MEKELLE UNIVERSITY

COLLEGE OF HEALTH SCIENCE

SCHOOL OF NURSING

MOTHER’S SATISFACTION WITH CHILDBIRTH CARE AT

HEALTH CENTERS AND HOSPITALS OF MEKELLE PUBLIC
HEALTH INSTITUTIONS, TIGRAY, ETHIOPIA, 2017/18

BY: TESFAY GEBRESLASSIE (BSC.N)

A THESIS PROPOSAL SUBMITTED TO THE SCHOOL OF NURSING

MEKELLE UNIVERSITY IN PARTIAL FULFILLMENT OF THE
REQUIREMENT FOR THE DEGREE OF MASTERS IN MATERNITY AND
REPRODUCTIVE HEALTH NURSING

DEC, 2017

MEKELLE, ETHIOPIA

i
 MEKELLE UNIVERSITY

COLLEGE OF HEALTH SCIENCE

SCHOOL OF NURSING

MOTHER’S SATISFACTION WITH CHILDBIRTH CARE AT

HEALTH CENTERS AND HOSPITALS OF MEKELLE PUBLIC
HEALTH INSTITUTIONS, TIGRAY, ETHIOPIA, 2017/18

BY: TESFAY GEBRESLASSIE (BSC.N)

ADVISORS:-
1. Dr. HAFTU BERHE (Assoc. professor)
2. YOHANESS TESFAY (Bsc, Msc)

A THESIS PROPOSAL SUBMITTED TO THE SCHOOL OF NURSING

MEKELLE UNIVERSITY IN PARTIAL FULFILLMENT OF THE
REQUIREMENT FOR THE DEGREE OF MASTERS IN MATERNITY AND
REPRODUCTIVE HEALTH NURSING

ii
Acknowledgements

First of all, I would like to express my deepest gratitude to Mekelle University who provides me
the opportunity to conduct this thesis. Next my advisors Dr. Haftu Berhe and Mr. Yohannes
Tesfay for their valuable advice, guidance and support in writing the proposal and provision of
encouragement they offered me.

iii
Table of Contents
Acknowledgements.....................................................................................................................................iii
Table of Contents........................................................................................................................................iv
List of abbreviations...................................................................................................................................ix
List of tables and figures..............................................................................................................................x
Summary.....................................................................................................................................................xi
1. Introduction.............................................................................................................................................2
1.2 Background.......................................................................................................................................2
1.2 Statement of problem.........................................................................................................................3
1.3 Rational of the study..........................................................................................................................5
2. Literature review.....................................................................................................................................7
2.1Mothers satisfaction with childbirth care given..................................................................................7
2.3 Factors affecting mothers satisfaction with childbirth care given......................................................8
2.3 Conceptual frame work....................................................................................................................12
3. Objectives..............................................................................................................................................14
3.1 General objectives...........................................................................................................................14
3.2 Specific objectives...........................................................................................................................14
4. Methodology.........................................................................................................................................15
4.1. Study Area......................................................................................................................................15
4.2 Study Period....................................................................................................................................15
4.3 Study design....................................................................................................................................15
4.4. Source population...........................................................................................................................15
4.5. Study population.............................................................................................................................15
4.6. Inclusion and Exclusion criteria......................................................................................................15
4.6.1 Inclusion criteria.......................................................................................................................15
4.6.1. Exclusion criteria:....................................................................................................................15
4.7 sample size determination................................................................................................................16
4.8. Sampling procedure........................................................................................................................16
4.9. Method of data collection and Tools...............................................................................................17
4.10. Data quality control......................................................................................................................17

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 4.11. Data analysis method....................................................................................................................18
4.12 Variables........................................................................................................................................19
Dependent variable............................................................................................................................19
Independent variables........................................................................................................................19
4.13 Operational definitions..................................................................................................................19
4.14 Ethical considerations....................................................................................................................20
4.15 Plan for dissemination of the result................................................................................................20
5. Work plan..............................................................................................................................................21
6. Budget break down................................................................................................................................22
7. References.............................................................................................................................................23
Annexes.....................................................................................................................................................27

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List of abbreviations

EDHS - Ethiopian Demographic and Health survey

ETB - Ethiopian Birr
FMOH - Federal Ministry of Health
HC - Health Center
HEWs - Health Extension Workers
HSDP - Health Sector Development Program
IMR - Infant Mortality Rate
LMICs - Low and Middle Income Countries
MDGs - Millennium Development Goals
MNCH - Maternal, Newborn and Child Health
PHC - Primary Health Care
SBA - Skilled Birth Attendance
SPSS - Statistical Package for Social Sciences
WHO - World Health Organization

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List of tables and figures

Table 1: proposal work plan for mother’s satisfaction on childbirth care at health centers and hospitals of
mekelle public health facilities, Tigray, Ethiopia, 2017/18........................................................................19
Table 2: budget break down for mother’s satisfaction on childbirth care at health centers and hospitals of
mekelle public health facilities, Tigray, Ethiopia, 2017/18........................................................................20

Figure 1: Conceptual frame work on Assessment of mothers’ satisfaction with childbirth care ...............13

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Summary
Background: Child birth is considered to be an imperative life event in parent’s life that should
provide with lasting satisfaction for the mother as well as for those who share this occasion with
her. Satisfaction with child birth care at medical facilities affects birth place selection and has a
great influential feature on maternal service return behaviors and utilization. Hence, measuring
mother’s satisfaction with childbirth care helps to improves quality of delivery service given to
mothers and address different problems. We believe such a study would provide valuable
information to health care providers, local administrators, and policy makers to improve services
in Ethiopia.

Objective: The aim of this study is to compare maternal satisfaction with childbirth care and to
identify factors affecting the level of maternal satisfaction in health centers and hospitals of
Mekelle public health facilities, Tigray, Ethiopia.

Methods: Institution based comparative cross sectional study will be conducted from
January15/2018 to April15/2018. The totals sample size is 266 calculated using two population
proportion formula. Systematic random sampling method will be used to select mothers from 3
health centers and 3 hospitals. Interviewer based structured questionnaire will be used to collect
the data. And data will be entered to Epi-data and export to SPSS version 21 for analysis.
Descriptive statistics like mean, frequency and proportions will be explored using tables and
figures to display the values of the variables in the study. Overall satisfaction, which is the
dependent variable, will be computed by adding the mean score of the satisfaction items with 5
point Likert scale and it will be dichotomized in to Satisfied and not satisfied. Bivariate and
multivariable logistic regressions will be applied at 95% CI will be conducted to see the
association and to measure the strength between dependent and independent variables.
Work plan: the study will be carried out from December to June, 2017/18.

Budget: the total budget used to conduct this thesis is estimated to be 36,852.90ETB.

viii
 1. Introduction
1.2 Background

Delivery is extremely important physiological event in a woman's life with deep physical,
psychological and emotional effects on them which is associated with pain, psychological strain,
vulnerability, probable physical effects and death in some rare cases.[1]

Nearly Half a million maternal deaths occurs worldwide. developing countries accounts for 99%
of those death[2].Women’s are central contributors to the nation’s development effort and
children are nation’s important resource of all their needs are a national main concern. However,
About 287,000 women die every year and another 10 million suffer from complications which
are allied to pregnancy and childbirth. despite those illnesses and deaths are preventable through
timely interventions confirmed to be effective and affordable[3, 4].

Sub-Saharan Africa has the highest maternal mortality ratio (MMR) and the lowest coverage of
births attended by skilled health personnel in the world[5]. Although maternal mortality has
reduced, Ethiopia still has one of the highest maternal mortality rates in Africa at 676/100 000
live births and considered to be a major contributor to the worldwide death toll of mothers [6, 7].
The World Health Organization (WHO) emphasizes that ensuring patient satisfaction as a means
of secondary prevention of maternal mortality since satisfied women may be more likely to stick
on to health providers’ recommendations[8].

In the last decades of years infrastructure opening out was phenomenal In Ethiopia. But some
health facilities were made outfitted with the necessary materials and human resources which
cast worries about the quality of service. Health facilities can only make available quality
services if their physical infrastructure is in line with sufficient and serviceable materials and
supplies, if there is sufficient number of trained human resources that are performing up to
standards, and if their target population is satisfied with the services and go on with utilizing the
services[9].

Patient satisfaction is well thought-out as an outcome of health care service delivery as well as
measure of its quality and has become now days a central part of hospitals/clinics management

9
strategies across the world[4]. Clients wait for health workers to provide quality services with a
high sense of kindliness when working. Quality of care provided during childbirth is a significant
determinant of increasing utilization of services and preventing maternal mortality and
morbidity[10].

