Women’s Satisfaction with Intrapartum Care and Associated Factors at Muhimbili National Hospital in Dar Es Salaam, Tanzania

Abstract

Background: Satisfaction with intrapartum care is an important determinant of maternal health services return behavior and utilization. Assessing maternal satisfaction with intrapartum care will assist in improving the way health services are delivered to the women. Objective: The aim of this study was to assess the proportion of the women satisfied with intrapartum care and its associated factors among post-delivery women at Muhimbili National Hospital. Materials and method: An analytical cross – sectional study was conducted among women who delivered at Muhimbili National Hospital between October to November 2019. A total of 363 study participants were selected by systematic random sampling method. Data was collected using an interviewer-administered Swahili structured questionnaire in which included the socio-demographic and obstetrics characteristics, questions measuring satisfaction of which the answers were ranked in a 5-likert scale; very satisfied, satisfied, neutral, unsatisfied and very unsatisfied and the last questions on loyalty return behaviours. During analysis the dependent variable was dichotomized into satisfied scoring 1 and unsatisfied scoring 0. Those who scored more than 66.6% of the 17 tools of satisfaction were deemed satisfied. Data was analyzed in descriptive statistics in the form of frequencies and percentages using statistical package for social sciences software version 23. Bivariate and multivariate logistic regression was done to identify factors associated with intrapartum care satisfaction. A p-value <0.05 was considered statistically significant. Results: 73.33% of women who delivered at Muhimbili National Hospital were satisfied with the care during childbirth which was relatively high and more than 80% would return to the facility or recommend the facility to friends and relatives. Among those satisfied, more than 90% were satisfied with most elements of the interpersonal relationship; like reception, respect, support, time spent with the health professionals, on the way the examination was performed, assistance, attention and knowledge while only 75.4% satisfied with the attitude of the health staffs. More than 70% were satisfied with all the elements of physical birth environment; privacy hygiene and the availability of equipment and medical supplies. More than 60% also satisfied with most elements of the information received and decision making like opportunity given to ask questions, opportunity given to express one self and only about 50% were satisfied with the pain management and the decision of not having a companion during labour and delivery. Regression analysis revealed that women who had caesarean section were two times more likely to be satisfied with intrapartum care than those who delivered vaginally (AOR=1.90, 95% CI=1.09-3.30). The multipara were three times more likely to be satisfied with intrapartum care than the primipara (AOR= 2.62, 95% CI=1.20- 5.75). Conclusion: The proportion of women satisfied with the intrapartum care services at Muhimbili National Hospital was relatively high (73.33%), with more than 80% of the women would return or recommend the facility to friends and relatives. Most women were satisfied with most elements of satisfaction like in interpersonal relationship more than 90% were satisfied except 75.4% satisfied with the attitude of the health workers, in the physical birth environment more than 70% were satisfied and in the decision making more than 60% were satisfied except in pain management and decision of not having a companion whereby only 50% were satisfied. We also noted that those who delivered by caesarean section and the multipara were more satisfied than their counterpart. Continuous improvement of the intrapartum care services, especially on the attitude of the health workers, training on pain management and modifying the labour wards environment to have the potential to accommodate companion involvement during labour as well as Increasing individualized care, patient centered care, support, proper monitoring, timely interventions and decreasing unnecessary vaginal birth interventions may contribute to improving satisfaction with labour and delivery.