10. Influence of women’s perceived quality of services on the utilization of antenatal care services in Kisarawe district, Pwani-Tanzania

Abstract

Background: Low antenatal care (ANC) utilization is the public health problem especially in sub Saharan African countries. In Tanzania, antenatal care is experienced with irregular visits and studies show that one of the reasons for dropouts is the poor quality of services provided. Despite the initiatives taken by the government, antenatal care adherence has still been a challenge especially in the rural areas with national data of 39% compared to urban areas 55%. According to DRCHco report of 2012, only 37% of women in Kisarawe district were attending ANC as recommended by focused antenatal care model of the World Health Organization that has been adapted in Tanzania since 2002. Objectives: This study aimed at assessing the influence of women’s perceived quality of services on the utilization of ANC services in Kisarawe district. Materials and Methods: Cros-sectional study design with quantitative methods was employed using structured questionnaires. Household survey was conducted among 540 women with children of less than one year prior to survey in May 2014 in Kisarawe District. Perceived quality was analyzed to ascertain the frequency of women who perceived ANC services as good and those who perceived as bad, cross tabulation was done to obtain the association between perceived quality and utilization of ANC services. Satisfaction index was analyzed by adding up the scores for the satisfaction questions asked. Satisfaction score was done for each level of satisfaction. Point rating scale was from very unsatisfied (1) to very satisfied (4). The questions focused on five areas of antenatal care service provision, the scores ranged from 5-20. Averages for each area of satisfaction were done, followed by cross tabulation to obtain the association between satisfaction and utilization of ANC services. Data was analyzed using SPSS version 16. Results: A total of 540 women were recruited into the study, with ages ranging from 15-47 years. Most of the women (93.1%) had attended antenatal care (ANC) four or more times during the last index pregnancy. Highest (93.7 %) attendance was among those in the age group above 25 years. Majority of them were married (77.4), Muslims (63.0%) and (8.9%) were not able to read and write. None of the socio demographic characteristics have significant difference on utilization of antenatal care, p>0.05. ANC utilization was generally high, (93.1). Higher proportion (95.5%) of those who utilized ANC services agreed that healthcare providers at the health facility are cooperative and generous, comparing to (89.4%) who did not, (χ2 =7.336, p=0.008).Similarly a higher proportion (95.4%) among those who expressed satisfaction to ANC services provided, utilized services compared to (89.6%) who did not, (χ2 =6.536, p=0.011). Also higher proportion (95.9%) of those who expressed satisfaction with the communication between healthcare providers and pregnant women utilized ANC services compared to 90.0% who did not, (χ2 =7.395, p=0.007). Similarly higher proportion ( 96.3) among those who were satisfied with waiting time at the ANC utilized services compared to those who were not satisfied(89.4%), (χ2 =9.936, p=0.002). Satisfaction to ANC services in the area of waiting time at ANC clinics was generally low (44.1%). Conclusion and recommendations This study reveales that antenatal services were well utilized, but the perception on quality of services was low. Low satisfaction level in the area of waiting time at the antenatal care service delivery points has been observed , this might have impact to future ANC services utilization. Due effort should be made to address quality of care, especially on waiting time .