Assessment of Quality of Antenatal Care Services at the La-General Hospital

Abstract

Introduction: Despite measures to improve the quality of health care delivery in Ghana, there is still perceived unsatisfactory services rendered. La General Hospital recorded ANC attendance of 21,879 in 2015. The years 2016 and 2017 recorded a total number of 21,682 and 21,432 respectively. In 2017, about seven (7) stillbirths and nine (9) maternal deaths were recorded midyear at the hospital. Objective: This study sought to assess the quality of antenatal care services and the associated factors at the La General Hospital, and to determine the socio-demographic as well as provider-related factors that influence clients' satisfaction with the quality of ANC. Method: A quantitative cross-sectional study was conducted using a total of 385 pregnant women who attended Antenatal care at the La-General Hospital. The study was done in June, 2018 using structured questionnaires. Data were analyzed using STATA 15.0 statistical software. Descriptive and analytical statistics were used to generate means, percentages, cross tabulations to describe the findings, while bivariate analysis was conducted using Chi-square and logistic regression to determine significant associations reporting crude odds ratios. Confidence level of 95% and p < 0.05 was set as statistical significance. Results: The majority of respondents were between the ages of 23 and 33, 57.6 % and 76.6% was employed. Many of them were also married 64.5%. Majority of respondents, 93.9% rated the quality of antenatal care at the La General Hospital as good (P = 93.9%, 95% CI= 91% - 96.1%). Tertiary education (cOR = 0.08, 95% CI = 0.009 – 0.7), marital status, separated (cOR = 0.02 95% CI = 0.0009 – 0.5); quality of service as a reason for attending ANC (cOR = 5.3, 95% CI = 1.1 – 25.2), ANC visits significantly increased the odds of a good rating of quality (cOR = 1.35, 95% CI = 1.02 – 1.78). The environmental factors such as clean toilets at the facility (cOR = 8.8, 95% CI = 2.9 – 25.7), adequate number of washrooms (cOR = 4.8, 95% CI = 1.5 – 15.6), enough chairs at waiting area(cOR = 13.1, 95% CI = 4.4 – 39.0), ventilation at waiting area (cOR = 10.1 95% CI = 3.5 – 29.0), enough privacy at ANC clinic (p < 0.01), confidentiality of information (p <0.001), waiting time to meet the nurse (cOR = 0.74, 95% CI = 0.57 – 0.05) and waiting time to see doctor/midwife had significantly 33% reduction in the odds of rating overall ANC care as good. Perceived levels of respect shown by doctors and nurses were both significantly associated with the quality rating. The explanation of health state of mothers and unborn babies by doctors/midwives was significantly associated with the overall rating of care (cOR = 23.7, CI = 95% 1.3 – 419.0). From this study, 93% were satisfied with antenatal care services at the La General Hospital and rated quality of antenatal services as good. Conclusion: ANC attendance, structural factors (physical environment: adequate ventilation in waiting area, adequate wash rooms, enough chair at waiting area, enough privacy at ANC clinic), and health provider factors (prompt attendance to clients by health workers, maintenance of confidentiality and show of respect towards clients, waiting time, contact time, clarity of diagnosis and treatment, health education on labour, medication and its importance, as well as breast feeding) influenced overall clients rating of quality of Antenatal Care at the La General Hospital. It was recommended that the administrators of La General Hospital should encourage and motivate staff to maintain existing relationship with clients and improve on maternal education through capacity building.