CHAPTER ONE

INTRODUCTION

1.1 Background to the study

Antenatal care or prenatal care is the care a woman receives while pregnant to ensure that

both mother and baby are as healthy as possible. It involves regular check-ups with the baby

and identifies any health problems in either mother or child that could cause problems.

Pregnancies that are considered high risk may require additional tests or more frequent

check-ups. Mothers-to-be are also offered antenatal classes to prepare them for looking after

their baby, such as workshops on breastfeeding. Antenatal care is carried out because it is

important for the wellbeing of the mother and the baby. During pregnancy, a number of

complications can occur for the baby and the mother that can be prevented and avoided by

monitoring the development of the foetus. Regular visits with a doctor or midwife is also

useful for providing the expecting mother with useful information about pregnancy, labor,

and having a baby, along with advice on how to stay healthy while pregnant. Antenatal care

may also involve discussing options for when the baby comes, including making a birth plan

(Barnick, 2023).

According to Fawole et al. (2021), the concept of antenatal care as an effective public health

strategy is credited to the dramatic improvements in maternal and prenatal outcomes

witnessed in Europe in the last century, but the impact of antenatal care in these settings has

not recorded the desired results. Whereas acceptance of antenatal care in industrialized

countries is near universal, in developing countries, the uptake is less, and a large proportion

of women deliver outside the healthcare system. About 63.6% of Nigerian mothers receive

antenatal care, while trained personnel attend 41.6% of births. Consequently, high maternal

1
mortality figures and rising perinatal mortality rates are the norm. Nwaeze et al. (2020)

further reported that the proportion of Nigerian women that receive antenatal care and those

that are delivered by skilled birth attendance have however remained far from acceptance.

The World Health Organization (WHO) reported in 2019 that around 830 women died

everyday from problems in pregnancy and childbirth. The WHO recommends that women

should all receive four antenatal visits to spot and treat problems and give immunization.

Although antenatal care is important for improving the health of the mother and the baby,

Nigeria unfortunately is among the countries worst hit by maternal death challenges.

According to the World Health Organization (2021) report, Nigeria is the second in the world

after India in terms of maternal and infant deaths. The international community has

committed to improving maternal mortality by 3/4 and reach universal access to reproductive

Healthcare. According to WHO, the Maternal Mortality Ratio in low-income countries in

2020 were 430 per 100,000 live births and 12 per 100,000 live births in high income

countries. Even with this commitment, many countries are failed to implement effective

programs to reduce maternal morbidity and women continue to suffer from the complications

of pregnancy and childbirth.

Many countries have made targeted efforts to ensure the provision and utilization of timely

and adequate antenatal care (Bbaale 2021). The most common indicators of health and

reproductive behaviour include utilization rates of antenatal care, age when women give

birth, pregnancy order and birth spacing. These factors can be modified if the services can be

made accessible and affordable to women and their families. The role of timely and adequate

antenatal care visits in ensuring maternal and neonatal health cannot be underestimated. Early

antenatal care visits facilitates the follow up and monitoring of foetal growth and maternal

health by Physicians. During antenatal care visit can be informed about the warning signs and

2
symptoms during pregnancy, preventive care and treatment strategies, proper nutrition,

breastfeeding, use of contraceptive methods for family planning, prevention of mother to

child transmission of HIV(PMTCT) use of sulfadoxinepyrimethamine (IPTp) (Bbaale, 2021).

Overall, the mentioned issues show the critical need for early initiation of antenatal care.

Women's perception of antenatal visits significantly influences their assessment of quality

services and our widely recognized as a tool to improve health services in many developed

countries. Women's perceived quality is defined as subjective and dynamic perception of the

extent to which expected Healthcare is received by the person. Since the person quality

invariably affects mother's behaviour, a modern may choose not to return and may result in

adverse outcome to the mother and the child and also results in poor utilization of antenatal

care services. Satisfied women are likely to come back for the services and recommend

services to others (Eijesinghe and Fernando, 2014). Various factors including attitude of staff,

cost of care, time spent at the hospital and doctor's communication have been found to

influence patient satisfaction.

