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Mothers' satisfaction with care during facility-based childbirth: a cross-sectional survey in southern Mozambique
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health).ORCID iD: 0000-0002-2475-2560
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health). (Obstetric and Reproductive Health Research)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
Centro de Investigação em Saúde da Manhiça (CISM).
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Client satisfaction is an essential component of quality of care. Health system factors, processes of care as well as mothers’ characteristics influence the extent to which care meets the expectations of mothers and families. In our study, we specifically aimed to address the mother’s experiences of, and satisfaction with, care during childbirth.

Methods: A population-based cross-sectional study, using structured interviews with published sequences of questions assessing satisfaction, included 4358 mothers who gave birth during the 12 months before June 2016 to estimate satisfaction with childbirth care. Regression analysis was used to determine the predictors of client satisfaction.

Results: Most mothers (92.5%) reported being satisfied with care during childbirth and would recommend a family member to deliver at the same facility. Specifically, 94.7% were satisfied with the cleanliness of the facility, 92% reported being satisfied with the interaction with the healthcare providers, but only 49.8% felt satisfied with the assistance to feed their baby. Mothers who had negative experiences during the process of care, such as abandoned when needed help, disrespect, humiliation, or physical abuse, reported low levels of satisfaction when compared to those who had not had such experiences (68.5% vs 93.5%). Additionally, they reported higher levels of dissatisfaction (20.1% vs 2.1%). Regression analysis revealed that mothers who gave birth in primary level facilities tended to be more satisfied than those gave birth in hospitals, and having a companion, increased, on average, the overall satisfaction score, with 0.06 in type II health centres (CI 0.03 – 0.10) and with 0.05 in type I health centres (CI -0.02 – 0.13), compared to -0.01(CI -0.08 – 0.07) in the hospitals, irrespective of age, education and socio-economic background.

Conclusion: Childbirth at the primary facilities contributes to the level of satisfaction. The provision of childbirth care should consider women’s preferences and needs, including having a companion of choice. We highlight the challenge in balancing safety of care versus satisfaction with care and for policies on health care organizations for deliveries to be conducted in fully equipped hospitals rather than primary facilities. Interventions to improve the interaction with providers and the provision of respectful care are recommended.

Keywords [en]
Satisfaction with care, experiences of care, facility-based childbirth
National Category
Medical and Health Sciences
Research subject
Medical Science
Identifiers
URN: urn:nbn:se:uu:diva-380577OAI: oai:DiVA.org:uu-380577DiVA, id: diva2:1300580
Available from: 2019-03-29 Created: 2019-03-29 Last updated: 2019-03-29
In thesis
1. ‘How good is good?’: Studies of facility-based childbirth care in southern Mozambique, from the perspectives of women and health providers
Open this publication in new window or tab >>‘How good is good?’: Studies of facility-based childbirth care in southern Mozambique, from the perspectives of women and health providers
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Despite the large shift toward facility-based childbirths occurred during the last 15 years in several low resource settings, including in Mozambique, the burden of maternal mortality and morbidity remain considerable. Obstetric fistula is one of the most devastating of all maternal morbidities which still prevalent and is entirely avoidable.

The aim of this thesis was to evaluate and explore the provision of childbirth care, focusing on obstetric fistula as one of its complications, in a rural Mozambican setting of high facility delivery rate.

The four studies constituting this thesis were implemented in Maputo and Gaza provinces, southern Mozambique, between April 2016 and March 2017. We included 4385 women having given birth up to 12 months the study identified from a cohort of women of reproductive age (12-49 years). We identified women with constant urine leakage, assess them clinically, confirm the diagnosis and estimate the incidence of obstetric fistula. In-depth interviews with selected women with and without fistula (n=28), were used to describe the women’s experiences of maternal care and pinpoint those experiences that are unique to women with fistula. During the same cross-sectional survey (n=4385) we also assessed the women’s experiences of care and satisfaction with care during childbirth. We complemented the women’s survey with a survey among 175 health workers of the study area to assess their perception of their work context.

The incidence of fistulae was 1.1 per recently pregnant women (95% CI 0.14-2.16). Delays in receiving definite care at referral hospitals despite having reached the primary health facility in time, were reported by the women who had fistulae. Women without fistula, blamed the fistula condition on women’s physiological and behavioural characteristics. Most (92.5%) of the 4358 women interviewed reported to be satisfied with care during childbirth and would recommend a family member to deliver in the same facility. Women who gave birth in primary level facilities tended to be more satisfied than those gave birth in hospitals, and presence of a companion had a positive influence on the satisfaction, irrespective of age, education and socio-economic background. Health workers rated highly the items on all dimensions of context when asked to evaluate their work context using the Context Assessment for Community Health (COACH) tool, although still above the scale midpoint, the organizational resources dimension had the lowest score.

This thesis demonstrates a high incidence of obstetric fistula despite a high coverage of facility-based childbirths in a rural context where services are generally perceived as adequate by childbearing women and health providers. To reduce maternal morbidity by fistula, major interventions are needed to improve the quality of childbirth care, including complication recognition and decision-making for referral, health facility preparedness as well as to improve the health providers’ work environment.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2019. p. 84
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1561
Keywords
Facility-based childbirth, Obstetric fistula, Satisfaction with care, Health providers, Context assessment, Mozambique
National Category
Medical and Health Sciences
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-380580 (URN)978-91-513-0619-3 (ISBN)
Public defence
2019-05-20, Rudbecksalen, Rudbeck entréplan C11, Dag Hammarskjölds väg 20, Uppsala, 09:00 (English)
Opponent
Supervisors
Available from: 2019-04-26 Created: 2019-03-29 Last updated: 2019-06-18

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