Abstract
BackgroundThe Malawi government encourages early antenatal care, delivery in health facilities, and timely postnatal care. Efforts to sustain or increase current levels of perinatal service utilization may not achieve desired gains if the quality of care provided is neglected. This study examined predictors of perinatal service utilization and patients’ satisfaction with these services with a focus on quality of care.MethodsWe used baseline, two-stage cluster sampling household survey data collected between November and December, 2012 before implementation of CARE’s Community Score Card© intervention in Ntcheu district, Malawi. Women with a birth during the last year (N = 1301) were asked about seeking: 1) family planning, 2) antenatal, 3) delivery, and 4) postnatal care; the quality of care received; and their overall satisfaction with the care received. Specific quality of care items were assessed for each type of service, and up to five such items per type of service were used in analyses. Separate logistic regression models were fitted to examine predictors of family planning, antenatal, delivery, and postnatal service utilization and of complete satisfaction with each of these services; all models were adjusted for women’s socio-demographic characteristics, perceptions of the closest facility to their homes, service use indicators, and quality of care items.ResultsWe found higher levels of perinatal service use than previously documented in Malawi (baseline antenatal care 99.4%; skilled birth attendance 97.3%; postnatal care 77.5%; current family planning use 52.8%). Almost 73% of quality of perinatal care items assessed were favorably reported by > 90% of women. Women reported high overall satisfaction (≥85%) with all types of services examined, higher for antenatal and postnatal care than for family planning and delivery care. We found significant associations between perceived and actual quality of care and both women’s use and satisfaction with the perinatal health services received.ConclusionsQuality of care is a key predictor of perinatal health service utilization and complete patient satisfaction with such services in Malawi. The current heightened attention toward perinatal health services and outcomes should be coupled with efforts to improve the actual quality of care offered to women in this country.
Highlights
The Malawi government encourages early antenatal care, delivery in health facilities, and timely postnatal care
Utilization of perinatal health services was high for antenatal care (99.4% attended at least one visit) and delivery care (97.3% delivered in a health facility), and relatively lower for postnatal care (77.5% had at least one postnatal check) and family planning (74.5% ever use and 52.8% current use of any contraceptive method; Table 2)
Nine in 10 women received the contraceptive method of choice, were counseled on correct method use and possible side-effects, and had a follow-up visit scheduled during the office visit; yet, only two thirds of women were counseled on whether or not their method of choice offered protection against Human immunodeficiency virus (HIV) infection the last time they sought family planning services. These results indicate a higher quality of family planning provision in Ntcheu district than documented by the 2013 Malawi Service Provision Assessment at the national level [32] –the latter found that most family planning consultations included discussions
Summary
The Malawi government encourages early antenatal care, delivery in health facilities, and timely postnatal care. Women who perceive the quality of care in a health facility to be high are more likely to seek services there [7, 8]; perceived poor quality of care can lead to underutilization of services [9,10,11,12]. Both actual and perceived quality of care can be measured, and several frameworks for doing so have been proposed in the literature [4, 13]. It was defined as “patient’s judgment on the quality and goodness of care” [13] or “a subjective and dynamic perception of the extent to which the expected health care is received” [15], and, it is, of key interest to quality improvement in health care
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