Women’s satisfaction with the quality of antenatal care services rendered at public health facilities in Northwest Ethiopia: the application of partial proportional odds model

OBJECTIVES: The study was aimed: (1) to describe the quality of antenatal care (ANC) at public health facilities in Northwest Ethiopia, including dimensions of the structure, process and outcome; and (2) to assess the relationship between ANC satisfaction and structure and process dimension of ANC quality. DESIGN: Cross sectional. SETTING: Healthcare facilities providing ANC services in Northwest Ethiopia. PARTICIPANTS: 795 pregnant women attending the antenatal clinics at 15 public health facilities and 41 health workers working for the surveyed facilities. OUTCOME MEASURES: The outcome variable, women’s satisfaction with ANC, was constructed from multiple satisfaction items using principal component analysis on an ordered, categorical and three-point Likert scale. The key hypothesised factors considered were structural and process aspects of care. Data were analysed using the partial proportional odds model with 95% CI. RESULTS: The result revealed that only 30.3% of the pregnant women were highly satisfied, whereas 31.7% had a lower satisfaction level. The findings showed that process quality indicators better predicted client satisfaction. In relation to this, better scores in history taking (aOR(1)=aOR(2); 1.81 (95% CI 1.25 to 2.60)), counselling (aOR(1) = aOR(2); 1.89 (95% CI 1.33 to 2.69)) and screening (aOR(1)= aOR(2); 18.10 (95% CI 11.52 to 28.39)) were associated with achieving higher satisfaction. We also observed a significant but lower satisfaction among women in the late trimester of pregnancy (aOR(1) = aOR(2); 0.87 (95% CI 0.78 to 0.97)). However, we did not see any significant relationship between structural variables and client satisfaction. CONCLUSIONS: The study demonstrated that women’s satisfaction with ANC was low. The contents of ANC services covered during client–provider interaction were the main factors affecting client satisfaction. This suggests that efforts are required to improve the competencies of health professionals to make them more effective while dealing with clients.