Satisfaction with health services, including childbirth services, has emerged as a universal cost-
effective method of evaluating service quality. It is known that, the aim of every obstetrician and
midwife is to provide the best possible reproductive health Care and Taking care of mother in
delivery with no side effects. It is, therefore, necessary to recognize the consequences of
insensitive care during labour and to facilitate the experience of birth for women and for their
chosen companions as much as possible. Appreciating maternal perception of care and
satisfaction with services is important in this regard[11].When clients visit to the health facilities
and health care providers they have a specific agenda which usually reflects concerns and
problems they want the health service providers to address during consultation[12].

1.2 Statement of problem

The health of women is an important contributing factor to the overall health of any nation;
where maternal health care service is one of the most effective health interventions for
preventing maternal morbidity and mortality[13].

An estimated of 287,000 maternal deaths occurred in 2010. Developing countries accounted for
99% (284,000) of those deaths which is particularly worrying in Sub-Saharan Africa where most
maternal deaths occur every year because of absence of quality healthcare among the developing
regions. Maternal and neonatal morbidity and mortality rates in Ethiopia are among the highest
in the World. According to World Health Organization (WHO) 2012 report, 9000 maternal
deaths occurred in Ethiopia in 2010 [3].

Child birth is considered to be an imperative life event in parent’s life that should provide with
lasting satisfaction for the mother as well as for those who share this occasion with her. Taking
in mind that a bad experience of labor may interfere with her full recovery, it is necessary to be
aware of the consequence of unfeeling care during labor. Therefore, It is important to facilitate
the experience of birth for women and for their chosen companion as much as possible.[11].

10
Labour and delivery care satisfaction has a great influential feature on maternal service return
behaviors and utilization. Hence, measuring mother’s satisfaction with labour and delivery care
helps to address different problems and improves quality of delivery service given to mothers.
[14]

An important component of efforts to reduce health risks to mothers and children is increasing
the proportion of babies that are delivered in health facilities[15]. Despite the Ethiopian
government has made efforts to expand health service facilities and promote institution-based
delivery service in the country, many women continue to deliver at home. For instance, in
Ethiopia, access to health service has been significantly improved and maternal services had
been free but facility based childbirth is still 26% even as skilled attendance at birth is only
28%[16, 17]. Some of the reasons for not delivered in health facilities are: inaccessible transport,
unmet community expectation, shortage of skilled human resources, too much cost, no female
provider, husband or family not allowed during delivery and labour, service not customary and
poor satisfaction of mothers with delivery service[6, 15, 18].

Different Studies discovered that the quality of intra-partum care services was poor and women
satisfaction was low from the perspective of clients. This is attributable to provider’s bad attitude
and communication, longer duration of stay in the ward, inadequate information about the drug
prescribed and explanation of procedures to be done to the client, experiencing an episiotomy
and poor pain relief during labor[19-22]. On the other hand women’s level of satisfaction during
labor and delivery was high. This is associated with wanted status of pregnancy, good maternal
condition after delivery, short waiting time to see the health worker, availability of waiting area,
provider’s measure taken to assure privacy during examinations and reasonable amount of cost
paid for the service [14, 23-26]

Satisfaction with delivery care for mothers giving birth at medical facilities, particularly
hospitals, affects birth place selection[27]. Evidence had indicated that satisfaction affects health
service utilization, individuals blissful with the care received and act in accordance with services
and follow up, and continue with the care[4]. Several factors affect women’s satisfaction during
childbirth including interpersonal manner of care providers, technical quality of care,
accessibility to care, birth outcomes, physical environment and availability of medical care

11
resources[28]. For instance An Exploratory Study of Women’s Perspective on Experience of
Facility Based Childbirth in Rural Ethiopia indicated that, a range of experiences they had during
childbirth at health facilities that forced them to choose home delivery in their most recent
delivery. Those were abusive and disrespectful treatment, unskilled care, poor client provider
interaction, non-continuous care, lack of privacy, and traditional practices[29]. Similarly,
Community based cross sectional study in Afambo district, Afar, Ethiopia show that institutional
delivery service utilization was very low 22.4% in the study area[18].

Patient satisfaction is a necessary measure for the quality of medical service since it provides
information on the providers’ success when meeting client’s value. Nevertheless, different
studies revealed that the level of patient satisfaction varies in different types of health
institutions. Therefore, assessment of client satisfaction adds an important ‘consumer’
perspective to evaluation taking in mind that feedback from the client can influence the whole
quality improvement agenda within the institution or organization[13]. Study on Quality of the
delivery services in health facilities of Northern Ethiopia reported that lower delivery quality in
health facilities as compared to some other African countries. Overall, only 6.3% of the health
facilities were rated as good in all the three quality components; that is input, process and
output[9].

Previous studies on patients’ assessment of Health centers and Hospitals showed lapses in
relation to timeliness of delivery care, waiting time, physical environment, medication
communication, lack of opportunity to Talk, continuity of care and patient follow-up [26, 30,
31].in addition Different studies from health delivery institutions show that client care
satisfaction levels range from 19% to 81%.[13, 14, 24-26, 32]. However, none of these studies
compared the findings from health center and hospital settings. Little is known about mother’s
satisfaction at public health facilities in mekelle, northern Ethiopia. This can be done using
childbirth care that is given in health centers and hospitals of health facilities in mekelle. We
believe such a study would provide valuable information to health care providers, local
administrators, and policy makers to improve services in Ethiopia.

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1.3 Rational of the study

Although many researchers have examined delivery service satisfaction in different health
institutions in Ethiopia, The findings have not always been comparable across the health centers
and hospitals. Given the significance of childbirth care satisfaction, additional research is needed
that examine and compares the components of satisfaction in between health centers and
hospitals and addresses the contradictions surrounding factors associated with childbirth care
satisfaction.
No study was conducted on maternal satisfaction regarding childbirth care in the hospitals and
health centers in mekelle before. The results of this study will provide scientific evidence
regarding mothers’ satisfaction with delivery care at hospitals and health centers. In addition the
satisfaction will be compared in between the two settings and factors that affect the satisfaction
will be addressed. Consideration of the satisfaction by health policy makers, health care
providers and local administrators might be necessary for improving the quality of mother and
newborn care, and reducing MMR and IMR.

Recommendations and interventions can be developed based on findings of the study to improve
overall quality of care given in the maternal and newborn care services. In addition, this study
will be used as a baseline data for future studies in the context of maternal satisfaction in health
delivery system. Therefore, this study is Aimed to compare the levels of delivery care
satisfaction among mothers who gave birth in hospitals and health centers, and to examine the
associations between their overall delivery care satisfaction and background factors.

13
 2. Literature review
2.1Mothers satisfaction with childbirth care given

Maternal satisfaction has often been defined using theoretical models of patient satisfaction and
there is consensus that it is a multidimensional concept, influenced by a variety of factors. It is
therefore defined as “positive evaluation of distinct dimensions of childbirth”[28].

According to a study done on women’s Satisfaction with childbirth services at Chhattisgarh,

India revealed that Women giving vaginal birth at the community health centers had better odds
of receiving basic facilities as compared to women who had vaginal births at the hospitals. The
study indicated that the proportion of women satisfied with childbirth services offered at the
health centers were 81% as compared with women who gave birth at hospitals 59.7% [33].
Another study conducted in Jordan on women’s satisfaction with hospital based intrapartum care
show that only 17.8% of women’s were satisfied[22].

According to a study carried out amongst mothers who delivered at primary health centers of
India revealed that Eighty-six percent of clients expressed complete satisfaction and 14% were
partially satisfied with their stay and treatment at the facility[34]. Similarly a study conducted in
Nairobi’s, Kenya on Women’s satisfaction with delivery care, Over half (56%) of women would
both recommend and deliver again in the same facility[35]. study done on patients’ satisfaction
with midwifery services at a regional hospital and its referring clinics in the Limpopo province
of south Africa reviewed that 51.9% of the mothers were satisfied[36].

Research conducted on Predictors of Women’s Satisfaction with Hospital Based Intra-partum

Care in Asmara Public Hospitals, Eritrea indicated that only 20.8% of the participants were
satisfied with intra-partum care given[37].

Study in Ethiopian public health facilities on performance of Respectful maternity care during
labor and child birth show that health centers was significantly higher 69% as compared to
hospitals 59%[38].Another Study in Public Health Facilities of Gamo Gofa Zone on Client

14
Satisfaction with Delivery Care Service indicated that Women attending health centers were
more likely satisfied than women attending hospitals 94.4% and 58% respectively[8].
A facility based cross-sectional study conducted on mothers who gave birth in selected public
health centers of Omo Nada district, south west of Addis Ababa show that The overall
satisfaction with institutional delivery service was 65.2% [13]. A study on Maternal satisfaction
on delivery service and its associated factors among mothers who gave birth in public health
facilities of Debre Markos Town revealed that overall satisfaction of mothers on delivery service
was found to be 81.7%[19]. And there were similar finding in a study that was conducted in
Wolaita Zone 82.9% [39].

