PROCESS EVALUATION OF THE QUALITY OF POSTNATAL CARE SERVICE AT THE UNVERSITY OF GONDAR COMPREHENSIVE SPECIALIZED HOSPITAL NORTHWEST ETHIOPIA, 2021

Abstract

Abstract Background: Postnatal care (PNC) is the most neglected maternal health care delivery system despite the fact that the majority of maternal and neonatal deaths happen during the first weeks of life. Evaluation of postnatal care quality is overlooked or not yet touched. Therefore, available evidence is crucial to identify the gap and to take corrective action.

Objective: The objective of the study was to evaluate the quality of postnatal care service at the University of Gondar Comprehensive Specialized Hospital, Central Gondar zone, north west Ethiopia 2021.

Methods: Single case study design with quantitative and qualitative methods was employed to evaluate the quality of PNC service from May 26 to July 26, 2021. The service quality was evaluated using availability, compliance, and satisfaction dimensions. Systematically selected 394 mothers who attended postnatal care service were interviewed. Similarly, systematically selected 394 clients’ chart was reviewed retrospectively. Moreover, twelve purposely selected direct observations session, and twelve purposely selected key informant interviews were conducted. The quantitative data was entered into EpiData

version 4.6 and exported to SPSS version 21 software for analysis. Bi-variable and multivariable logistic regression analyses were used to assess factors associated with client satisfaction. Variables with p-value < 0.25 in bivariate logistic regression were candidate for multiple logistic regressions. The statistical association between the dependent and independent variables were ascertained at a p-value of less than 0.05 in the multiple logistic regression analyses.The qualitative data were analyzed using thematic analysis through thematizing the availability of resources, compliance of healthcare providers, and the satisfaction of mothers with PNC services. Finally, the overall quality of service implementation was determined based on pre-determined judgment criteria.

Result: The overall quality of PNC services was judged as fair (63.5%), based on pre-set judgment criteria, to which availability of resources, healthcare providers’ compliance with the WHO practice guideline, and maternal satisfaction contributed 60%, 61.5%, and 70.2%, respectively. Three fourth (79.4%; 95% CI: 75.0, 83.2) of the mothers were satisfied with PNC service. Urban residence (AOR=3.0; 95% CI: 1.38, 6.54), mothers having previous history of still birth (AOR= 0.42; 95% CI: 0.19, 0.94), mothers who planned their pregnancy (AOR= 2.13; 95% CI = 1.02, 4.44), mothers who did not face any complications during birth (AOR= 6.0; 95% CI: 2.76,13.13), mothers who felt unhappy by the welcoming approach of health care providers (AOR=0.1; 95% CI: 0.06, 0.27) were significance factors associated with maternal satisfaction. Conclusion and recommendation: The process of PNC service quality was found to be fair. Inadequate infrastructure and medical equipment were impeding the quality of service provided. There is a need to strengthen the facility by availability of recommended resources and also need to have a standard guideline that will serve as a framework for provision of quality postnatal care. Key words: Postnatal care, Quality, Evaluation, Availability, Compliance, satisfaction.