CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Antenatal care (ANC) is one of the core interventions for interventions for improving maternal outcomes. Antenatal care (ANC) services enable early identification of pregnancy related risks and complications; and ensure access of services including health education, vaccines, diagnostic tests and treatment, it also help to establish good relationship between pregnant women and service providers  (WHO, 2017). pregnancy is the condition between conception (fertilization of egg by a sperm) and birth; during which the fertilized egg develops into the uterus(NCI, 2018).

Globally ,pregnancy and child birth are significant phenomena for pregnant women and their families(WRA,2010) .More than 99.0% of maternal deaths occur in low and middle-income countries. Although, by 2015,maternal mortality had decrease by over 44.0%, maternal mortality levels have continued to remain unacceptably high in sub-Saharan Africa (SSA) (WHO,2019). Inadequate access to quality antenatal care(ANC) and poor satisfaction contribute significantly to these preventable maternal deaths ( Lawn et al.,2009).

Different studies in deferent parts of the world revealed that maternal satisfaction with antennal care was affected by examination room cleanness, healthcare provider attitude, quality of antenatal care service provide, adequacy of information provided by the health care professional, waiting time, supervision of antenatal care, adequacy of water supply, adequacy of waiting area educational status of the mother, monthly income, type of pregnancy and history of still birth, patient on previous experiences, social and cultural norms, physical environment, ability of adequate resources,(human, medicine, drug, equipment and supplies), adequacy of clinical care and access to treatment in health facilities(Cross et al…2013).

In Cameroon, the maternal mortality ratio was 592 per 100,000 live births according to the 2015 Cameroon Demographic Health Survey, which is among countries with high maternal deaths (DHS-MICS,2015).The country  is committed to achieving the sustainable Development Goal (SDGs), which plans to reduce maternal death to less than 70 deaths per 100,00o live births between 2016 and 2030.However,progress has been stagnated in low- and middle-income countries, including Cameroon(WHO,2016;WHO,2015).

Fortunately, most maternal deaths are avoidable as health solutions to the causes of complication are well known(Hairel et al.., 2010). The solution includes a strong health system that provides maternal services based on a continuum, the essence of ANC services as a platform for important healthcare activities including health promotion and diseases prevention, screening, diagnosis and management of pregnancy related complication(Kerber, 2007 Finlayson, 2013). As such, ANC create a unique opportunity for early detection and management of hypertension, gestational diabetes, anemia, malaria, HIV and other health conditions which can otherwise would jeopardize the health of the mother and the growing fetus (WHO, 2016 Horn, 2014)

The ANC is considered one of the best strategies to reduce maternal morbidity and mortality (Haftu et al., 2017). Although the 2016 World Health Organization(WHO) ANC model recommends a minimum of eight ANC contacts, with the first contact scheduled to take place in the first trimester, two contacts scheduled in the second trimester, and five contacts scheduled in the third trimester, Cameroon still appears the 2022 WHO focused ANC(FANC) model, which recommends that pregnant women need to have a minimum of four antenatal visits for  a normal pregnancy. Worldwide, 85% of the pregnant women had at least one ANC visit, whereas only 58% had the recommended four  ANC visits (WHO, 2018). In Cameroon, 62.0% of pregnant women had at least one ANC visit and only 32.0% of pregnant women in Cameroon had recommended four ANC visits as per the 2015 (DHS-MICS, 2015, Edi et al., 2015). The Health Sector Strategy Plan in Cameroon targets to increase the proportion of women receiving at least four ANC visits up to 95.0% in 2027(HSS, 2016)

In many African countries, the utilization of ANC services in directly related to the satisfaction of clients(Nwaez et al., 2013, Edie et al., 2015.Different studies conducted in sub- Saharan.Africa revealed that pregnant women’s satisfactions with ANC services ranges between 33.0% and 84.0% (Tesfye et.,al 2017; Fseha et al ., 2019).Patient’s satisfaction with the service also affects other people’s service utilization in such a way that the satisfied patient will express their satisfaction recommendation to the other four to five people, and the dissatisfied one will complain to twenty or more other people about their dissatisfaction with the services (Press et al., 2000).

