In this study, study participants were selected by convenience sampling following their written consent. Women attending booking and post-natal clinics were excluded. The instrument for the study was an interviewer administered questionnaire which was divided into sections: Socio-demographic and obstetric characteristics, Ser vices/procedures, Amenities, Content of health information & education, Cost implication, Attitude of health personnel, Waiting time/total time spent, Effective communication and Overall rating of antenatal care services. Each questionnaire took 10-15 minutes to complete. Total time spent was defined as time spent from arrival to the end of the clinic consultation by the obstetrician waiting time was defined as time spent from the end of the health talk to the beginning of the clinic consultation; these values were obtained from the patient. The interviewers were research assistants who were trained to administer the questionnaire in English language. Translation to native languages was done in cases where the respondents were uneducated. The questions were closed and open ended and written in simple language. Sample size calculation was done using the Kish formula for cross sectional studies; an overall client satisfaction prevalence of 81% with a precision of 0.05 was used 10.
The data was collected, coded and entered into a computer using SPSS v.15.0. The data was then cleaned and analysis carried out using descriptive statistics and frequency tables. Cross tabulation was done between socio-demographic variables and client satisfaction and significant variables were entered into a logistic regression model to identify predictors. The level of significance was <0.05.