1.2 Statement of the problem

Maternal mortality is unacceptably high. About 287, 000 women died during and following

pregnancy and childbirth in 2020. Almost 95% of all maternal deaths occurred in developing

countries in 2020, and most could have been prevented while 5% occur in developed

countries. This means that every year a lot of women suffer some type of injury from

pregnancy or child birth that can have profound effects on their lives and families. Nigeria is

regarded as a developing country and one of the major sectors of the economy is health which

looks to take care of the health status of the people, progress in improving antenatal care

comma disparities on access to antenatal care remain significance. Women that are with

tertiary education I likely to have antenatal care and report for the matter visit as women with

3
secondary or no education. All these are indications that despite the eye and senator coverage,

some registrants may not be deriving maximum benefits from the services. Based on these,

the researcher intends to find the perception of pregnancy women towards antenatal care

services and their level of satisfaction.

1.3 Aim and objectives of the study

The aim of this study is to determine the perception and satisfaction of women towards the

quality of antenatal care services in Holley Memorial Hospital Ochadamu.

The objectives include:

1. To determine the perception of pregnant women towards the quality of Atlanta care

services in only Memorial Hospital Ochadamu.

2. To examine providers processes of care in delivering mathematical services in only

Memorial Hospital Ochadamu.

3. To determine the level of client satisfaction with antenatal services provided in Holley

Memorial Hospital Ochadamu.

4. To recommend strategies to improve women's perception and satisfaction with antenatal

care services at Holley Memorial Hospital Ochadamu.

1.4 Significance of the study

The significance of the study is to alleviate the complications resulting from maternal and

child mortality rate in Nigeria especially in Kogi State. To assist in planning and educating

pregnant women attending antenatal clinic in Holley Memorial Hospital on the importance of

4
antenatal care services in Nigeria, to act as a guide for further studies, to assist to see areas

where clients are facing difficulty assessing antenatal care services and to decide on how to

improve the services for women.

1.5 Research Questions

1. What is the perception of pregnant women towards the quality of antenatal care services in

Holley Memorial Hospital?

2. What are the provider’s processes of care in delivering antenatal services in Holley

Memorial Hospital?

3. What is the level of client satisfaction with antenatal services provided in Holley Memorial

Hospital?

4. What are the strategies that can be put in place to improve women's perception and

satisfaction with antenatal care services at Holley Memorial Hospital?

1.6 Scope of the study

This study is to determine the perception and satisfaction of pregnant women so what's the

quality of antenatal care services in only Memorial Hospital Ochadamu.

1.7 Operational Definition of Terms

Perception: an overview of a pregnant woman's thought, belief, idea and ability to

understand the true meaning and impact of antenatal care would make towards health, family

and entire populace at large.

5
Quality Antenatal Care: the ability of pregnant women to receive four or more antenatal

care visits with all necessary care rendered during the visits.

Satisfaction: the extent to which specific needs of pregnant on antenatal care are met.

Antenatal: the period before birth.

Pregnancy: the period from conception to the expulsion of the foetus

Foetus: the term used, 8 weeks after conception until birth.

Client: pregnant women receiving advice and treatment in the hospital or antenatal clinic.

Check-up: it is the examination of a woman before, during, and after conception.

Maternal morbidity: any short or long-term health problems that results from pregnancy or

childbirth.

Maternal Mortality: it refers to maternal death during pregnancy or childbirth.

