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Background: Available evidence suggests that the low use of antenatal, delivery, and post-natal services by Nigerian women may be due to their perceptions of low quality of care in health facilities. This study investigated the perceptions of women regarding their satisfaction with the maternity services offered in secondary and tertiary hospitals in Nigeria. Methods: Five focus group discussions (FGDs) were held with women in eight secondary and tertiary hospitals in four of the six geo-political zones of the country. In all, 40 FGDs were held with women attending antenatal and post-natal clinics in the hospitals. The questions assessed women’s level of satisfaction with the care they received in the hospitals, their views on what needed to be done to improve patients’ satisfaction, and the overall quality of maternity services in the hospitals. The discussions were audio-taped, transcribed, and analyzed by themes using Atlas ti computer software. Results: Few of the participants expressed satisfaction with the quality of care they received during antenatal, intrapartum, and postnatal care. Many had areas of dissatisfaction, or were not satisfied at all with the quality of care. Reasons for dissatisfaction included poor staff attitude, long waiting time, poor attention to women in labour, high cost of services, and sub-standard facilities. These sources of dissatisfaction were given as the reasons why women often preferred traditional rather than modern facility based maternity care. The recommendations they made for improving maternity care were also consistent with their perceptions of the gaps and inadequacies. These included the improvement of hospital facilities, re-organization of services to eliminate delays, the training and re-training of health workers, and feedback/counseling and education of women. Conclusion: A women-friendly approach to delivery of maternal health care based on adequate response to women’s concerns and experiences of health care will be critical to curbing women’s dissatisfaction with modern facility based health care, improving access to maternal health, and reducing maternal morbidity and mortality in Nigeria. Trial registration: Trial Registration Number NCTR No: 91540209. Nigeria Clinical Trials Registry. http://www.nctr.nhrec.net/ . Registered April 14th 2016.
Focus Group Discussions (FGDs) were conducted with women attending maternity clinics in eight tertiary and secondary hospitals in Nigeria to determine their perceptions about the care they received. The hospitals were purposively selected from four out of six geo-political zones in Nigeria (see Fig. 1). Administratively, Nigeria is made up of thirty-six states and a Federal Capital Territoty (FCT), Abuja, which are grouped into six geo-political zones: Northcentral, Northeast, Northwest, Southeast, South-south and Southwest. Two hospitals were selected from each zone except the Northeast and Southeast. The Northeast was not included because of the current insurgency by a terrorist group in that zone, thus the eastern zone in the South was also left out of the study. In the Northwest, the Aminu Kano Teaching Hospital in Kano, Kano State and the Ahmadu Bello University Teaching Hospital, Zaria in Kaduna State were selected. In the Northcentral, General Hospital, Minna, Niger State and Karshi General Hospital, FCT, Abuja were slected. Two facilities were selected from the Southwest: Adeoyo Maternity Hospital, Ibadan, Oyo State; State Hospital, Ijaye, Abeokuta, Ogun state; and Central Hospital, Warri, Delta State and General Hospital, Benin City, Edo State were from the South-south. Map of Nigeria showing geo-political zones and the study sites Five FGDs were conducted in each health facility in 2015. Each FGD consisted of 8 to 12 pregnant women or those who had recently delivered that were attending antenatal or postnatal clinics in the hospital. The participants were recruited through personal contacts when they came for antenatal and postnatal clinics. Two FGDs per hospital consisted of women attending antenatal care, while three FGDs per hospital consisted of women attending postnatal care. The FGD guide was developed and revised by the team leaders at a central meeting held in the project coordinating office. The guide was pre-tested in that location and again pre-tested in the individual study sites before application. In particular, the study guides were translated into the local languages appropriate for the study sites and used for women groups not literate in English. Trained researchers facilitated the FGDs., asking questions, about the women’s perceptions of the quality of care received in the hospital. They were asked about their levels of satisfaction and to make recommendations on what needed to be done to improve the quality of services in the hospitals. All FGDs were audio-taped and transcribed in each hospital. Transcripts in local languages were back-translated to English before final analysis. The transcripts were then forwarded to the coordinating Centre where they were analysed qualitatively. Analysis was conducted in the Department of Sociology and Anthropology at the University of Ibadan, Nigeria. Qualitative data analysis package Atlas ti 6.2 was used for coding. At the first step, transcripts were assigned into Atlas ti and open coding was used to generate themes following the FGD guide for the study, and emerging concepts. At the second level, the codes were organized into analytical categories in form of code families in relation to the study objectives. Data analysis consisted of description of the content and form of transcripts conducted in each site, followed by a review and comparison of the results between the sites. The results enabled us to gain insights into the nature of the policies in each site as well as women’s perceptions and level of satisfaction regarding the quality of services. Ethical approval for the study was obtained from the World Health Organization and the National Health Research Ethics Committee (NHREC) of Nigeria – number NHREC/01/01/2007 – 16/07/2014, renewed in 2015 with NHREC 01/01/20047-12/12/2015b.
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