According to study at St. Paul’s Hospital Millennium Medical College (SPHMMC), Addis
Ababa Ethiopia, Only 19% of the study participants were found to be satisfied with the intra
partum care received [14]. A hospital-based cross-sectional survey conducted on Mothers’
satisfaction with Delivery service in Amhara referral hospital showed that, the proportion of
mothers who were satisfied with delivery care in the study was 61.9%[25]. Another study in
Amhara region showed 74.9% of mothers satisfied with service given for them and others
unsatisfied with the service given for them[32].

Findings from Maternal Satisfaction with the Delivery Services in Assela Hospital, Arsi Zone,
Oromia Region showed that the overall maternal satisfaction level with the delivery services
rendered at the hospital was 80.7%[26]. Similarly findings from facility based cross-sectional
survey in West Arsi, Oromia Regional State showed that the overall satisfaction level of mothers
with delivery service was 74.6% [24]. A community-based cross sectional study done on
Institutional delivery service utilization and associated factors among mothers who gave birth in
Sekela District, North West of Ethiopia reviewed that 33% of mothers were satisfied with
delivery service[18].

2.3 Factors affecting maternal satisfaction with childbirth care given

When global efforts to reduce maternal mortality have been stepped up, it is important to look at
maternal satisfaction and its determinants. Factors affecting maternal satisfaction covered all
dimensions of care across structure, process and outcome. Where, Structural elements included
good physical environment, cleanliness, and availability of adequate human resources, medicines

15
and supplies) and Process factors affecting maternal satisfaction included interpersonal behavior,
privacy, promptness, cognitive care, perceived provider competency and emotional support.
Whereas Outcome related factors affecting maternal satisfaction are health status of the mother
and newborn[24].in addition socio demographic ,cost of the service and obstetric characteristics
are also other factors that affect maternal satisfaction .

2.3.1 Structure related factors

When environments are explicitly designed to complement birth physiology, studies have found
decreased use of intra-partum analgesia, oxytocin augmentation, instrumental vaginal birth and
episiotomy, as well as increased likelihood of spontaneous vaginal birth and can support the
hormonal processes of labour and birth by providing a sense of control over privacy[40].
Cleanliness, good housekeeping services and maintenance of hygiene were reported as
determinants of satisfaction where, frequent changing of bed sheets led to enhanced satisfaction
with care [28]. Non-availability of nursing personnel, and essential medicine and inadequacy of
staff to attend to women, especially during labor, was reported as a cause for dissatisfaction with
service. Whereas, Availability of prescription drugs, essential equipment like blood pressure
monitors or thermometers, lab ser- vices and emergency supplies like blood and transfusion
services, were reported as significant predictors of satisfaction with care[28].

Research done at government hospitals in Xiengkhuang province, Lao PDR on Delivery care
satisfaction show that presence of medical service facilities in the ward (81.7%) such as drug,
equipment, etc. was among the highest variable with satisfaction level, On the other hand
sanitary facilities, cleanliness of facility were among the Components of low satisfaction[27].
According to Study on Predictors of Women’s Satisfaction with Hospital Based Intra-partum
Care in Asmara Public Hospitals, Eritrea revealed that clean bed and beddings, toilet ease of
access and cleanliness availability of chairs for relatives, were some of The key predictor
variables of satisfaction with intrapartum care provision[37].

According to study on Public Health Facilities of Omo Nada District, Jimma Zone, cleanliness of
the toilet, estimated walking distance and time of delivery were significant factors associated
with mothers’ overall satisfaction. As per the study more than quarter of mothers were not
satisfied and strongly not satisfied with the distance of health center from their residence,

16
whereas about (45.5%) mothers were satisfied and (29.9%) of them are neither satisfied nor
Unsatisfied. satisfaction with cleanliness of the delivery room in which the delivery was
conducted was 14.3% Strongly satisfied and 65.3% satisfied.[13]. Another Study done in Asela
hospital Among the delivering mothers showed that 64.8% of mothers were satisfied with the
facility distance but the remaining 35.2% were not satisfied[26]. the same to that according to
Institutional based study in West Arsi zone oromia regional state on mother’s satisfaction and
associated factors show that 68% satisfied from distance to hospital[24].

A community-based cross sectional study done on Institutional delivery service utilization and
associated factors among mothers who gave birth in Sekela District, North West of Ethiopia
reviewed that 33% of mothers were satisfied with delivery service. No drugs and supplies
(43.2%), were among The major reasons for dissatisfaction [18].Study in health institutions of
west arsi, oromia regional state reviewed that 68.6% and 58.9%) of the respondents were
satisfied with access and cleanliness of toilet and 78.2%of the mothers were satisfied with the
cleanliness and comfort of examination room[24].

2.3.2 Process related factors

Interpersonal behavior, privacy, promptness, cognitive care, perceived provider competency and
emotional support are process factors believed to affect the level of maternal satisfaction[28].

Research done at government hospitals in Xiengkhuang province, Lao PDR on Delivery care
satisfaction show that there was high satisfaction with politeness, courtesy, and respect from
providers (nurses, midwives, and doctors). While opportunity to clarify doubts about baby care,
mothers’ own health condition, and privacy maintained during care were among the low
satisfaction components[27].

Results from a cross- sectional survey among postnatal women in Chhattisgarh, India show that
women giving birth at the Community health centers were most satisfied with ‘Maintaining
privacy’ than women’s delivering at District hospitals. Where interacting with care providers,
being able to maintain privacy, and being free from fear of childbirth had a positive influence on
overall satisfaction with the childbirth [33].

17
Based on client’s perspective on obstetric care received at primary health centers of a district
located in western India Found that waiting period before consulting health care provider was less
than 15 minutes in most 83% of the cases . The study also found that 89 % of the mothers saying
that, they were adequately explained about the procedure before examination. The clients found
the behavior of the staff to be good in majority (88.9%) of the cases. Not a single client reported
negative behavior like arrogance, rudeness or negligence by any of the staff members, right from
the doctors and nurses to the other staff members. According to the study Privacy being
maintained at the place of examination, 100% clients reported the maintenance of privacy at the
place of examination. around half of the clients’ family member was allowed to stay with them
during labour [34].

A cross-sectional study of health facilities on direct observation of respectful maternity care in

five countries: in East and Southern Africa show that The least observed checklist item was
whether the client was asked if she had any questions, with a prevalence of 16 % in Ethiopia and
high of only 42 % in Rwanda[41].

According to Study on Predictors of Women’s Satisfaction with Hospital Based Intra-partum

Care in Asmara Public Hospitals, Eritrea revealed that privacy during maternal examinations,
using language women could understand staff, showing how to summon for help, showing baby
immediately after birth of the delivery room, receive back massage, allowing parents/sibling to
stay during labour and request for permission before any procedure were The key predictor
variables of satisfaction with intrapartum care provision[37].

Result from respect full maternity care at Ethiopian public health facilities show that 17% and 17%
privacy were violated among health centers and hospitals. According to the study Support person
allowed during labor was higher among health centers than hospitals 86%,78%. Similarly, on the
case of Explaining each step of the examination to the woman, encourage to ask question to the
woman, explain what will happen during labor to the woman (, 69%, 57%),(44%,26%),(78%,88%) in
health centers and hospitals respectively. And the practice of allowing preferred positions was
significantly higher in health centers than in hospitals 42%,27%[38].

Quality of Delivery Service at Public Health Facilities in Arba Minch District, Gamo Gofa Zone
revealed that 10.9% women in the study area complained about courtesy and respect from health

18
workers during the course of labor. This was 20.45% in hospitals compared to health centers,
only 4.01%. Proportion of women who complained about an unfriendly attitude or UN respectful
care from health workers was higher in the hospitals than health centers. The same to that
mothers satisfied with emotional support to the client during child birth and Presence of support
person during child birth 78.4% and respectively 65.3%). As per the finding support person
during child birth was one determinant factor for satisfaction of delivering [8].

Study carried out on Mothers' satisfaction with referral hospital delivery service in Amhara
Region, Ethiopia, show that client privacy related satisfaction (46.7) were among least values
associated with client satisfaction[25]. Study in health institutions of west arsi, oromia regional
state on mother’s satisfaction and associated factors show that privacy of mothers and waiting
time were among the important predictors of level of satisfaction. Of these 77.1% of mothers
waiting time to see a doctor or midwife or other health care provider was less than one hour, 12.9%
was 1-2 hours and 10% were greater than two hours. Of these 88.3% of them were satisfied with the
time spent to be seen by health care providers and 11.7% of them were unsatisfied [24].

