Do Malawian women critically assess the quality of care? A qualitative study on women’s perceptions of perinatal care at a district hospital in Malawi

Abstract

BackgroundMalawi has a high perinatal mortality rate of 40 deaths per 1,000 births. To promote neonatal health, the Government of Malawi has identified essential health care packages for improving maternal and neonatal health in health care facilities. However, regardless of the availability of health services, women’s perceptions of the care is important as it influences whether the women will or will not use the services. In Malawi 95% of pregnant women receive antenatal care from skilled attendants, but the number is reduced to 71% deliveries being conducted by skilled attendants. The objective of this study was to describe women’s perceptions on perinatal care among the women delivered at a district hospital.MethodsA descriptive study design with qualitative data collection and analysis methods. Data were collected through face-to-face in-depth interviews using semi-structured interview guides collecting information on women’s perceptions on perinatal care. A total of 14 in depth interviews were conducted with women delivering at Chiradzulu District Hospital from February to March 2011. The women were asked how they perceived the care they received from health workers during antepartum, intrapartum and postpartum. They were also asked about the information they received during provision of care. Data were manually analyzed using thematic analysis.ResultsTwo themes from the study were good care and unsatisfactory care. Subthemes under good care were: respect, confidentiality, privacy and normal delivery. Providers’ attitude, delay in providing care, inadequate care, and unavailability of delivery attendants were subthemes under unsatisfactory care.ConclusionsAlthough the results show that women wanted to be well received at health facilities, respected, treated with kindness, dignity and not shouted at, they were not critical of the care they received. The women did not know the quality of care to expect because they were not well informed. The women were not critical of the care they received because they were not aware of the standard of care. Instead they had low expectations. Health workers have a responsibility to inform women and their families about the care that women should expect. There is also a need for standardization of the antenatal information that is provided.

Assessment of Provision of Women Friendly Care and Associated Factors among Postnatal Mothers at Three Public Hospitals of Jimma Zone, Oromia Region, Ethiopia, 2016

“…This was supported with the study conducted in Malawi which stated that health workers' attitudes are a great challenge in the provision of health care particularly during labor and delivery as deterred pregnant and laboring women from utilizing health services [10].…”

Job satisfaction and attitudes towards nursing care among nurses working at Mzuzu Central Hospital in Mzuzu, Malawi

“…28 Some qualitative studies done in Malawi reveal negative attitudes among some nurses. 8,20,21 The differences in findings between these studies and the present study may be attributable to differences in the methodological approaches used in data collection. The positive attitudes of the nurses towards nursing care may have several possible explanations.…”

“…19 Studies conducted in Malawi have reported that negative attitudes among nurses are sometimes manifested by rudeness and scolding of patients. 8,20,21 Such behaviours are associated with job dissatisfaction among nurses. [22][23][24] Patient and public complaints about the quality of nursing care in Malawi may be related to negative attitudes among nurses who are dissatisfied with their jobs.…”

Do women’s perspectives of quality of care during childbirth match with those of providers? A qualitative study in Uttar Pradesh, India

“…Management of complications as necessary, in addition to good health of the mother and child, are the most desirable aspect of care expressed by the women in this study as well as others,, as these elements affect their health and survival [27,37,41]. Similarly, inadequate information sharing with women and her family, disrespectful treatment by staff and poor provider attitude, are perceived to equate with poor quality by women in our study and others, and can be a deterrent for further seeking care in health facilities [43–46,60–66]. …”