Identifying the determinants of patient satisfaction in the context of antenatal care in Kenya, Tanzania, and Malawi using service provision assessment data.

BACKGROUND: Antenatal care (ANC) is a service that can reduce the incidence of maternal and neonatal deaths when provided by skilled healthcare workers. Patient satisfaction is an important health system responsiveness goal which has been shown to influence adherence to healthcare interventions. This study aims to assess the determinants of pregnant women's satisfaction with ANC across Kenya, Tanzania, and Malawi using nationally representative Service Provision Assessment data. METHODS: Patient satisfaction was conceptualised mainly based on Donabedian's theory of healthcare quality with patient characteristics, structure, and process as the major determinants. Bivariate and multivariate analyses were conducted to identify the potential determinants. RESULTS: Findings show that satisfaction was negatively associated with women's age (AOR: 0.95; 95% CI: 0.92-0.99) and having a secondary (AOR: 0.39; 95% CI: 0.17-0.87) or tertiary education (AOR: 0.41; 95% CI: 0.17-0.99) in Kenya. Women on their first pregnancy were more likely to report satisfaction in Tanzania (AOR: 1.62; 95% CI: 1.00-2.62) while women were less likely to report being satisfied in their second trimester in Malawi (AOR: 0.31; 95% CI: 0.09-0.97). The important structural and process factors for patient satisfaction included: private versus public run facilities in Kenya (AOR: 2.05; 95% CI: 1.22-3.43) and Malawi (AOR: 1.85; 95% CI: 0.99-3.43); level of provider training, that is, specialist versus enrolled nurse in Tanzania (AOR: 0.35; 95% CI: 0.13-0.93) or clinical technician in Malawi (AOR: 0.08; 95% CI: 0.01-0.36); and shorter waiting times across all countries. CONCLUSION: Findings highlight the importance of professional proficiency and efficient service delivery in determining pregnant women's satisfaction with ANC. Future studies should incorporate both patient characteristics and institutional factors at health facilities into their conceptualisation of patient satisfaction.

Factors associated with long-acting and short-acting reversible contraceptive use in Ethiopia: an analysis of the 2016 Demographic and Health Survey.

PURPOSE: This study sought to examine different factors associated with use of contraceptive types among Ethiopian women, as well as to update the literature on general contraceptive use. These analyses can be used to tailor and improve family planning policy and long-acting contraceptive use. METHODS: The Ethiopia Demographic and Health Survey 2016 conducted in-person interviews with 15,683 women aged 15-49. Participants were asked about contraceptive use, family planning attitudes, personal and household characteristics, and lifestyle. We used bivariate and multivariate logistic regression to analyse factors associated with general contraceptive use and long-acting contraceptive use. RESULTS: Our study confirms many previously documented determinants of general contraceptive use including marital status, age, religion, decision-making ability, and occupation. Factors associated with long- versus short-term reversible contraceptive use were religion, region, age group, highest level of education, and discussing family planning at a health facility. CONCLUSION: This study outlines crucial differences between long- and short-acting contraceptive users. Further family planning policy efforts taking into account regional, religious and other personal and socio-economic factors would effectively augment ongoing efforts. Additionally, the role played by discussion with health professionals in supporting long-term contraceptive use reflects the success of the ongoing effort to drive use in Ethiopia. KEY MESSAGE Global and national health actors are focused on improving access to long-acting contraceptives, however there is little evidence on factors that facilitate their uptake compared to the traditionally popular, short-acting contraceptives. Our study found significant religious and regional differences in long-acting contraceptive use which policy makers can use to guide their efforts.. Community health extension workers play a key role in long-term contraceptive access through tailored person-person education, consultation, and provision.