Study in Asela hospital reviewed that waiting time less than 2 hrs and measures taken to assure
privacy were considered among the determinant factors associated with maternal satisfaction
during delivery. From the respondents 78.1%, 80.9% were satisfied with waiting time to see the
doctor and privacy respectively[26]. According to study in St Paul’s Hospital Millennium
Medical College Addis Ababa Ethiopia show that opportunity to talk, Pain Management, Short
Length of Time Taken for Admission after Seen by Health Professionals and Short Length of
Stay in the Hospital were factors associated with delivery service satisfaction. It indicated that
when the length of stay in the hospital increases, women were less likely to be satisfied. And
odds/chance of satisfaction for women who had an opportunity to talk with health care providers
was 2.44 times higher than those who did not have an opportunity to talk[14].
A community-based cross sectional study done on Institutional delivery service utilization and
associated factors among mothers who gave birth in Sekela District, North West of Ethiopia
reviewed that 33% of mothers were satisfied with delivery service. Bad behavior of professionals
(20.8), Lack of privacy (6.4%), Presence of male professional (5.2%) were among The major
reasons for dissatisfaction[18].

2.3.3 Outcome related factors

19
Maternal and newborn outcomes in terms of survival and health of mothers and newborns (for
example, mother alive in spite of fetal loss; baby alive and healthy) affected satisfaction with
care[28].Research done at government hospitals in Xiengkhuang province, Lao PDR on Delivery
care satisfaction show that there was low satisfaction with infant’s and maternal health condition,
42.7% and 43.5% respectively[27]. Study in amhara region show that Women’s satisfaction with
delivery care was associated with favorable immediate maternal condition after deliver][25].
Study in Asela hospital reviewed that, normal maternal outcome, alive fetal outcome were
associated with maternal satisfaction during delivery[26].

2.3.4 Other factors

Socio demographic factors, cost and obstetric characteristics

Maternal characteristics also affected women’s perceived satisfaction with care. Maternal age
and education was positively associated with maternal satisfaction, possibly because of greater
experience and maturity[28]

According to study on Public Health Facilities of Omo Nada District, Jimma Zone, Age of the
mother, wanted status of the pregnancy, ANC utilization, admission to MWH, and time of
delivery were significant factors associated with mothers’ overall satisfaction. Those whose age
is less than 20 and mothers 20-34 years of age were more likely to be satisfied compared to those
within 34-49 years of age group. Mothers who planned their pregnancy were 2.85 times more
likely to be satisfied with institutional delivery service compared to those did not planned. The
study also revealed that mothers who had ANC follow up had two fold increased satisfaction
compared to those did not receive ANC service[13].

Research done in Asela hospital reviewed that Maternal age, educational status, monthly income,
having 1-5 parity, planned hospital for delivery, pregnancy being wanted, normal, having ANC
follow up, charge for service payment, were among the determinant factors associated with
maternal satisfaction during delivery. Those respondents who had ANC follow up were found to
have two fold increased odds of maternal satisfaction compared to those who had no ANC
follow up. Concerning respondents age, mothers whose age 20-34 were more likely satisfied
compared to those whose age were 35-49. respondents who had no higher education were more

20
satisfied than those who had diploma and above the ratio of mothers who satisfied with cost of
service were 61.3% and 38.7% were unsatisfied[26].

According to a study done in Felegehiwot referral hospital, Bahirdar, age, ANC follow up, and
the number of pregnancies was statically significant predictors of women’s satisfaction on
childbirth care services[32].Another Study in health institutions of west arsi, oromia regional
state on mother’s satisfaction and associated factors show that educational status, economical
status, was important predictors of level of satisfaction. Mothers whose educational status was 1-
6 and 7-12 were less satisfied than mothers whose their educational status were diploma and
above respectively[24].

cost measures women’s satisfaction with the financial aspect related to delivery service and
identifies the satisfaction with the cost they had to bare for utilizing the services thus 42 % of
women were not satisfied with the financial aspect, while 58% of women were satisfied as per
study in Pakistan[2]. Study in Amhara region showed that Women’s satisfaction with delivery
care was associated with amount of cost paid for service[25]. And study in Asela hospital also
revealed that the ratio of mothers who satisfied with cost of service were 61.3% and 38.7% were
unsatisfied[26].

2.3 Conceptual frame work

This framework considers structure related factors, process related factors, outcome related
factors as well as socio demographic and other obstetric and cost related factors which affect the
satisfaction of mothers with childbirth care service (figure1).

21
 Structure related factors
-Physical environment
-Medicine and supplies
-Cleanliness of Health
Institution
-Human resources

Other
Process related -Socio-
factors Mother’s demographic
-Interpersonal satisfaction characteristics
behavior -obstetric
-Privacy characteristics
-Perceived good -cost
care
-Cognitive support
-Emotional support
-female provider
-Waiting time Outcome related
factors
-delivery outcome

Figure 1: Conceptual frame work on Assessment of mothers’ satisfaction with childbirth care
[28].

22
3. Objectives
3.1 General objectives
 To compare women’s satisfaction and its associated factors with childbirth care at health
centers and Hospitals in Mekelle public health facilities, Tigray Region, Ethiopia,
2017/18.

3.2 Specific objectives

 To compare health centers and Hospitals in relation to women’s satisfaction with
childbirth care in Mekelle public health facilities, Tigray Region, Ethiopia, 2017/18.
 To determine factors associated with satisfaction with childbirth care at health centers
and Hospitals in Mekelle public health facilities, Tigray Region, Ethiopia, 2017/18.

23
 4. Methods and materials
4.1. Study Area

Mekelle is found at 783 Km north of Addis Ababa with latitude and longitude 130
29’N39’E13.4830N39.4570E and at elevation of 2084 meters above sea level. It is
administratively divided in to seven wereda 20 Kebeles which are named corner by corner.
Mekelle has 3 governmental hospitals, 9 governmental health centers all of them are giving
delivery service, postnatal care according to regional health bureau.

4.2 Study Period

The study will be conducted from January to April at governmental public hospitals and health
centers of Mekelle town, 2017/18.

4.3 Study design

Institutional based Comparative cross sectional study design will be conducted.

4.4. Source population

All women who visited, Mekelle Governmental public Health institutions for childbirth
Service, will be taken as a source of population.

4.5. Study population

Selected mothers who visited the hospitals and health centers for childbirth service during the
data collection period will be the study population.

4.6. Inclusion and Exclusion criteria

4.6.1 Inclusion criteria

Mothers’ who have spontaneous vaginal birth in Governmental Health centers and hospitals
during the data collection period and those who are volunteer to participate will be the study
subjects.

4.6.1. Exclusion criteria:

 Mothers ‘who are diagnosed with mentally or critically ill
 Those mothers who undergo cesarean section in the hospital
 mothers whose neonates admitted to intensive care for any reason in the hospitals

24
4.7 sample size determination

The sample size for this study will determined using double population proportion formula
taking the prevalence of delivering mothers satisfied with hospital delivery care service [26] and
prevalence of patients delivery satisfaction in health centers [13]from previous studies . The
sample size will be calculated using Epi Info Version 7 with the following assumptions: 80%
power, 95% confidence level, ratio of 1, 10% non response rate. Therefore the final sample size
will be estimated to be 266.

4.8. Sampling procedure

All the governmental hospitals and the selected health centers in Mekelle town will be taken and
Number of participants from each selected health centers and hospitals will be determined by
proportion allocation to population size by reviewing the first quarter average number of delivery
services. After reviewing the first quarter report of 2010 EFY delivery services, 3 health centers
will be selected from the study health centers based on their delivery flow. Then systematic
random sampling technique will be used to get each individual from the health facility until the
required number allocated is obtained. Based on 3 months report from the hospitals and health
centers preceding the survey, there are 2280 women received childbirth care service in the
hospitals and health centers, which implies that on average 760 women received childbirth care
in each month, assuming that number of women attended the hospitals and health centers for
childbirth care; then the sample size 266 is divided to the total number of women received the
care in each month to find the sampling fraction, and is found to be one third (1/3). Then every
third woman in the immediate post natal ward will be recruited for the study.