6
 CHAPTER TWO

LITERATURE REVIEW

This chapter of study deals with the review of relevant literature, studies and researches

previously done that is related to this study. It will be carried out under the following

headings:

1. Conceptual review

2. Theoretical framework

3. Empirical review

4. Summary of the review

2.1 Conceptual Review

2.1.1 Antenatal Care

Antenatal care according to Adesokan (2022) refers to the attention, education, supervision

and treatment given to the pregnant mother from the time of conception until the beginning of

labour in order to ensure safe pregnancy, labour and puerperium. It is also known as prenatal

care which is a type of preventive health care with a goal of providing regular check-ups that

allow doctors or Midwives to treat and prevent potential health problems throughout the

course of pregnancy while promoting health lifestyles that benefit both mother and Child.

7
During check-ups, pregnant women will receive medical information over maternal

physiological changes in pregnancy, biological changes and antenatal nutrition including

antenatal vitamins. Recommendations on management and healthy lifestyle changes are also

made during regular check-ups.

The availability of routine antenatal care has played a part in reducing maternal death rates

and miscarriages as well as birth defects, low bet weight, neonatal infections and other

persuadable health problems. The World Health Organization reported that in 2020 almost

800 women die every day from preventable causes related to pregnancy and childbirth. Only

five of the women who died lived in high income countries. The vast of the women live in

low income countries. The World Health Organization recommends that pregnant women

should all receive four antenatal visits to spot and treat problems and give immunizations.

Although antenatal care is important for improving the health of the mother and the baby,

many women do not receive four visits.

There are many ways changing health systems to help people change their behaviour can also

play a part. Examples of these interventions are: Media campaigns reaching many people,

enabling communities to take control of their own health, information, communication

interventions or financial incentives. A review looking at these interventions found that one

intervention helps improve the number of women receiving antenatal care. However,

interventions used together may reduce baby's death in pregnancy and early life, lower

numbers of low birth weight babies born and improve numbers of women receiving antenatal

care.

2.1.2 Aims of Antenatal Care

8
The aims of antenatal care are maintenance of health of mother during pregnancy; promote

physical, mental and social well-being of Mother and Child; ensure delivery of full-term

healthy baby; early detection of high risk cases and minimize risks by taking appropriate

management; prevents development of complications through health Education, adequate

nutrition, exercise, vitamin intake and appropriate medical and pharmaceutical intervention;

diseases such as anaemia, STIs, HIV infection, mental health problems and domestic

violence; teach the mother about child care, nutrition, sanitation and hygiene; decrease

maternal and infant mortality and morbidity; remove the stress and worries of the mother

regarding the delivery process; provides save the delivery for mother and educate mother

about the physiology of pregnancy and labour (Ejike 2020).

2.1.3 Types of Antenatal Visits

According to “the WHO FANC model” in 2020, the timely ANC visits refer to the first and

subsequent visits. The first visit is between 8–12 weeks of pregnancy, subsequently, the visits

include the 2nd ANC visit between 24–26 weeks, the 3rd ANC visit at 32nd week, and the

4th ANC Visit between 36–38 weeks of gestation.

2.1.4 Antenatal Health Care Activities

Antenatal Healthcare activities involve the activities carried out during the first visit and

those in the subsequent visit. First visit Which is also known as booking visit is the first

contact between a pregnant woman and a midwife in a particular pregnancy, during which

pertinent information about the expectant mother are collected by the midwife. Ideally,

according to the transitional Islamic government of Afghanistan (2022), the first visit should

occur in the first trimester, around all preferably before 12 weeks of pregnancy. Normally,

this visit is expected to take 30 to 40 minutes.

9
Ejike (2020) looked into the following objectives as an important principle of booking:

 To assess levels of health by taking a detailed history and to employ screening test as

appropriate.

 Ascertain based line recording of weight, Heights, blood pressure and haemoglobin.

 Identify risk factors by taking accurate details of past and present obstetric and

medical history.

 Provide an opportunity for the woman and her family to express any concern that they

might have about this pregnancy and previous obstetric experience.

 Give general advice on health matters especially those pertaining pregnancy for the

health of the mother and of the baby.

 Start gradually to build a trusting relationship in which realistic plans of care are

discussed.

