Factors Associated with Client Satisfaction with Institutional Delivery Care at Public Health Facilities in South Ethiopia

Background: Ethiopia has one of the world’s highest maternal death rates. Client satisfaction is a dynamic indicator of quality of delivery care services. However, little is known about the factors that contribute to client satisfaction in this setting. Objective: To assess client satisfaction with institutional delivery in women attending for delivery at public health facilities in South EthiopiaMethods: A quantitative and qualitative cross-sectional study was conducted. Sixteen health facilities (one hospital and 15 health centers) were included in the study: a total of 380 mothers were interviewed when discharged. Consecutive sampling was employed to obtain the required sample size. Trained nurses collected the quantitative data, and the principal investigator collected qualitative data from focus groups. Data were coded, entered, cleaned, and analyzed using binary logistic and multivariable logistic regression analyses to identify predictors of client satisfaction. Qualitative data were analyzed according to themes and triangulated with the quantitative data. Result: Overall, 67.9% of clients were satisfied with delivery care in public health facilities in the study zone. Satisfaction varied from 23.4% in the technical dimension to 76.1% in outcomes of care. Predictors of satisfaction were: the presence of an attendant throughout delivery (AOR=2.18; 95% CIs 1.23-3.85), being informed about the baby following neonatal examination (3.22; 1.85-5.62), being prepared for labor and delivery (3.53 1.81-6.89), and care taken to assure privacy (3.07; 1.70-5.52). Qualitative data revealed a range of client satisfaction from perceiving warm, courteous, and respectful care to expressing grievances about being insulted, embarrassed, and even beaten by care providers. Conclusion and recommendations: Physical, interpersonal, and technical aspects of care influence client satisfaction with delivery care services. Healthcare providers should address problems related to physical, technical, and intrapersonal aspects of care and develop friendly and courteous relationships with clients and cleaner environments to escalate satisfaction, and hence utilization, of services by clients. Keywords: Client satisfaction, delivery services, South Ethiopi

Institutional Delivery Service Utilization among Women from Rural Districts of Wolaita and Dawro Zones, Southern Ethiopia; a Community Based Cross-Sectional Study.

The highest number of maternal deaths occur during labour, delivery and the first day after delivery highlighting the critical need for good quality care during this period. Therefore, for the strategies of institutional delivery to be effective, it is essential to understand the factors that influence individual and household factors to utilize skilled birth attendance and institutions for delivery. This study was aimed to assess factors affecting the utilization of institutional delivery service of women in rural districts of Wolaita and Dawro Zones.A community based cross-sectional study was done among mothers who gave birth within the past one year preceding the survey in Wolaita and Dawro Zones, from February 01 -April 30, 2015 by using a three stage sampling technique. Initially, 6 districts were selected randomly from the total of 17 eligible districts. Then, 2 kebele from each district was selected randomly cumulating a total of 12 clusters. Finally, study participants were selected from each cluster by using systematic sampling technique. Accordingly, 957 mothers were included in the survey. Data was collected by using a pretested interviewer administered structured questionnaire. The questionnaire was prepared by including socio-demographic variables and variables of maternal health service utilization factors. Data was entered using Epi-data version 1.4.4.0 and exported to SPSS version 20 for analysis. Bivariate and multiple logistic regressions were applied to identify candidate and predictor variables respectively.Only 38% of study participants delivered the index child at health facility. Husband's educational status, wealth index, average distance from nearest health facility, wanted pregnancy, agreement to follow post-natal care, problem faced during delivery, birth order, preference of health professional for ante-natal care and maternity care were predictors of institutional delivery.The use of institutional delivery service is low in the study community. Eventhough antenatal care service is high; nearly two in every three mothers delivered their index child out of health facility. Improving socio-economic status of mothers as well as availing modern health facilities to the nearest locality will have a good impact to improve institutional delivery service utilization. Similarly, education is also a tool to improve awareness of mothers and their husbands for the improvement of health care service utilization

Client satisfaction with antiretroviral treatment services in South Ethiopian public health facilities: an institution-based cross-sectional survey