25
 Mekelle governmental hospitals

3 hospitals 9 health centers

ACSH (500), Mekelle hospital(700), Quiha Hospital(150) Semen HC(250), Adishmdhun HC(330) , Caseach HC(350)

Sample size Sample size Sample size Sample size Sample size Sample size
=58 =81 =18 =29 =39 =41

Proportional allocation to
size
Total sample
=266

4.9. Method of data collection and Tools

Data will be collected using interviewer based structured questionnaire having three parts, the
first Containing Socio demographic characteristics of delivering mothers. The second part
Obstetric history of delivering mothers, to measure mothers satisfaction with delivery service
and The third parts containing respondents’ satisfaction on health facility process, structure and
distance traveled related. Delivery service satisfaction related questions are adopted and
modified from The Donabedian quality assessment framework[28] and presented using a 5-
likert scale (1-very satisfied, 2-satisfied, 3-neutral, 4-disatisfied, and 5-very dissatisfied).
Mothers will be interviewed whenever legible after delivery as per the criteria. 4 Diploma holder
Nurses will selected to collect the data; and two BSC holders Nurse will selected as a supervisors
from other area outside of study site.

26
4.10. Data quality control

The first draft of the English questionnaire will translated to Tigrigna language by language
expert translators then back to English language to check for consistency. Before starting the
actual survey, the questionnaire will pre-tested on five percent of sample from the Hospital and
Health centers which are outside study area. The selected data collectors and supervisor will be
trained on the objective; benefit of the study, individual’s right, informed consent and techniques
of the interview for one day. Throughout the course of the data collection, interviewers will
supervised at each site, regular Meetings will held between the data collectors and the principal
investigator together in which Problematic issues arising from interviews which will be
conducted and mistakes found during Editing will be discussed. The collected data will be
reviewed and checked for completeness before data entry; the incomplete data will discard.

4.11. Data analysis method

Data will be checked, coded and entered to Epi-data and export to SPSS (Statistical Package for
Social science) version 21 for analysis. Data entry will be made by the principal investigator.
Descriptive statistics like mean, frequency and proportions will be explored using tables and
figures to display the values of the variables in the study. First the overall satisfaction, which is
Dependent variable will be computed by adding the mean score of the satisfaction items with 5
point Likert scale (ranging from strongly not Satisfied to Strongly Satisfied).

Mothers’ overall satisfaction will be categorized/dichotomized in to Satisfied and not satisfied.

Bivariate and multivariable analysis will be conducted to see the association and to measure the
strength of between dependent and independent variables. The association between dependent
and independent variables will be determined using odds ratio with 95% confidence interval.
First bivariate logistic regression will be performed to identify determinants of mothers’
satisfaction with the service, significant variables which are candidates for the multivariable
logistic regression analysis will be determined using the p value, and then multivariate logistic
regression analysis will be applied to describe the relative effect of independent variables on the
mothers satisfaction.

27
4.12 Variables

Dependent variable

 level of mothers satisfaction

Independent variables

 Structural factors include: Physical environment , Cleanliness , Human

resources ,Medicines and supplies ,distance traveled

 Process factors: Interpersonal behavior , Privacy/confidentiality , perceived good care,

waiting time,Pain management, Cognitive support ,Emotional support , Sex of service
providers

 Outcome factors : Delivery outcome

 Other factors , Socio demographic characteristics , Obstetric history , Cost

4.13 Operational definitions

Maternal satisfaction; - mothers’ expressed state of being satisfied with health care service in
the dimension of quality of care (process, outcome and physical environment and other related
factors).
Satisfied: - mothers, who scored above the mean score from the items of Patient Satisfaction
Questionnaire, will be categorized under “satisfied”. Each response of ‘very satisfied’ and
‘satisfied’ are classified as satisfied.
Unsatisfied: - mothers who scored below the mean score from the items of Patient Satisfaction
Questionnaire, will be categorized under “unsatisfied” for the overall satisfaction level and for
each responses, ‘very dissatisfied’, ‘dissatisfied’ and ‘neutral’ as unsatisfied. Neutral Responses
are classified as dissatisfied considering that they may represent a fearful way of expressing
dissatisfaction.
Waiting time: - the time between admissions to the time seen by health professional.
Promptness of care: - provision of care without delay/immediately, avoidance of prolonged
waiting time.
Interpersonal behavior: - the way in which health professionals communicate with mothers;
such as with dignity, respect, courtesy, therapeutic communications (listening, politeness, prompt

28
pain relief, kindness, approachability and smiling demeanor), caring behavior (attentive to needs,
making clients feel accepted and coaxing clients).
Cognitive care: - process of sharing adequate information with mothers about their condition or
the care required,
Emotional support: - provision of reassurance, acceptance and encouragement during times of
stress.

4.14 Ethical considerations

Ethical clearance letter will be obtained from Institutional Review Board (research committee) of
mekelle University College of Health Science. Official letters of cooperation will obtained from
tigray Regional health Bureau. And permissions for collection of data will be obtained from the
selected health centers and hospitals. Before conducting the interviews, information will be given to
the participants and participants’ voluntary participation, confidentiality, anonymity and freedom to
withdraw from the study at any time will be assured. The nature and importance of the study will be
explained and oral consents will be obtained from the participants.

4.15 Plan for dissemination of the result

The result of this study will be presented to mekelle University, college of health science school of
nursing. And copy of the study publication will be distributed to the Ministry of Health, tigray
Regional Health Bureau, for the selected health centers as well as hospitals and other concerned
bodies through reports and publication on an appropriate journal.

29
 5. Work plan
Table 1: proposal work plan for mother’s satisfaction on childbirth care at health centers and
hospitals of mekelle public health facilities, Tigray, Ethiopia, 2017/18

Months

Resp.
Body
Jan Feb Apr May Jun
Activities Dec Mar
Title selection and Thesis
Proposal development PI

Proposal defence PI

Proposal submission PI
Obtaining ethical
clearance & Collection of
finance MU
Preparation of supplies &
training of data collectors PI+DC

Pre-testing PI

Data collection PI+DC

Data entry, cleaning,
analysis PI

Report writing PI
Submission of 1st draft
Report PI
Incorporating Advisors
feedback PI
Submission of 2nd draft
Report PI
Incorporating Advisors
feedback PI
Defense and Submission
of final draft report PI

30
6. Budget break down

Table 2: budget break down for mother’s satisfaction on childbirth care at health centers and
hospitals of mekelle public health facilities, Tigray, Ethiopia, 2017/18

Budget Description Unit quantity Rate unit Number Total birr

category cost cost of days
personnel Perdiem for Person 6 266x25 per 6,650
data collectors questionnair
e
Perdiem for Person 2 200 25 10,000
supervisors
Perdiem for Person 1 100 2 200
translators
Stationar Pen Pieces 8 5 40
y
materials
Photo copying Pieces 266x8 1 2128
costs
Note book Pieces 8 5 40
Binder Packs 4 10 40

supplies Taxi transport 8 10 50 4000

Mobile card 8 10 25 2000
Total 25,098.00
Contingency 10%=2,509.80
Grand total 27,607.80ETB

31
 7. References

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2. Ashraf, M., et al., Assessing womenâ s satisfaction level with maternity services:
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UNFPA and The World Bank estimates, 2012.

4. Dzomeku, M., Maternal satisfaction with care during labour: a case study of the
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10. Das, J.K., et al., Evidence from facility level inputs to improve quality of care for
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11. Chalmers, B., V. Mangiaterra, and R. Porter, WHO principles of perinatal care: the
essential antenatal, perinatal, and postpartum care course. Birth, 2001. 28(3): p. 202-
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12. Berhane, A. and F. Enquselassie, Patient expectations and their satisfaction in the
context of public hospitals. Patient preference and adherence, 2016. 10: p. 1919.

13. Biniyam Haile Tadesse, N.B.B., Gebeyehu Tsega Nebeb, Mothers’ Satisfaction with
Institutional Delivery Service in Public Health Facilities of Omo Nada District, Jimma
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14. Demas, T., et al., Women’s satisfaction with intrapartum care in St Paul’s Hospital
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15. AGENCY, C.S., ETHIOPAN MINI DEMOGRAPHIC HEALTH SURVEY, 2014:

ADDIS ABEBA,ETHIOPIA.

16. Agency, C.S., Ethiopian Demographic Health survey, 2016: Addis Abeba,Ethiopia.

17. Organization, W.H., The prevention and elimination of disrespect and abuse during
facility-based childbirth: WHO statement, 2014.

18. Teferra, A.S., F.M. Alemu, and S.M. Woldeyohannes, Institutional delivery service
utilization and associated factors among mothers who gave birth in the last 12 months
in Sekela District, North West of Ethiopia: A community-based cross sectional study.
BMC Pregnancy Childbirth, 2012. 12(1): p. 74.

19. Bitew, K., M. Ayichiluhm, and K. Yimam, Maternal satisfaction on delivery service
and its associated factors among mothers who gave birth in public health facilities of
Debre Markos Town, Northwest Ethiopia. BioMed research international, 2015. 2015.

