Satisfaction Levels with Maternity Services among Postnatal Women Attending Public Hospitals in Nairobi City County, Kenya
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Date
2018-11
Authors
Okari, Maseme Geoffrey
Journal Title
Journal ISSN
Volume Title
Publisher
Kenyatta University
Abstract
Globally, the rate of maternal mortality is unacceptably on the rise. A considerable
number of women are dying from pregnancy or child birth related complications
across the world. Many initiatives have been intensified on policy intervention to curb
the high cases of maternal mortality. Delivery in unhygienic conditions without the
assistance of a skilled birth attendant may lead to adverse health outcomes. Maternal
mortality rates in Kenya remain high at 362 per 100,000 live births. Only 62% of
women deliver under the care of a skilled provider indicating a deficiency in the
quality of care. The government of Kenya introduced the policy of Free Maternity
Services to all women attending public health facilities by June 2013 to increase
access to skilled care delivery and help reduce the rate of maternal mortality and
morbidity in the country. The study sought to establish the satisfaction levels with free
maternity services among postnatal women attending public hospitals in Nairobi City
County. The study mainly focused on the individual client characteristics, the health
provider related factors, the health system factors and the obstetric experiences
associated with maternal satisfaction. The study adopted a descriptive cross-sectional
facility-based study design which encompassed use of both quantitative and
qualitative data collection methods. Quantitative data was collected using pretested
questionnaires administered to post-natal women by trained research assistants.
Qualitative data was collected through Focused Group Discussion sessions with
patients and Key Informant Interviews with care providers. A sample size of 417
postnatal mothers was proportionally selected from each hospital through systematic
random sampling and interviewed. Kenyatta National Hospital, Pumwani maternity,
Mbagathi and Mama Lucy Kibaki hospitals were purposively selected. Necessary
approvals were sought from relevant authorities and informed consent obtained from
research participants prior to data collection. Descriptive data was analyzed using
Statistical Package for Social Sciences version 20.0 in conjunction with Microsoft
Excel program. Frequency distribution tables, graphs and pie-charts were used for
data presentation. Qualitative data was presented as direct quotes or narrations from
respondents and triangulated with quantitative results. Inferential statistics were
calculated using Chi-Square tests (p<0.05) done at 95% confidence interval to
establish the association between study variables. The study found out that the overall
satisfaction level of respondents was 62.4%. Chi-square analysis revealed significant
statistical association between age (p=0.001), educational level (p=0.001), occupation
(p=0.002), parity (p=0.001), income (p=0.001), provision of patient privacy
(p=0.001), involvement of patients in decision making (p=0.007), listening to patient
issues attentively (p=0.003), availability of staff (p=0.014), facility cleanliness
(p=0.002), availability of drugs (p=0.006), sharing of beds (p=0.034), antenatal care
advice (p=0.001), labour time (p=0.001) and pain management (p=0.001) with
maternal satisfaction level. The study results indicated a sub-optimal maternal
satisfaction level with maternity services among post-natal women attending public
hospitals in Nairobi City County. These findings would assist key healthcare
stakeholders to design strategic policies and initiatives to ensure sustenance of Free
Maternity Services in the country. This would enable Human Resources for Health to
provide services in an appealing treatment environment matched with adequate
equipment, drugs and supplies. This would further ensure that the Free Maternity
policy leads to improved quality of maternal service provision in all public hospitals
thus increased satisfaction with care among women of reproductive age.
Description
A Thesis Submitted in Fulfilment of the Requirements for the Award of a Degree of Master of Science in Health Management in the School of Public Health of Kenyatta University