All these objectives would be met through personnel questioning of pregnant mothers based

on history taking; personal and social history(ask about history of specific disease and

conditions, including: tuberculosis, cardiovascular diseases, hypertension, chronic renal

disease, epilepsy, diabetes mellitus, respiratory tract infections/ HIV AIDS, malaria, hepatitis

and other liver diseases, any allergies, other chronic diseases, surgeries, blood transfusion,

current use of medicines); obstetric history(number and type of previous

pregnancy(miscarriage, tubal pregnancy, preterm delivery), previous deliveries and any

complication or procedure related to the previous deliveries(Caesarean section and it's

indication, if known; forceps or vacuum extraction, manual/ instrumental help in vagina

breach delivery; manual remover of placenta), date(month, year) and outcome of each

event( live birth, still birth, abortion, ectopic, twins, hydatidiform mole, child with any

abnormality, neonatal and infant death), birth weight if known, sex of children, specific

10
maternity complications, events and interventions in previous pregnancies (specify which

pregnancies and specific symptoms and signs such as haemorrhage, menstrual period (LMP)

(first day of bleeding in the last regular menstrual period), certainty of date( by regularity,

accuracy of recall, and other relevant information), bleeding or spotting since becoming away

aware of being pregnant; family history( this should be ascertained as some families have

some genetic predisposition to safety disease such as psychiatric disorders, diabetes mellitus

and essential hypertension. The tendency for these diseases to run in family is there.

Screening procedures play an important part in ascertaining health status of the client. This is

done to obtain baseline record of weight, height, blood pressure, urinalysis and haemoglobin

level. These values are used for comparison as the pregnancy progresses. They include:

1. Height: the height of the woman is measured because a woman of small stature (less than

1.5 m) and choose size less than 5, may have small pelvis.

2. Weight: This is monitored at every visit to the clinic to give a baseline data for monitoring

the weight of the woman. This is done because of health conditions associated with

overweight or being obese. For example: diabetes mellitus, pregnancy induced hypertension.

3. Urinalysis: This is also taken at every visit to rule out any abnormalities like sugar, protein

and ketones, urinary tract infections and genital tract infections.

4. Haemoglobin Estimation: Haemoglobin estimation is important to detect anaemia, the

cause and appropriate treatment to be commenced.

5. Blood pressure: This is taken at every clinic to rule out elevated blood pressure which can

result to pregnancy induced hypertension affecting placenta perfusion.

11
According to Fraser, Cooper and Nolte (2014), physical examination of a pregnant woman is

done from head to toe on a couch on examination room in order to rule out any abnormalities

(infections, oedema and anaemia) and note any changes that might occur during the period of

pregnancy. Several parts of the body like head, face, eye, ear, tongue, neck, breast, arms,

genitalia, legs and back are examined for several pregnancy symptoms. Additionally,

Benneth and Brown (2019) stated that women do not always appreciate the importance of

attending regular examination but the midwife will be able to explain the chief aim which is

to establish and affirm the abdominal norms of the body whose aims are to observe signs of

pregnancy, assess foetal size and growth and foetal heart rate, diagnose the location of the

foetal parts, detect any deviation from normal. This examination is made up of three parts

namely: Inspection, palpation and Auscultation.

1. Inspection: Observe the shape of the abdomen whether it is ovoid, board, pendulous,

saucer shaped depression in case of occipito-posterior position, foetal movement,

striaegravidarum, lineanigra and any post operative scar.

2. Palpation: the midwife uses her hand during palpation to determine the gestational age but

prior to palpation, the midwife should rub her hands together to warm it because cold hands

could stimulate uterine contractions. This includes fundal height estimation to determine

fundal height, lateral palpation to determine the lie and pelvic to determine which is

presenting engagement.

3. Auscultation: the foetal heart can be heard my means of pinnards(foetal) stethoscope

through the abdominal wall. The range of the foetal heart rate can be between 110 to 160b/m

and while listening to the foetal heart beat, you cross check with maternal pulse.