20. Birmeta, K., Y. Dibaba, and D. Woldeyohannes, Determinants of maternal health

care utilization in Holeta town, central Ethiopia. BMC health services research, 2013.
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21. Kigenyi, O., et al., Quality of intrapartum care at Mulago national referral hospital,
Uganda: clients’ perspective. BMC Pregnancy Childbirth, 2013. 13(1): p. 162.

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22. Mohammad, K.I.S., et al., Womens satisfaction with hospital-based intrapartum care:
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23. Ngula, A.K., Women's perception on the under utilization of intrapartum care services
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24. URGESSA, A., MOTHERS’SATISFATION WITH DELIVERY SERVICES

ANDASSOCIATED FACTORS AT HEALTH INSTITUTIONS IN WEST ARSI,
OROMIA REGIONAL STATE, 2016, ADDIS ABABA UNIVERSITY.

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26. Amdemichael, R., Tafa, M,Fekadu, H, Maternal satisfaction with the delivery services
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27. Khammany, P., YoshitokuSarker, Mohammad Abul BasharTouy,

ChanthalangsyReyer, Joshua A Hamajima, Nobuyuki, Delivery care satisfaction at
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strategy in Lao PDR. Nagoya journal of medical science, 2015. 77(1-2): p. 69.

28. Srivastava, A., et al., Determinants of women’s satisfaction with maternal health care:
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29. Mehretie Adinew, Y. and N. Abera Assefa, Experience of Facility Based Childbirth
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32. Mekonnen, M.E., Worku AwokeAnteneh, Zelalem Alamrew, Women’s satisfaction
with childbirth care in Felege Hiwot Referral Hospital, Bahir Dar city, Northwest
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37. Kifle, M.M., et al., Predictors of Women’s Satisfaction with Hospital Based
Intrapartum Care in Asmara Public Hospitals, Eritrea.

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35
 Annexes

Annex I

English version information sheet and consent form.

Good morning/ afternoon?

My name is _____________________. I am working as a data collector on behalf of Tesfay
Gebresslassie who is currently a postgraduate student on Maternity and Reproductive health at
Mekelle University, College of Health Sciences, School of nursing. The objective of this study is
to compare mothers’ satisfaction with delivery services and factors affecting the level of
mothers’ satisfaction at public health centers and Hospitals in Mekelle Town.
This interview might take 20 - 30 minutes. Your name will not be written anywhere in the form
and all the information you give us is confidential except for the purposes of this study and it will
never be disclosed for the third parity. In addition, I would like to inform you that by
participating in this study, you will get no short term or long term risk or benefit. I also would
like to inform you that you have a full right to withdraw from the study or to stop the interview
any time or to skip any question that you do not want to answer. Your cooperation and
willingness for the interview is very helpful in identifying the problem related to the issue.
So do you agree to participate in this study?
Respondent agrees to be interviewed go to the next part.
Respondent does not agree to be interviewed stop interview.
Thank you in advance for your cooperation.
Data collectors Name____________________ sign: __________
If you have any question or doubt, you can contact as with the address below.
Name of the principal Investigator: Tesfay Gebresslasie
Mobile: +251 914816889. E-mail: tesfitagebrex1@[Link]

36
Annex II

English version questionnaire

Instruction; - Circle the response in the response column that best matches with the answer of the
respondent.
01. Questionnaire identification number-------------------------------------------
02. Interviewer code -------------------------- and name ----------------------------
03. Date of interview --------------------------------- 04. Health center code -------------05. Hospital code

Part one: socio economic characteristics

Sno Question Response Skip

101 Age in years
102 Marital status 1. Single
2. Married
3. Divorced
4. Widowed
5, Separated
103 Educational status 1. No formal education
2. Grade 1–6
3. Grade 7–12
4. Diploma and above
104 Occupation 1. Governmental employee
2. private employee
3. self employed
4. unemployed
5. Other(specify)________
105 Average Annually household
income

Part two: obstetric history questions

Sno Question Response Skip

201 Parity (number)

202 Status of pregnancy 1, Wanted

2, Unwanted
203 Maternal outcome 1, Normal
2, With complication
204 Fetal outcome 1, Live birth
2, Still birth
3, Neonatal death
4, Others --- specify
205 Did you have ANC follow up? 1, Yes

37
 2, No
206 Time of admission
1. 6 am – 12 pm
2. 12 pm – 6 pm
3. 6 pm – 12 am
4. 12 am – 6 am

Part 3: Satisfaction Related Questions

A) Health facility related:
Sno Question Response
301 How much KMs distance you
traveled for service?
302 Mode of transportation used 1. Car
2. On foot

303 How much you satisfied with 1. Very satisfied

the facility distance? 2. Satisfied.
3. Neutral
4. Dissatisfied
5. Very dissatisfied
304 How satisfactory was the 1. Very satisfied
number of health providers in 2. Satisfied.
labour and delivery rooms? 3. Neutral
4. Dissatisfied
5. Very dissatisfied
305 How satisfied are you with the 1. Very satisfied
availability and adequacy of 2. Satisfied.
medical supply and drugs? 3. Neutral
4. Dissatisfied
5. Very dissatisfied
306 How satisfied are you with the 1. Very satisfied
availability and sanitation of 2. Satisfied.
toilets? 3. Neutral
4. Dissatisfied
5. Very dissatisfied
307 How satisfied are you with the 1. Very satisfied
sanitation of delivery and 2. Satisfied.
examination rooms? 3. Neutral
4. Dissatisfied
5. Very dissatisfied
308 Is there waiting area for the 1. Yes
patients And relatives? 2. No
309 How much are you satisfied 1. Very satisfied
with the overall cleanliness 2. Satisfied.
and comfort of the waiting 3. Neutral
area? 4. Dissatisfied

38
 5. Very dissatisfied
310 Have you had to pay for any 1, Yes If no skip no 312
services or products during your 2, No
stay?

311 How satisfied are you with the 1. Very satisfied

cost of the service 2. Satisfied.
3. Neutral
4. Dissatisfied
5. Very dissatisfied
B) Care provider related:
312 How long did you wait in this 1. less than 1 hour
health center/hospital before 2. 1-2 hours
receiving care from health care 3. greater than 2 hours
providers?

313 How satisfied are you with the 1. Very satisfied

time spent waiting to be seen by2. Satisfied.
a health care provider? 3. Neutral
4. Dissatisfied
5. Very dissatisfied
314 Health providers asked 1. Very satisfied
permission before applying any 2. Satisfied.
procedures and examination 3. Neutral
4. Dissatisfied
5. Very dissatisfied
315 Health worker explained the 1. Very satisfied
labour progress to you by 2. Satisfied.
using your local and clear 3. Neutral
language. 4. Dissatisfied
5. Very dissatisfied

316 1. Very satisfied

Have you felt confused because 2. Satisfied.
different member of staff have 3. Neutral
given you conflicting advice or 4. Dissatisfied
information. 5. Very dissatisfied

317 Health workers verbally 1. Very satisfied

encouraged praised and 2. Satisfied.
reassured during the time of 3. Neutral
labour. 4. Dissatisfied
5. Very dissatisfied
318 How satisfied are you with the 1. Very satisfied
respect and courtesy of the 2. Satisfied.
health care providers? 3. Neutral
4. Dissatisfied
5. Very dissatisfied
319 How satisfied are you with the 1. Very satisfied
competency and confidence of 2. Satisfied.

39
 the health care providers with 3. Neutral
their work. 4. Dissatisfied
5. Very dissatisfied
320 Were there measures taken to 1, Yes
assure privacy during physical 2, No
examinations and delivery? For
example, a private room,
Curtained or screened area, etc

321 How satisfied are you with the 1. Very satisfied

privacy during physical 2. Satisfied.
examinations and delivery? 3. Neutral
4. Dissatisfied
5. Very dissatisfied
322 What was the sex of the health 1, Male
care provider who attended your 2, Female
labour and delivery?

323 1. Very satisfied

How satisfied are you with the 2. Satisfied.
sex of the health care provider 3. Neutral
who attended your labour and 4. Dissatisfied
delivery? 5. Very dissatisfied

324 How satisfied are you with the 1. Very satisfied

overall care and pain 2. Satisfied.
management the time of labour 3. Neutral
and delivery. 4. Dissatisfied
5. Very dissatisfied
325 Was there any health problem 1, Yes
on your newborn baby? 2, No

326 You were able to ask any 1. Very satisfied

question about your baby at any 2. Satisfied.
time. 3. Neutral
4. Dissatisfied
5. Very dissatisfied
327 Received enough support from 1. Very satisfied
the staff in breastfeeding your 2. Satisfied.
baby immediately after birth and 3. Neutral
how to care for your baby. 4. Dissatisfied
5. Very dissatisfied
328 Your baby received enough care 1. Very satisfied
and support. 2. Satisfied.
3. Neutral
4. Dissatisfied
5. Very dissatisfied
329 Would you seek delivery service 1, Yes
in the same facility next time if 2, No
you get pregnant?

