Health System Factors Associated with Maternal Satisfaction Level among Postnatal Women Attending Public Hospitals in Nairobi City County, Kenya

Abstract

Background: Globally, the rate of maternal mortality is unacceptably on the rise. A considerable number of women are dying from pregnancy or child birth related complications across the world. Many initiatives have been intensified on policy intervention to curb the high cases of maternal mortality. Delivery in unhygienic conditions without the assistance of a skilled birth attendant may lead to adverse health outcomes. Maternal mortality rates in Kenya remain high at 362 per 100,000 live births. Only 62% of women deliver under the care of a skilled provider indicating a deficiency in the quality of care. The government of Kenya introduced the policy of free maternity services to all women attending public health facilities by June 2013 to increase access and help reduce the rate of maternal mortality and morbidity in the country. Objective: The study sought to establish the influence of health system factors with level of maternal satisfaction among postnatal women attending public hospitals in Nairobi City County.

Materials and methods: The study adopted a descriptive cross-sectional facility-based study design which encompassed use of both quantitative and qualitative data collection methods. Quantitative data was collected using pre-tested semi-structured questionnaires through interviews while qualitative data was collected using Focused Group Discussions with patients and Key Informant Interviews with care providers. A total of 383 postnatal mothers were proportionally selected through systematic random sampling and interviewed. Kenyatta National Hospital, Pumwani maternity, Mbagathi and Mama Lucy Kibaki hospitals were purposively selected. Necessary approvals were sought from relevant authorities and informed consent obtained from research participants prior to data collection. Descriptive data was analyzed with the aid of the Statistical Package for Social Sciences (SPSS) version 20.0 with the help of Microsoft Excel program to generate frequency tables, graphs and pie-charts. Thematic analysis of qualitative data and triangulation of results with quantitative data were also done. Inferential statistics were calculated using Chi-Square tests (p<0.05) done at 95% confidence interval to establish the relationship between study variables.

Results: The study found that the overall satisfaction level of respondents was 62.4%. Chi-square analysis revealed significant association between availability of staff (p=0.014), facility cleanliness (p=0.002), availability of drugs (p=0.006) and sharing of beds (p=0.034) on maternal satisfaction level.

Conclusion: The study results indicated a sub-optimal maternal satisfaction level with free maternity services. The policy of free maternal services has led to increased Skilled Birth Attendant deliveries due to breakdown of financial barriers associated with hospital deliveries. These research findings would assist key healthcare stakeholders to design strategic policies and initiatives to address the plight of mothers attending public hospitals. Addressing the challenges would promote sustenance and ensure improved quality of service provision in all public hospitals thus increased satisfaction with care among postnatal women.