12
For laboratory test investigation, Fraser, Cooper and Nolte (2014) explained that for every

pregnant woman, blood examination should be carried out routinely at the initial and

subsequent visits. Blood test is done to determine ABO blood group and Rhesus factor,

haemoglobin level, veneral disease research laboratory test (VDRL) 2 exclude syphilis, HIV,

Rubella and other blood disorders.

Lastly, Skykes (2015) explained that antenatal visits are each four to six weeks until 28

weeks, then each two or three weeks and then weekly until your baby is born.

 If there are any pregnancy complications or special considerations, you may need

some extra visits. These visits are usually straightforward check-ups. A woman is

expected to make a minimum of four visits throughout pregnancy. These visits are as

follows:

 First visit: within the first week 16th week or when she feels she's pregnant.

 Second visit: 20 to 24 weeks or at least once in second trimester

 Third visit: 28 to 32 weeks

 Fourth visit: at 36 weeks or later than that.

During these visits, the already explained examinations are carried out as required with

regular care on blood pressure command urine testing command foetal heart rate and fundal

height.

Benefits/Importance of Antenatal Care

The numerous benefits of antenatal care are embedded in the primary aims of antenatal care

as reported (2015) include the following:

1. To prepare for birth and parenthood as well as prevent, detect, alleviate or manage the

three types of health problems during pregnancy that affects mothers and babies

13
 which are; complication of pregnancy itself, pre-existing conditions that worsen

during pregnancy and effects of unhealthy lifestyle

2. It also provides women and their families with appropriate information and advice for

a healthy pregnancy, safe childbirth and postnatal recovery, including care of the

newborn, promotion of early, exclusive breastfeeding and assistance with deciding on

the future pregnancy in order to improve pregnancy outcomes

3. Antenatal care improves the survival and health of babies directly by reducing still

birth and neonatal death and indirectly by providing an entry points for health

contacts with the woman at a key point in the Continuum of care.

4. Antenatal care indirectly saved the lives of mothers and babies by promoting an

establishing good health before childbirth and the early postnatal period. The time

period of highest risk

Perception of Pregnant Women towards Antenatal Care Services

The perception of pregnant women towards antenatal care services influences its utilization.

According to a study conducted by Lino and Chompikul (2020) in Thailand reported that

perception of pregnant women regarding antenatal care was categorized into negative and

positive and 60% of the women had positive perceptions. It also showed that increasing

positive perception of pregnant women regarding antenatal may influence the percentage of

pregnant women to make antenatal care visit and improve the state of maternal and child

health. They also identified some factors that influence the perception of antenatal care.

Married women were more likely to have positive perceptions because married pregnant

women can receive more support from their husbands and those who had fair access to

antenatal care information were more likely to have negative perception compared to those

who had easy access.

14
Also, study conducted by Edie et al. (2019), revealed that 99% of the respondents affirmed

that ANC was important not only for the mothers but for the foetus as well. It also showed

that women who had attended antenatal visits in their previous pregnancy thought that it was

beneficial to start antenatal care early in pregnancy unlike those who did not have experience

and who opted for third trimester enrolment. Again, primigravida, younger and single women

were less likely to know how many antenatal visits they were expected to attend during the

gestational period when compared to older and multiparous women.

Factors Influencing Perception of Women towards Antenatal Care Services

Lino et al. (2020) observed that many factors that influenced the perceptions of pregnant

women towards antenatal care were identified. These factors may be implicated in perception

of women towards antenatal health services in Holley Memorial hospital Ochadamu. These

include: education level, marital status, knowledge regarding ANC, family support,

accessibility to antenatal information, and pregnancy intention.

 Educational Level

Level of education influences pregnant women positively or negatively. Positive perception is

associated with women who are highly educated. This may be because those with high

educational levels understands antenatal care better that those with low educational level.

 Marital status

15
There is a significant association between marital status and the perception of pregnant

women. Married women have positive perceptions towards antenatal care. This may be

because married pregnant women receive more support from their husband.