40
 330 Would you recommend this 1, Yes
facility to your family and other 2, No
relatives?

Annexes III
Tigrigna version information and consent form
ናይ መረዳእታ እና ስምምዕነት መውሃቢ ውዕል

አብ ትሕቲ አክሱም ከተማ ምምሕዳር ዝርከባ ሆስፒታላትን ጥዕና ጣብያን ዝወልዳ አዴታት ናይ
ዕግበት መጠን ንምውድዳርን ፅዕንቶ ዘሕድሩ ነገራት ንምፍላይን ዝተዛጋጀየ ቃለ መሕተት

ናይቲ መጽናዕቲ ባዓል ዋና፡ ተስፋይ ገ/ስላሴ

ናይቲ መፅናዕቲ ርእሲ፡ አብ መቀለ ምምሕዳር ዝርከባ ሆስፒታላትን ጥዕና ጣብያን ዝወልዳ
አዴታት ናይ ዕግበት መጠን ንምውድዳርን ፅዕንቶ ዘሕድሩ ነገራት ምፍላይን

መፅናዕቱ ዘካይደሉ ትካል፡ መቀለ ዩኒቨርስቲ

ጥዕና ይሃበለይ ሽመይ----------------ይባሃል፡፡ ኣነ መረዳእታ ሰብሳቢ ኮይነ እዚ መረዳእታ

ዝእክቦ ተስፋይ ገ/ስላሴ (መቀለ ዩኒቨርሰቲ ጥዕና ሳይንስ ኮለጅ ነርሲንግ ትምህርቲ ክፍሊ
ናይ ድሕሪ ምረቓ ትምህርቲ ተማሃሪ) ናይ ማስተርስ ትምህርቲ ንምጥንቃቕ ናይ መመረቂ ፅሕፎም
ንምድላው ንክሕግዞም ኮይኑ ናይቲ መፅናዕቲ ዓላማ ኣብ ሆስፒታላትን ጥዕና ጣብያን ዝወልዳ
አዴታት ናይ ዕግበት መጠን ንምውድዳርን ዕእንቶ ዘሕድሩ ነገራትን ችግራትን ምፍላይ እዩ፡፡ እዞም ሕቶታት
ንምሕታት ካብ 25-30 ደቂቃ ይወስድ፡፡ ኣብቲ መፅዕናቲ ናትክን ስምን ኣድራሻን ኣይጥቀስን፡፡ ካባክን ዝውሰድ
መረዳእታ ካብቲ መፅናዕቲ ዓላማ ሓሊፉ ን ካሊእ አካል ኣሕሊፍካ ኣይዋሃብን ሚስጢሩ ዝታሓለወ እዩ፡፡ ኣብዚ መፅዕናቲ
ብምስታፍክን ዝበፀሐክን ጉዳአት ይኩን ዝተፈለየ ጥቅሚ የለን፡፡ኣብዚ መፅናዕቲ ንምስታፍ ፍቓደኛ ተዘይኮይንክን
ከምኡ እውን ምምላስ ዘይትደሊኦ ሕቶ ታሃሊዩ ኣብ ጥያቄ ግዘ ናይ ምቁራፅ መሰልክን ዝታሓለወ ምካኑ ክገልፀልክን
ይፈቱ፡፡አብዚ መፅናዕቲ ነምስታፍ ናትክን ምትሕብባርን ኣብቲ ጉዳይ ዝላዕሉ ችግራት ንምፍላይን ብጣዕሚ ኣድላይ
ስለዝኮነ ንክትሳተፋ ብትሕትና ንላወ፡፡ ልዕል ኢሉ ብዝትገለፀ መረዳእታ መሰረት ኣብዚ መፅናዕቲ ንክሳተፍ ፍቓደኛ
እየ፡፡

ፌርማ---------------

ምጥያቅ ዝደልይዎ ጥያቄ ወይም ግልፂ ዘይኮነ ነገር ታሃሊዩ ኣብዚ ትሕት ኢሉ ብዝተገልፀ ኣድራሻ መሰረት ከግንዩና
ይክእሉ ፡

ናይቲ መፅናዕቲ ባዓል ዋና ሽም፡- ተስፋይ ገ/ስላሴ ሰልክ ቁፅሪ - 251-914-816-889 ኢሜይል-
tesfitagebrex1@[Link]

ቃለ መሕተት

41
መምርሒ፤ ናብቲ ጥያቄ ዝማሳሰል መልሲ መሪፀን የክብባ

01. ናይቲ ጥያቄ መለለዩ ቁፅሪ----------

02. ናይቲ ጥያቄ ሰብሳቢ መለለዩ ቁፅሪ----------

03. ቃለ መሕተት ዝተካየደሉ ዕለት-----------

04. ናይ ጥዕና ጣብያ መለለዩ ቁፅሪ---------

05. ናይ ሆስፒታል መለለዩ ቁፅሪ---------

ክፍሊ 1፡ ናይ ተጠያቂ ማሕበራዊን ዲሞግራፊያዊን ኩነታት

ተራ ቁፅሪ ሕቶ መልሲ
101 ዕድመ
102 ናይ መርዓ ኩነታት 1.ዘይተመርዐወት
2. ዝተመርዐወት
3.ዝፈትሐት
4.ባዓል በታ ዝሞታ
5.ዝተፈላለየት
103 ደረጃ ትምህርቲ 1.ዘይተማሃረት
2. ቀዳማይ ደረጃ ትምህርቲ ዘጠናቃቀት
3.ካላኣይ ደረጃ ትምህርቲ ዘጠናቃቀት
4. ካላኣይ ደረጃ ትምህርቲ ካብኡ ንላዕልን
104 ስራሕ 1. ናይመንግስቲ ሰራሕተኛ
2. ኣብ ናይ ግሊ መስርያበት ዝተቆፀረት
3.ናይ ግሊ ስራሕ
4.ስራሕ ዘየብላ
5.ካሊእ እንታሃሊዩ ይጥቀሳ
105 ብማእከላይ ዓመታዊ ጠቅላላ ናይ
ገዛ ኣታዊ

ክፍሊ 2፤ ናይ ውላድ ኩነታት

ተራ ቁፅሪ ሕቶ መልሲ
201 ክንደይ ቆልዑት አለዉኪ
202 ናይ ጥንሲ ኩነታት 1.ዝተደለየ
2. ዘይተደለየ
203 ድሕሪ ምውላድኪ ዝነበረ ናይ ጥዕና 1. ኣብ ጥዕናይ ችግር ነይሩ
ኩነታት 2. ኣብ ጥዕናይ ችግር ኣይነበረን
204 ድሕሪ ምውላድኪ ዝነበረ ናይ 1. ብሂወት ዝተወለደ
ቆላዕኪ ጥዕና ኩነታት 2.ሞይቱ ዝተወለደ
3.ድሕሪ ምውላዱ ዝሞተ
4.ካሊእ ታሃሊዩ ይጥቀሱ----

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205 ናይ ጥንሲ ክትትል ነዩርኪ ዶ 1. እወ
2.አይነበረንን
206 አብዙይ ዝበፃሕክሉ ሳዓት 1.ካብ ንጉሆ 12-ቀትሪ 6 ሳዓት
2. ካብ ቀትሪ 6 ሳዓት-ምሸት 12
ሳዓት
3.ካብ ምሸት 12 ሳዓት-ለይቲ 6
ሳዓት
4. ካብ ለይቲ 6 ሳዓት-ንጉሆ 12

