Qualitative assessment of women’s satisfaction with maternal health care in referral hospitals in Nigeria

Abstract

BackgroundAvailable evidence suggests that the low use of antenatal, delivery, and post-natal services by Nigerian women may be due to their perceptions of low quality of care in health facilities. This study investigated the perceptions of women regarding their satisfaction with the maternity services offered in secondary and tertiary hospitals in Nigeria.MethodsFive focus group discussions (FGDs) were held with women in eight secondary and tertiary hospitals in four of the six geo-political zones of the country. In all, 40 FGDs were held with women attending antenatal and post-natal clinics in the hospitals. The questions assessed women’s level of satisfaction with the care they received in the hospitals, their views on what needed to be done to improve patients’ satisfaction, and the overall quality of maternity services in the hospitals. The discussions were audio-taped, transcribed, and analyzed by themes using Atlas ti computer software.ResultsFew of the participants expressed satisfaction with the quality of care they received during antenatal, intrapartum, and postnatal care. Many had areas of dissatisfaction, or were not satisfied at all with the quality of care. Reasons for dissatisfaction included poor staff attitude, long waiting time, poor attention to women in labour, high cost of services, and sub-standard facilities. These sources of dissatisfaction were given as the reasons why women often preferred traditional rather than modern facility based maternity care. The recommendations they made for improving maternity care were also consistent with their perceptions of the gaps and inadequacies. These included the improvement of hospital facilities, re-organization of services to eliminate delays, the training and re-training of health workers, and feedback/counseling and education of women.ConclusionA women-friendly approach to delivery of maternal health care based on adequate response to women’s concerns and experiences of health care will be critical to curbing women’s dissatisfaction with modern facility based health care, improving access to maternal health, and reducing maternal morbidity and mortality in Nigeria.Trial registrationTrial Registration Number NCTR No: 91540209. Nigeria Clinical Trials Registry. http://www.nctr.nhrec.net/. Registered April 14th 2016.

Quality of Antenatal Care: Comparison between Secondary and Tertiary Health Facilities in Ibadan, Nigeria

“…Women who received care at the tertiary health facility were about 3 times less likely than women who received care at the secondary health facility to report high quality care in regards to availability of their antenatal care provider. This finding is comparable to that of Okonuofa et al, although they conducted a focus group discussion [12].…”

“…Nigeria in which only a few of the women studied were satisfied with the QPC though it was a qualitative study conducted among both antenatal and post-natal clinics attendees in secondary and tertiary health facilities [12].…”

“…Bearing this in mind, the quality of services-general and specific will influence the coming back of patients for scheduled antenatal clinic visits and presentation in the health care facility for delivery during labor as well as recommendation of these services to others [11]. A qualitative study on quality of care received during antenatal, intrapartum and post natal period in secondary and tertiary health facilities in Nigeria reported a lot of the women were not satisfied at all with the care received and many of them had areas of dissatisfaction which included poor staffs' attitude and attention, long waiting time, high cost of services and sub-standard facilities [12]. The women in the study also identified dissatisfaction with quality of care as the reason why women preferred traditional based maternity care which has been identified to contribute to maternal and fetal morbidities and mortalities [12].…”

“…A qualitative study on quality of care received during antenatal, intrapartum and post natal period in secondary and tertiary health facilities in Nigeria reported a lot of the women were not satisfied at all with the care received and many of them had areas of dissatisfaction which included poor staffs' attitude and attention, long waiting time, high cost of services and sub-standard facilities [12]. The women in the study also identified dissatisfaction with quality of care as the reason why women preferred traditional based maternity care which has been identified to contribute to maternal and fetal morbidities and mortalities [12]. However, a quantitative study in a tertiary health facility reported high (81.1%) maternal satisfaction with QPC but majority were dissatisfied with the provided amenities, besides a similar report of high level (89.7%) of satisfaction was documented among women who received antenatal and intranatal care in primary health facility [13] [14].…”

Qualitative evidence syntheses: Assessing the relative contributions of multi‐context and single‐context reviews

“…More importantly, these systems are not necessarily mutually exclusive so a Christian‐Traditional belief may differ markedly from an Islam‐Traditional belief and, in turn, from an exclusively traditional belief:

“…an Islamic religious rite that believes cure comes when you write down a prayer, put it in water and give the ill person to drink”. (Okonofua et al, )“Once something is family tradition, you just have to follow it as well. In my husband’s house the custom is to give birth where the mother in‐law is, it's like that with most people and you can't change it....” (Love, )

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