 Family support

Family Support has a significant association with perception of pregnant women regarding

ANC. Many pregnant women receive support from their husbands in terms of advising for

regular check-ups and sharing information of antenatal care.

 Pregnancy Intention

Women who have planned to have their pregnancy have positive perception. This is because

those who intend to get pregnant make greater efforts to have good health and healthy infants.

They are willing to have ANC and make them have good knowledge and positive perception.

Quality of Antenatal Care Services as related to Satisfaction

 User’s satisfaction is considered client’s judgment on the quality and goodness of

care. Client’s satisfaction is thus indispensible to quality improvement with regard to

design and management of healthcare systems (Srivastava et al., 2019). The ratings of

women satisfaction indicate general ratings across developing countries. In 24 studies,

more than 75% of the women reported care to be satisfactory. In 10 studies the

proportion ranged between 50-70% while in only three studies, it was less than 50%.

Nine studies discussed rating intern of mean scores, eight studies did not report any

specific numerical value of satisfaction as they were qualitative in nature (Srivastava

et al., 2019). A large spectrum of determinants influencing women’s satisfaction was

summarized according to the Donabedian framework of structure, process and

16
 outcome, besides access, socio-economic determinant and other determinants. This

includes structure (physical environment, availability of medicines, supplies and

services, interpersonal behaviour, privacy and confidentiality), cost and outcome

(delivery outcome).

 Physical Environment

Good physical environment and efficient management were significant in women’s positive

assessment of health facility and maternal care services. These include good building

infrastructures with water supply, electricity, beds, and cleanliness. Adequate room space,

seating arrangement and waiting areas as found in Nigeria. Women who rated the availability

of services at the facility (a composite of waiting area, drinking water, clean toilet) as “good”

were significantly most satisfied with care than those who rated services “poor”.

 Availability of Medicine, Supplies and Services

Availability of prescription drugs, essential equipment like blood pressure monitors or

thermometers, lab services were reported as significant predictors of satisfaction with care in

studies in Nigeria. Occasionally non-availability of essential medicine emerged as a cause for

dissatisfaction with service.

 Interpersonal Behaviour

Being treated with dignity, respect and courtesy was a key determinant of women

satisfaction. Therapeutic communication (Listening, politeness, prompt pain relief, kindness,

approachability and smiling demeanor), caring behaviour (attentive to needs, making client

feel accepted and coaxing clients) and interpersonal skill of staff (staff confidence and

competence) were significant themes that were identified as influencing clients satisfaction of

17
care. The use of praising words by midwife during delivery encouraged women and boosted

their self esteem. Infract, women chose to repeat the same provider for their next delivery. On

the other hand, staff unfriendliness, negative and impatience are the major causes for

dissatisfaction with service and avoidance of use in Nigeria.

 Privacy and Confidentiality

This is a key requirement of women utilizing antenatal care services for physical

examinations as well as the delivery itself. A sense of shame is also attached to the process of

physical examination and also procedures like perineal shaving, thereby increasing women’s

discomfort and diminishing their satisfaction level. Inadequate privacy during antenatal

check-up and counselling was associated with women’s poor perception of services.

Maintenance of privacy via a separate room or screen for examination or delivery was a

significant determinant of satisfaction with antenatal care services. Lack of confidentiality

during check-ups and deliveries on the other hand caused dissatisfaction with services.

 Cost

Significant association between cost and women satisfaction and the utilization of care in

both home and institutional births were founded in studies in Nigeria. Affordable care was a

significant determinant of satisfaction with antenatal care services in both facility and home

deliveries. Besides, overall cost of care, affordable drugs, availability of finance for

healthcare and transparency in financial transactions also influenced satisfaction with care.

Availability of free medicines in the facility enhances women satisfaction with antenatal care.

 Delivery Outcome

18
Maternal and newborn outcomes in terms of survival and health of mothers and newborns

(for example, mother alive inspite of foetal loss, baby alive and healthy) affected satisfaction

with antenatal care.