ክፍሊ 3፤ብ ኣጣቃላሊ ናይ ዕግበት ኩነታት

ሀ) ናይ ጥዕና ትካል ዝምልከት

ተራ ቁፅሪ ሕቶ መልሲ ዝለል

301 ናብ ጥዕና ትካል ንምብፃሕ
ክንደይ ኪሎመ ይጋዓዙ
302 ናብ ጥዕና ትካል ንምብፃሕ 1.ብ መኪና
ብምንታይ ይጋዓዙ 2. ብእግሪ
3. ካሊእ ታሃሊዩ ይጥቀሱ
303 ናብ ጥዕና ትካል ንምብፃሕ 1.ብጣዕሚ ዓጊበ
ዘሎ ናይ ርሕቀት ዕግበት 2.ዓጊበ
3.ሞንገኛ
4.ኣይዓገብኩን
5.ብጣዕሚ ኣይዓገብኩን
304 ኣብ ሕርስን ወሊድን ግዘ 1.ብጣዕሚ ዓጊበ
ዝነበሩ ጥዕና ባዓል 2.ዓጊበ
ሞያታት በዝሒ 3.ሞንገኛ
4.ኣይዓገብኩን
5.ብጣዕሚ ኣይዓገብኩን
305 ኣብ ጥዕና ጣብያ/ሆስፒታል 1.ብጣዕሚ ዓጊበ
ናይ ሕክምና መሳርሕታትን 2.ዓጊበ
መድሓኒታትን ኣቅርቦት 3.ሞንገኛ
4.ኣይዓገብኩን
5.ብጣዕሚ ኣይዓገብኩን
306 ሽንተ ቤት ኣቅርቦትን 1.ብጣዕሚ ዓጊበ
ፅሬትን 2.ዓጊበ
3.ሞንገኛ
4.ኣይዓገብኩን
5.ብጣዕሚ ኣይዓገብኩን
307 መመርመርን መዋለዲ 1.ብጣዕሚ ዓጊበ
ክፍሊን ፅሬት 2.ዓጊበ
3.ሞንገኛ
4.ኣይዓገብኩን
5.ብጣዕሚ ኣይዓገብኩን
308 ን ታሓካምን ቤተሰብን 1. የለን

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 መፅንሒ ቦታ አሎ ዶ 2.አሎ
309 ን ታሓካምን ቤተሰብን 1.ብጣዕሚ ዓጊበ
መፅንሒ ቦታ ፅሬትን 2.ዓጊበ
ምቾትን 3.ሞንገኛ
4.ኣይዓገብኩን
5.ብጣዕሚ ኣይዓገብኩን
310 ን ግልጋሎትን ንሕክምና 1.እወ መልሱ ኣይከፈልኩን
መሳረሒታት ወጪ ከፊልኪ 2.ኣይከፈልኩን ተኮይኑ ሕቶ ቁፅሪ 312
ዶ? ዝለልዮ
311 ዋጋ ተመጣጣኒ ነይሩ ዶ 1.ብጣዕሚ ዓጊበ
2.ዓጊበ
3.ሞንገኛ
4.ኣይዓገብኩን
5.ብጣዕሚ ኣይዓገብኩን
ለ) ብዛዕባ ጥዕና ባዓል ሞያ ዝምልከት
312 ካብ ጥዕና ባዓል ሞያታት 1. < 1 ሳዓት
ሓግዝ ንምርካብ ክንደይ 2. 1-2 ሳዓት
ዝኣክል ተፀቢኪ 3. >2 ሳዓት
313 ኣብ ጥዕና ባዓል ሞያታት 1.ብጣዕሚ ዓጊበ
ሕክምና ንምርካብ 2.ዓጊበ
ዝተፀበክዮ ሳዓት ዕግበት 3.ሞንገኛ
4.ኣይዓገብኩን
5.ብጣዕሚ ኣይዓገብኩን
314 ብ ጥዕና ባዓል ሞያታት 1.ብጣዕሚ ዓጊበ
ምርመራን ሕክምናን ቅድሚ 2.ዓጊበ
ምሃቦም ፍቃደኛነትኪ 3.ሞንገኛ
4.ኣይዓገብኩን
5.ብጣዕሚ ኣይዓገብኩን
315 ጥዕና ባዓል ሞያታት ኣብ 1.ብጣዕሚ ዓጊበ
ሕርሲኪ ግዘ ናይቲ ሕርሲ 2.ዓጊበ
ኩነታት ብዝርደአኪ ቓንቃ 3.ሞንገኛ
ኣርዲአሙኪ ዶ 4.ኣይዓገብኩን
5.ብጣዕሚ ኣይዓገብኩን
316 ጥዕና ባዓል ሞያታት 1.ብጣዕሚ ዓጊበ
ዝፃረር ወይ ዝተፈላለየ 2.ዓጊበ
ምክሪ ወይ መረዳእታ ስለ 3.ሞንገኛ
ዝሃቡኒ ተደናጊርኪ ነይርኪ 4.ኣይዓገብኩን
ዶ 5.ብጣዕሚ ኣይዓገብኩን
317 ጥዕና ባዓል ሞያታት ኣብ 1.ብጣዕሚ ዓጊበ
ሕርሲኪ ወይ ወሊድ ሳዓት 2.ዓጊበ
የበራታተዑኪን 3.ሞንገኛ
የፅናዕንዑኪን ነይሮም 4.ኣይዓገብኩን
5.ብጣዕሚ ኣይዓገብኩን
318 ኣብ ጥዕና ባዓል ሞያታት 1.ብጣዕሚ ዓጊበ
ትሕትናን ኣክብሮትን 2.ዓጊበ

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 ዝተመልኦ ግልጋሎት 3.ሞንገኛ
ዝነበረኪ ዕግበት ታይ 4.ኣይዓገብኩን
ይመስል 5.ብጣዕሚ ኣይዓገብኩን
319 ጥዕና ባዓል ሞያታት ኣብ 1.ብጣዕሚ ዓጊበ
ምርመራ ዝፀንሕሉ ሳዓት 2.ዓጊበ
3.ሞንገኛ
4.ኣይዓገብኩን
5.ብጣዕሚ ኣይዓገብኩን
320 ጥዕና ባዓል ሞያታት ኣብ 1.ብጣዕሚ ዓጊበ
ኣሰራርሐኦም ዘለዎም ዓርሰ 2.ዓጊበ
እምነትን ብቃዓትን 3.ሞንገኛ
4.ኣይዓገብኩን
5.ብጣዕሚ ኣይዓገብኩን
321 ኣብ ምርመራን ወሊዲን ግዘ 1.ብጣዕሚ ዓጊበ
ካብ ካለኦት ሰባት 2.ዓጊበ
ንዘይምርይ ዝተገበረ ነገር 3.ሞንገኛ
ንኣብነት መጋረጃ ኣብ 4.ኣይዓገብኩን
ዘለዎ ዝተፈለየ ክፍሊ 5.ብጣዕሚ ኣይዓገብኩን
322 ዘዋለደኪ ጥዕና ባዓል ሞያ 1. ወዲ
ፆታ ታይ ነይሩ 2.ኣነስታይ
323 ብዘዋለደኪ ጥዕና ባዓል 1.ብጣዕሚ ዓጊበ
ሞያ ፆታ ዓጊብኪ ዶ 2.ዓጊበ
3.ሞንገኛ
4.ኣይዓገብኩን
5.ብጣዕሚ ኣይዓገብኩን
324 ኣብ ወሊድን ሕርሲን 1.ብጣዕሚ ዓጊበ
ዝተገበረልኪ ድጋፍን 2.ዓጊበ
ቃንዛ ሕርሲ ዕግበትኪ ታይ 3.ሞንገኛ
ይመስል ነይሩ 4.ኣይዓገብኩን
5.ብጣዕሚ ኣይዓገብኩን
325 ኣብ ዝተወለደ ህፃን ናይ 1.እወ
ጥዕና ችግር ኣጋጢሙ ነይሩ 2.ኣየነበረን
326 ብዛዕባ ናይ ቆላዕኪ 1.ብጣዕሚ ዓጊበ
ኩነታት ዝደለኪዮ ጥያቄ 2.ዓጊበ
ኣብ ዝደለኪዮ ሳዓት 3.ሞንገኛ
ምጥያቅ ኪእልኪ ነይርኪ ዶ 4.ኣይዓገብኩን
5.ብጣዕሚ ኣይዓገብኩን
327 ቆላዕኪ ከመይ ከምእተጡብን 1.ብጣዕሚ ዓጊበ
ከም እትንከባከብዮን 2.ዓጊበ
ኣድላዩ ዝባሃል ድጋፍ ካብ 3.ሞንገኛ
ጥዕና በዓል ሞያ ረኪብኪ 4.ኣይዓገብኩን
5.ብጣዕሚ ኣይዓገብኩን
328 ቆላዕኪ ኣድላዩ ዝባሃል 1.ብጣዕሚ ዓጊበ
ምንክብካብ ን ድጋፍን 2.ዓጊበ
ረኪባ/ቡ 3.ሞንገኛ

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 4.ኣይዓገብኩን
5.ብጣዕሚ ኣይዓገብኩን
329 ድሕሪ ሕዚ ናይ 1. እወ
ጥንሲንወሊድን ኣገልገሎት 2. ኣይመዕእን
ንምርካብ ናብዚ ጥዕና
ትካል ትመፂ ድኪ
330 እዚ ጥዕና ትካል 1. እወ
ንዘመድኪን አዕርክተክን 2. ኣይመክርን
ኣገልግሎት ንክረክብሉ
ትመክሪ ዶ

46