Client Satisfaction on Antenatal Care Service by Pregnant Women in Public and Private Hospitals in Addis Ababa, Ethiopia: A Cross-sectional Comparative Descriptive Study

Abstract

Background: Antenatal care (ANC) is an important health care service which is intended to potentially reduce maternal morbidity and mortality particularly in areas where the general health status of women is presumed poor, choice of facilities is limited and the service delivery compromised by geography (terrain, transport), socio-demographic factors, financial capability and awareness. Though improving the quality of health care is one of the targeted strategies in the Health Sector Development Program IV (HSDP IV) of Ethiopia, little is known about the quality of antenatal care service and client satisfaction at the different hospitals in Addis Ababa, the capital city of Ethiopia. Objective: To determine satisfaction of ANC services among pregnant women at the public teaching and private hospitals in Addis Ababa, Ethiopia. Methods: Health institution-based comparative cross-sectional study was conducted from February to June, 2019 in public and private hospitals, in Addis Ababa, using sample size determination for comparisons of proportion between the two populations. All participants who fulfilled the inclusion criteria were enrolled based on the flow of pregnant women to the ANC clinics at the selected hospitals. Data were entered and cleaned using EPI-info version 3.5.1 and analysis was performed by SPSS version 21. Association of independent variables with the client satisfaction was done using binary and multivariate logistic regression. Significant association of variables with outcome was determined using adjusted odds ratio (AOR) together with 95 % confidence interval. Level of significance was set at P-value of ≤ 0.05. Results: Five hundred seventy one pregnant women attending Antenatal Care at private (281) and public (290) hospitals were included with response rates of 94.1 and 91.2% for public and private hospitals, respectively. The age distribution of the participants was between 17 and 43 years with a mean age of 27.3±5.1 years. Most of the clients, 249 (88.7%) at private and 276 (95.2%) at public hospitals were between the ages of 20 and 34 years. One hundred fourteen (39.3%) of the clients at public and 113 (40.2%) at private hospitals were nulliparous. The clients overall satisfaction with antenatal care was mostly positive both at the private and public hospitals and two hundred twenty eight (81.1%) of the private and 174 (60%) of the public hospitals were satisfied with the services provided. Having ANC follow up at the private hospitals had statistically significant difference in client satisfaction compared to those in public hospitals with P value of 0.019, (AOR 2.97, 95% CI:1.19 -7.74). Clients’ satisfaction with the cleanliness of the environment was 11.1 times more likely to be satisfied with the general ANC service, P<0.05, (AOR 12.18 95% CI: 7.45-19.91). Having more than 4 ANC visits was positively associated with client overall satisfaction, P= 0.021, (AOR 2.41, 95% CI: 1.12-5.24,) while long waiting time is negatively associated with client satisfaction. Conclusions: The study showed significant difference in client satisfaction rate between the selected private and public facilities. Private facilities outperformed public facilities with regards to structural features (privacy, waiting time, space, and neatness). We recommend concerted effort to improve ANC visits and pay due attention to the privacy, waiting time, and the neatness of the facilities in public hospitals.