Process of Care in Antenatal Service Provision

Process of care denotes what is actually done in giving and receiving care in antenatal setting

and it is usually compared against a set standard, usually a national guideline. However,

WHO recently advocated that only examinations and tests serving an immediate purpose and

proven to be beneficial should be performed during antenatal visits. These examinations

should include, at a minimum, measurement of blood pressure, testing of urine for bacteriuria

and proteinuria, and blood tests to detect syphilis and severe anaemia.

According to a study carried out in Mexico, the quality of antenatal care is measured by a

series of questions about antenatal services received that correspond with national clinical

guidelines and they include 12 activities that are routinely conducted during history taking

and diagnostics (blood and urine samples, and history of bleeding and discharge), the

physical examination (blood pressure and weight, and measurement of uterine height), and

other preventive procedures (tetanus toxoid immunization and iron supplements, advice about

family planning and breastfeeding, and use of the health card).

Giovanni et al. also posited that a functioning referral system between health facilities needs

to be part of the services provided to the pregnant woman. This will permit the transfer of the

woman to the appropriate level of assistance with proper and timely management of the

emergency obstetric situation, ideally at the lowest stage of severity.

19
A study in Tanzania revealed that out of the total 754 ANC visits made by 263 women in the

study, blood pressure, haemoglobin and albumin in urine were assessed in only 69%, 25%

and 22% respectively and 63 (52%) were found to have atleast one risk factor. Advice on

delivery was provided to only 40 (33%) women attending ANC on the day of study and most

frequent delivery advice (93%) given to women with risk factors was hospital delivery, when

to go and use of maternity waiting home. On the other hand, 25 (40%) women with risk

factors reported that they did not receive any advice on the delivery plan.

Studying women’s perception of antenatal care services in public and private clinics in

Gambia, over 50% of the women in both settings felt that they had been given inadequate

information on pregnancy issues with roughly 80% of the women reported that they had not

been told how to recognize or manage certain danger signs during pregnancy. Overall, among

women who attended either a public or a private facility, 87% worried about the position of

their babies, the size of the baby, having a premature baby, having an abnormal baby or their

own health and weight but very few women had received information related to these

worries. Less than half of the total sample had received information and felt reassured.

Significantly, more women attending private clinics felt reassured compared with their

public-facility counterparts.

A research on clients’ perception of ANC in Ibadan found out that counseling for HIV was

the predominant health education subject but more than half (53.9%) of respondents did not

receive information about cervical cancer. About 10% of patients did not receive information

about danger signs during pregnancy, breast self examination, family planning and

prevention of sexually transmitted infections. However, clinic amenities and constellation of

services were rated highly.

20
Client’s Satisfaction with Antenatal Care

Client’s satisfaction is an indirect way of measuring outcome attribute of quality or client’s

perceived quality of care. Satisfaction of clients attending ANC can be on different aspect of

care and can also be measured generally by asking these three basic questions; are you

satisfied, will you recommend this for a friend and will you come back if you become

pregnant again. Various studies used women’s satisfaction with service delivery as an

outcome indicator as it is influenced by women’s expectations and their previous

experiences. This was deemed appropriate because subtle changes in the quality of care can

be detected in women satisfaction long before the physical changes in health status can be

seen and it was assumed that a satisfied woman user would probably benefit more from the

care offered to her and than an unsatisfied woman. It was observed that a little amount of

focus on quality of care in many resource limited settings has been from the health care

provider’s point of view with his professional standards being used as index of quality but

studies have shown that perception of quality by pregnant women and their care givers may

differ with providers more interested in technical precision while women may be more

concerned with other sensitive issues such as interpersonal relations with care providers,

fulfillment of their information needs, birth positions and social supports during labor.

