Study Area and period
The study was conducted from March-May, 2022 at East-Gojjam zone selected primary hospitals of Amhara, Ethiopia. The three selected primary hospitals were Lummame primary hospital (LPH), Bichena primary hospital (BPH) and Yejube primary hospital (YPH). Each primary hospital has a catchment population of approximately 200,000. Based on previous annual reports from the three hospitals, 1000, 1200 and 940 women received delivery care services in Lummame, Bichena and Yejube primary hospitals respectively.
Study Design
Facility based cross sectional study design was employed to assess satisfaction with delivery care service.
Source and study population
All women who delivered in the selected primary hospitals 2022 GC is source population and mothers’ who gave birth/delivery in the hospital at the time of data collection is the study population
Eligibility Criteria
Mothers who get delivery services in the study hospital and willing to participate in the study within six hours of delivery were included and mothers with still birth and postnatal mothers who were critically ill and unable to speak were excluded.
Sample Size Determination
The sample size is estimated based on single population proportion. The formula: n = (Zα/2)2 P (1-P) / (d) 2, Where n is sample size, P (proportion of clients satisfied with the services) in the study sites & d is the margin of error. The sample size for this study was determined using single population proportion formula taking the prevalence of delivering mothers satisfied with institutional delivery care services in Mothers’ satisfaction with referral hospital delivery service in Amhara Region, Ethiopia (61.9%)(5). Since there is local data available for the value of P, it was taken to be 61.9% (P=0.619). Allowing 5% for margin of error (d), design effect 1.5, 95% confidence level, and10% non-response rate, the required sample size n =600.That is n= (1.96) (1.96) (0.619) (0.381)/ (0.05) (0.05) =363; 363*1.5*10% =600
Sample size calculation using associated factors from previous related study:
Factors
|
Power
|
CI
|
P
|
Ratio
|
AOR
|
Sample size
|
Maternal condition
|
80%
|
95%
|
64.15
|
1
|
2.1
|
438
|
Waiting time
|
80%
|
95%
|
84.90
|
1
|
2.9
|
507
|
Mode of delivery
|
80%
|
95%
|
6.25
|
1
|
0.11
|
522
|
Privacy
|
80%
|
95%
|
25.15
|
1
|
2.1
|
399
|
The larger sample 600 from the outcome variable is selected as a final sample size.
Sampling Technique and procedure
Three hospitals from E/Gojjam zone primary hospitals were selected by simple random technique. The systematic random sampling was used to select study participants of patients. Based on three months’ report from the three hospitals preceding the survey, there were 250, 300 and 210 women received delivery care services in Lummame, Bichena and Yejube primary hospital respectively. To find sampling fraction interval, total number of women received the care divided by the final sample size of 600. (k=1310/600= 2.1). Then every other woman received childbirth care was recruited for the study when they are preparing to leave the hospital. Samples were allocated proportionally based on the total number of deliveries of each institution.
Study Variables
The dependent variable was maternal satisfaction with labor and delivery service and the independent variables were sociodemographic factors (age, marital status, educational status, occupation, religion, family monthly income, place of residence) and obstetric and maternal health service related characteristics (status of pregnancy, outcome of delivery, mode of delivery, parity, maternal condition after delivery, perceived communication skill, respect, sex of service provider, waiting time, counseling, privacy, availability of drugs and supplies and cleanliness of health facility/hospital ).
Operational Definitions
Waiting time: The time from the admission of the mother’ until seen by health care provider
Overall maternal satisfaction: was measured by the percentage of maximum scale score which was computed using the formula Scale 1-5
Satisfied: Above average percentage mean score (scores 4-5 by using 16 questions) or just one’s expectation(2)
Unsatisfied: Less than or equal average percentage mean score or below one’s expectation(2)
Data collection tools and procedures
An adapted structured survey questionnaire that captures essential data elements which includes socio demographic information of the respondent; provider’s related characteristics (respect, privacy, consultation time and advice given), service characteristics (distance of health facility, waiting time, waiting place, cleanliness of health facility, cost of service, and drug availability), outcome of delivery (alive, stillbirth), mode of delivery (spontaneous vaginal delivery, assisted delivery, caesarean section) and delivery assisted by (female, male) was developed. Items including satisfaction assessment was prepared with score on a 5-point Likert-scale, i.e., ranging from 1 (very dissatisfied) to 5 (very satisfied). The questionnaire was first prepared in English and translated to Amharic for data collection purpose and re-translated back to English to keep its consistency. The data was collected through interviewer administered interview and chart review using structured, pre-tested questionnaire which was prepared from previous literatures. Data was collected in the post-natal period upon discharge while the patient was preparing to go home. The questionnaire was pre-tested on Shabel primary hospital which is not selected for the study on 5% of (30) mothers and adjustments was made based on the pretest findings.
Data Quality Control
Properly designed standardized data collection tool was prepared, then the English version questionnaire was translated in to Amharic which is the local language of the area. Half day training was given to four female clinical nurse data collectors and BSc holder nurse supervisors. Questionnaire was checked for completeness on a daily basis by immediate supervisors. After checking all questionnaires for consistency and completeness the supervisors submit the filled questionnaire to the principal investigator. Incorrectly filled or missed records were sent back to the respective data collector for correction. To crosscheck the collected data and maintain the quality of data, the principal investigator rechecked all the completed questionnaires daily.
Data Processing and Analysis
After coding and checking for completeness and consistency, data entered in to computer using Epi-data version 3.1 and were exported in to SPSS version 23 for analysis. The data further recoded, cleaned for missing data before analysis. Recoding and re-categorizing was made for relevant variables. Frequencies and summary statistics (mean, standard deviation, and percentage) were used to describe the study population in relation to socio-demographic and other relevant variables. The degree of association between dependent and independent variables were assessed using adjusted odds ratio with 95% confidence interval. Binary logistic regression analysis was performed to assess statistical association between dependent and independent variable, and also variables having p-value less than or equal to 0.25 in bi-variable binary logistic regression analysis entered to multi-variable logistic regression analysis for identifying determinants of maternal satisfaction on delivery services. Variables with p- value <0.05 was considered statistically significant. Stepwise backward elimination was applied for variable selection and Hosmer and Lemeshow statistic test was checked for model fitness.
Ethical Approval
Ethical clearance was obtained from the ethics review committee of Bahir Dar University, college of medicine and health sciences. Data confidentiality was maintained. The authors had no access to information that could identify individual participants during or after data collection.