Background HIV/AIDS remains the leading cause of morbidity and mortality worldwide. Moreover, sub-Saharan countries, including Ethiopia, are highly affected by HIV/AIDS pandemic. Ethiopia’s government has been working on a comprehensive HIV care and treatment programme, including antiretroviral therapy. However, evaluating client satisfaction with antiretroviral treatment services is not well studied. Objectives This study aimed to assess client satisfaction and associated factors with antiretroviral treatment services provided at public health facilities of Wolaita zone, South Ethiopia. Methods A facility-based cross-sectional study involved 605 randomly selected clients using ART services from six public health facilities in Southern Ethiopia. A multivariate regression model was used to see an association between independent variables and the outcome variable. The odds ratio with 95% CI was computed to determine the presence and strength of the association. Results Four hundred twenty-eight (70.7%) clients were satisfied with an overall antiretroviral treatment service, which included significant variations ranging from 21.1% to 90.0% among health facilities. Sex [AOR = 1.91; 95% CI = 1.10–3.29], employment [AOR = 13.04; 95% CI = 4.34–39.22], clients’ perception of the availability of prescribed laboratory services [AOR = 2.56; 95% CI = 1.42–4.63], availability of prescribed drugs [AOR = 6.26; 95% CI = 3.40–11.52] and cleanliness of toilet in the facility [AOR = 2.83; 95% CI = 1.56–5.14] were factors associated with client satisfaction with antiretroviral treatment services. Conclusion The overall client satisfaction with antiretroviral treatment service was lower than the national target of 85%, with a marked difference among facilities. Sex, occupational status, availability of comprehensive laboratory services, standard drugs, and cleanliness toilets in the facility were factors associated with client satisfaction with antiretroviral treatment services. Sex-sensitive services needed to address and sustained availability of laboratory services and medicine recommended

Health service utilization of study participants, assessment of institutional delivery service utilization in Wolaita and Dawro zone, 2015.

<p>Health service utilization of study participants, assessment of institutional delivery service utilization in Wolaita and Dawro zone, 2015.</p

Place of delivery of index child, assessment of institutional delivery service utilization in Wolaita and Dawro zone, 2015.

<p>Place of delivery of index child, assessment of institutional delivery service utilization in Wolaita and Dawro zone, 2015.</p

The sexual and reproductive healthcare challenges when dealing with female migrants and refugees in low and middle-income countries (a qualitative evidence synthesis)

Abstract Background Migrants and refugees face unprecedented inequalities in accessing sexual and reproductive health (SRH) in developed and developing countries. Most attention has focused on the rich world perspective, while there are huge numbers of migrants and refugees moving towards less developed countries. This article synthesizes the barriers to proper SRH care from low and middle-income countries perspective. Methods We performed a systematic review of articles containing primary source qualitative and quantitative studies with thick qualitative descriptions. Articles from various databases, including PubMed, Science Direct, HINARI, and Google Scholar, published between 2012 and 2022 were included. Because the context differed, we excluded articles dealing with migrants and refugees from low- and middle-income countries living in high-income countries. To select articles, a preferred reporting item for systematic reviews and meta-analyses (PRISMA) was used. The articles’ quality was assessed using the standard QASP checklist. We used a socio-ecological model to investigate barriers at various levels, and thematic analysis was used to identify the strongest themes at each level of the model. This synthesis is registered under PROSPERO number CRD42022341460. Results We selected fifteen articles from a total of 985 for the final analysis. The results show that despite the diversity of the participants’ homes and countries of origin, their experiences using SRH services were quite similar. Most female migrants and refugees claimed to have encountered discrimination from service providers, and linguistic and cultural obstacles played a significant role in their experiences. In nations lacking universal healthcare coverage, the cost of care was a barrier to the use of SRH services. Other main obstacles to using SRH services were a lack of knowledge about these programs, worries about privacy, inadequate communication, stigma in the community, and gender-related power imbalances. Conclusion To enhance the use of SRH by female migrants and refugees, it is vital to provide person-centered care and involve husbands, parents, in-laws, and communities in SRH coproduction. Training on cultural competency, compassion, and respect must be provided to healthcare personnel. Increasing financial access for migrant and refugee healthcare is crucial, as is meeting their basic requirements

Additional file 1 of The sexual and reproductive healthcare challenges when dealing with female migrants and refugees in low and middle-income countries (a qualitative evidence synthesis)

Supplementary Material