Determinants such as the history of previous ANC ,sex of service provider, initiation time, number of ANC visit, history of still birth, history of abortion , planned pregnancy, facility type, distance and waiting time, cost of initial ANC and maternal education had a potential impact on pregnant women’s satisfaction (Edie et al ., 2015; Lakew et al., 2018 ; Okedo-Alex et al., 2019).

However, there is an inconsistence between the above mentioned studies, which is influenced by socio-cultural, economic and geographical variations (Christians et al., 2017).One of the challenges that we continuously faced recently is suboptimal quality ANC and client dissatisfactions. Thus, assessing the extent of pregnant women’s satisfaction with the health services is crucial, as satisfied clients are more likely to adhere to treatment and received the benefits of ANC. Although client satisfaction is essential for further improvement of the quality of ANC and to provide quality health care service for pregnant women, there is a paucity of data on pregnant women’s satisfaction in Cameroon, particularly in the Buea Health District. Therefore, this study aimed to asses pregnant women’s satisfaction with the quality of ANC in public health facilities in the Buea Health District, South West Of Cameroon.

1.2. Problem Statement

The quality of  ANC services in most developing countries remains low probably because of poor equipment, cost of care and long waiting time therefore, contributing to high preventable maternal and infant death. In Buea, 62.0% of pregnant women had at list one ANC visit and only 32.0% of pregnant women had the recommended four ANC visit as per the 2015 national demographic health survey and clients dissatisfaction with ANC services in Cameroon is generally linked with the high cost of laboratory testing during ANC booking and the long waiting time (EDI et al, 2015; RDPH-SW,2020). Despite the increasing training of midwifes and the use of community health workers in maternal and infant health  care in Cameroon, infant (54 deaths/1000 lives births) and maternal (592 deaths/100,000 live births) mortality rates has remain relatively high (DHS-MICS,2015). This up take in ANC could be attributed to the low quality of ANC and client dissatisfaction as perceived by the pregnant women (Edie et al ., 2015). From the above statistics, it clearly shows that ANC activities is very low in developing countries and Cameroon in particular. This work is therefore  geared to assess pregnant women satisfaction with ANC services and their opinions per what measures can be employ, to suit the best treatment of pregnant women attending ANC in the Buea Regional Hospital.

1.3.  Rationale

Infant (54 deaths/1000 lives births) and maternal (592 deaths/100,000 live births) mortality rates has remain relatively high ( DHS-MICS,2015) and also The quality of  ANC services in most developing countries remains low probably because of poor equipment, cost of care and long waiting time therefore, contributing to high prevalence of maternal and infant death; this can also be attributable to the fact that, there is very limited information on the quality of ANC services in Cameroonian health sector. Little attempts have been made to provide a complete picture of the quality of ANC delivered by the healthcare system in LMICs (|WHO,2016). So with regard to this, it as imperative to pursue a study on the satisfaction of pregnant women with ANC services in the  Buea Regional Hospital, in Buea Health Area.

1.4.    Research Questions

1 What is the perception of pregnant women on ANC services in the Buea Regional Hospital?

2 How satisfied is pregnant women attending ANC in the Buea Regional Hospital?

3 What measures can best be employed to enhance pregnant women satisfaction, among ANC mothers in the Buea Regional Hospital?

1.5.  Research Objectives

1.5.1 General Objective

To assess pregnant women perception on the satisfaction of ANC services in the Buea Health Districts (CMA Muea, Mile 16 IHC and  Buea Regional Hospital).

1.5.2. Specific Objectives

1. To assess pregnant women perception on ANC services in the Buea Regional Hospital.
2. To assess pregnant woman satisfaction on ANC services delivered to them in Buea Regional Hospital
3. To identify measures that can be employ to increase satisfaction amongst pregnant women attending ANC in the Buea Regional Hospital.