Socio-demographic characteristics
A total of 446 subjects were participated in this study with of 98% response rate. More than half 228 (51.12%) of the participants were from public HF. The mean (± SD) age of respondents in both HF was 27.8 (± 5.2) years. Of those who served in public HF 38.6% was not attended formal education. The majority (92.2%) of the respondents who visited private HF were from urban residents [Table 1].
Table 1
Socio-demographic characteristics of respondents among public and private health facilities, Axum town, north Ethiopia
Socio-demographic variables | Public-HF (N = 228) N (%) | Private-HF (N = 218) N (%) | Total (N = 446) N (%) | Chi-square |
X2 | p-value |
Age (Years) |
15–24 | 56 (24.6) | 49 (22.5) | 105 (23.5) | 0.87 | 0.646 |
25–34 | 139 (61) | 146 (67) | 285(63.9) | | |
35–49 | 33 (14.5) | 23 (10.6) | 56 (12.6) | | |
Mean (± SD) years | 28.0 ± 5.7 | 27.7 ± 4.7 | 27.8 ± 5.2 | | |
Residence |
Urban | 133 (58.3) | 201 (92.2) | 334 (74.9) | 6.02 | 0.014 |
Rural | 95 (41.7) | 17 (7.8) | 112 (25.1) | | |
Education status |
Not attended formal education | 88 (38.6) | 19 (8.7) | 107 (24) | 4.03 | 0.045 |
Primary education(1 to 8) | 62 (27.1) | 54 (24.7) | 85( 19.1) | | |
Secondary education | 50 (2.9) | 79 (36.2) | 129 (28.9) | | |
Diploma & above | 28 (12.3) | 66 (30.3) | 94 (21.1) | | |
Marital status |
Single | 9 (3.9) | 4 (1.8) | 13 (2.9) | 0.39 | 0.942 |
Married | 219 (96.1) | 214 (98.2) | 433 (97.1) | | |
Occupation |
Student | 2 (0.9) | 5 (2.3) | 7 (1.6) | 15.35 | 0.009 |
Merchant | 28 (12.3) | 60 (27.5) | 88 (19.7) | | |
Governmental employee | 26 (11.4) | 65 (29.8) | 91 (20.4) | | |
Farmer & daily laborer | 99 (43.9) | 17 (7.8) | 115 (26) | | |
House wife | 63 (27.6) | 71 (32.6) | 134 (30) | | |
Estimated H/Hs monthly income |
< 500 ETB | 56 (24.6) | 37 (17) | 93 (20.9) | 2.19 | 0.534 |
501 to 1500 ETB | 103 (45.2) | 96 (44) | 199 (44.6) | | |
1501 to 3500 ETB | 64 (28.1) | 73 (33.5) | 137 (30.7) | | |
3501 to 6000 ETB | 5 (2.2) | 12 (5.5) | 17 (3.85) | | |
* Indicates significant difference at p-value < 0.05 |
ETB = Ethiopian Birr |
Time spent on provision of ANC in public and private health institutions
The mean (± SD) time spent during first ANC visit at both HF was 17.1 (± 7.7) minutes. At private HF the mean time spent for provision of ANC was 19.7 (± 8.5) minutes where as 13.2 (± 3.8) minutes in public HF. During revisit, the mean (± SD) time spent in getting ANC at both HF was 10.3 (± 5.5) minutes. The time spent during revisit ANC at private HF was 11.3 (± 6.6) and 9.7 (± 4.6) minutes in public HF.
The mean time spent on ANC provision was significantly different among public and private HF (t-test = 7.52, p < 0.001). Mothers who served in private HF have higher time spent on care than those who were served in public HF. Similarly, the mean time spent on provision o ANC was significantly different in first visit and revisit ANC (t-test = 10.39, p-value < 0.001). Mothers who first visited have higher time spent on care than who subsequently revisited.
Level Of Satisfaction About Time Spent During Anc
The mothers level of satisfaction about time spent on ANC with health care providers at public health facilities were: 62 (27.2%) very satisfied, 134 (58.8%) satisfied and, 32 (14%) not satisfied. And the level of satisfaction in private health facilities were 122 (56%), very satisfied, 74 (33.9) satisfied and 22 (10.1%) not satisfied.
Variables Significantly Associated With Time Spent On Anc Provision
On bivariate binary logestics regression analysis, variables found to be significantly associated with ime spent on provision of ANC were: residence, education level, occupation, type of HF (public versus private), maternal frequency of visit, provider sex, payment for ANC services and language similarity with health care providers.
After multivariable binary logistic regression was applied, variables significantly associated with time spent on ANC provision were: type of HF (public versus private), maternal frequency of visit and pregnant women speaks similar language with health care providers [Table 2].
Table 2
Variables associated with time spent on ANC provision in Axum public and private health facilities, Axum, North Ethiopia
Variables | Time spent on ANC Standard Short | Total (N = 446) | COR (95% CI) | AOR (95% CI) |
| N (%) | N (%) | N (%) | | |
Residence |
Urban | 59 (13.2) | 275 (61.7) | 334 (74.9) | 2.46 (1.18, 5.13)* | 0.79 (0.22,2.83) |
Rural | 9 (2.0) | 103 (23.1) | 112 (25.1) | 1.00 | 1.00 |
Educational status |
Not attended formal education | 14 (3.1) | 124 (27.8) | 138 (30.9) | 1.00 | 1.00 |
Attended formal education | 54 (12.1) | 254 (57) | 308 (69.1) | 1.88 (1.01, 3.52)* | 1.16 (0.51, 2.68) |
Occupation |
Student | 1 (0.2) | 6 (1.3) | 7 (1.6) | 0.58 (0.07, 4.99) | 0.36 (0.04, 3.44) |
Merchant | 18 (4) | 70 (15.7) | 88 (19.7) | 0.89 (0.46, 1.72) | 0.64 (0.32, 1.31) |
Employee | 9 (2) | 82 (18.4) | 91 (20.40) | 0.38 (0.17, 0.85)* | 0.27 (0.11, 0.63)* |
Farmer | 8 (1.8) | 107 (24.0) | 115 (25.8) | 0.26 (0.11, 0.59)* | 0.35 (0.09,1.37) |
Daily laborer | 2 (0.4) | 9 (2.0) | 11 (2.5) | 0.77 (0.16, 3.76) | 1.51 (0.2, 7.39) |
House wife | 30 (6.7) | 104 (23.3) | 134 (30.0) | 1.00 | 1.00 |
Type of Health facilities providing antenatal care service |
Public-HF | 19 (4.3) | 209 (46.9) | 228 (51.1) | 1.00 | 1.00 |
Private-HF | 49 (11) | 169 (37.9) | 218 (48.9) | 3.19 (1.81, 5.62)* | 2.61 (1.07, 6.33)* |
Frequency of ANC visit |
1st visit | 49 (11.0) | 151 (33.9) | 200 (44.8) | 3.88 (2.20, 6.84)* | 3.51 (1.93, 6.37)* |
Revisit | 19 (4.3) | 227 (50.9) | 246 (55.2) | 1.00 | 1.00 |
Provider sex for ANC care |
Male | 46 (0.31) | 186 (41.7) | 232 (52.0) | 2.16 (0.249, 3.73)* | 0.69 (0.29,1.66) |
Female | 22 (4.9) | 192 (430) | 214 (48.0) | 1.00 | 1.00 |
Payment for ANC service |
Yes | 49 (11.0) | 169 (37.9) | 218 (48.9) | 3.19 (1.81, 5.62)* | 2.24 (0.94, 5.30) |
No | 19 (4.3) | 209 (46.9) | 228 (51.1) | 1.00 | 1.00 |
Speak similar language with providers |
Yes | 58 (13.0) | 235 (52.7) | 293 (65.7) | 3.53 (1.75, 7.13)* | 2.74 (1.23,6.12)* |
No | 10 (2.2) | 143 (32.1) | 153 (34.3) | 1.00 | 1.00 |
Occupation of the pregnant mothers was strongly associated with time spent during ANC provision. Respondents who were governmental workers were 74% less likely to spent standard time than house wife (AOR = 0.26; (95% CI, 0.11–0.63)].
Pregnant mothers who attended their ANC in private health facilities were 2.6 times more likely to spend expanded time with care provider than who attended in public HF [AOR = 2.61; (95% CI, 1.07–6.33)].
Participants who has first visit for ANC were 3.5 times more likely to spent standard time with healthcare provider as compared to those pregnant mothers in subsequent ANC visit [AOR = 3.50; (95% CI, 1.93–6.37)].
Pregnant mothers who speak similar language with health care providers were 2.7 times more likely to spent longer time compared to who speaks different language [AOR = 2.74; (95% CI, 1.23–6.12)].
Qualitative findings
In-depth interview with health care provider
A total of ten health professionals (key–informants), one care provider from each service delivery points (six from public and four from private) and three the facility managers were included on the in-depth interview.
The three identified central themes that could be the reason for short time spent on care included: Health care provider’s commitment, medical supplies related and social & cultural belief of the mothers on antenatal care.
Health care provider’s commitment
Health care provider expressed the reasons for short time spend with mothers during care were lack of in-service training, low staff motivation, low payments, shortages of workers, and large number of ANC
20-26 years from public health facility expressed his idea
“…the time spent with clients was short, this could be due to lack of refresher training about focused ANC components, e.g. still I have not taken any in-service training either from the government or nongovernmental organizations as a result of this, I am unable even to counsel or deliver the whole ANC component to the clients in other words omission of some services resulted in short client contact time.”
Another 30-38 years from private health facility
“…for standard time spent, smart facial expression or good client provider relationship during history taking and physical examination is mandatory for pregnant women to initiating for asking and discussing their issue. He also reported low level qualification, lack of confidentiality and privacy are the main cause for short time spent. Knowledge and skill during history taking and physical examination is mandatory to deliver standard care on standard time. if pregnant mothers secured adequate confidential and privacy, they will more initiate for discussion their issue as a result spends enough time with us.”
A 20-25 years from public hospital also expressed that
“…the time we spent for care to pregnant women was not enough because of poor administration and payment that causes de-motivation of staff. This de-motivation makes us to be negligence in providing the service based on focused ANC standards. Additionally, we forced to provide ANC service with limited man power to numerous attendants in limited time. So, to address all within the short working hours, we obligate to shorten each mothers contact time”
Medical supplies or facilities
Some health care providers also expressed their reasons on shorter time spent with provision of ANC.
20-27 years from public health center explained is idea as
“… There is shortage and un-functional medical equipments like sphygmomanometer. And I was wondering here and there to find the functional equipment; as a result, I waste my working hours in finding rather than providing care with clients. As a result large number of pregnant mothers forced to wait me to get the service and I am hurrying in each client contact time to address all the clients which may the reason of short time spent on care.”
Social and cultural belief of the mothers
Religious, area of residence and family care has own affect on the time spent during care.
30-40 years old care providers reasoned their experiences as:
“Pregnant mothers living in rural areas were less likely to be cooperative to discuss detail with health care provider about their health issue. This may be due to family poor communication and relation. Additionally, muslin–religious follower mothers are not cooperative to make physical examination due to their religious/cultural influence. As a result we prefer to omit some care and this may make short time spent with the mothers”.