A study done to compare traditional ANC with new ANC model showed that women in both

trial arms were equally satisfied with the information provided by the care giver about their

health, tests during pregnancy and treatment they might need but women in the new ANC

model were substantially more satisfied with the information received about normal labor and

delivery processes, breastfeeding, family planning and danger signs. In the study above,

overall satisfaction by the women was measured by three affirmative answers to the questions

“If you were pregnant again, would you come back to this clinic?” “Would you recommend

21
this clinic to a relative or friend for their antenatal check-ups?” and “In general, are you

satisfied/very satisfied with the antenatal care you have received in this clinic so far?”

Women in both arms of the study showed very high levels of satisfaction with no statistically

significant differences between groups and the overall satisfaction index showed that more

than 90% of women in both ANC models said they were “very satisfied”. A Tanzanian study

reported that 93 (77%) of the women were satisfied with antenatal care services they received

in this facilities and this includes women who had a risk factor but never received any

delivery advice but it went ahead to state that the fact that satisfaction to ANC services is

subjective, the result posed a potential limitation as satisfaction can be influenced by a

number of factors including knowledge on the required types of services and attitude of the

individual clients. Based on these factors, clients might have expressed different levels of

satisfaction even if they received similar services.

University College hospital, Ibadan, client’s satisfaction to antenatal services was also done

and most respondents were found to be satisfied with the services given at the clinic; 81.1%

rated the services as good while 18.9% were not satisfied and stated that the service was poor.

Most women (83.3%) revealed that they will register in the same health facility in subsequent

pregnancies and would recommend the clinic to someone else. Similarly a study carried out

at PHC in the south west of Nigeria shows that women attending antenatal clinics at these

centers were satisfied with the quality of services received inspite of inconsistencies between

the received care and their expectations on the facilities.

2.2 Theoretical Framework

The study is backed up by health belief model which proposes that a person’s health related

behaviour depends on the person’s perception of four critical areas: the severity of a potential

22
condition, the person’s susceptibility to that condition, the benefit of taking preventive action,

the barriers that prevents taking such actions. The health belief model is a psychological

model proposed for studying and promoting the uptake of health services like screening. The

model explains preventive behaviour (Ilozumba 2022).

The six major concepts and definition of the Health Promotion Model or Health Belief Model

includes: perceived susceptibility, perceived severity, perceived benefit, perceived cost,

motivation, enabling or modifying factors.

 Perceived Susceptibility

It refers to how a person views a health problem and considers a diagnosis of illness to be

relevant and accurate.

 Perceived Severity

Even when one recognizes personal susceptibility action, it may not occur unless the

individual perceives the severity to be high enough to have serious organic and social

complications.

 Perceived Benefit

It refers to the patient’s belief that a given treatment will cure the illness or help prevent it.

 Perceived Cost

It refers to the complexity, duration and accessibility of the treatment.

 Motivation

23
It includes the desire to comply with a treatment and the belief that the person should do what

they should do.

 Modifying Factors

It includes personality variable, patient’s satisfaction and socio-demographic factors. The

health belief model explains the need for individuals to be in position to have the benefit of

the available health care available at the institution and accessible to the patient. Although the

model is being criticized as not being rational, it focuses on the individual and ignores the

socioeconomic factors like finance and that the model is predicting outcome of a disease

condition when it should focus on preventive health.

Application of Health Belief Model

 Perceived susceptibility

Based on this model, pregnant women are more likely to attend regular antenatal care when

they have the belief that attending regular antenatal care provides support and encouragement

to them while pregnant and also improve their delivery outcome.

 Perceived Benefit

In order for a new behaviour to be adopted, the women need to believe that benefit of the new

behaviour outweigh the consequences of not adopting the new behaviour. Therefore, women

will attend antenatal care regularly when they know that the benefit outweighs the

consequences of multiple antenatal booking.

 Perceived Cost

24
In this context, long waiting time and location of antenatal care by pregnant women are the

reasons for poor antenatal attendance. Therefore, women attend antenatal care if their life and

that of their baby is in danger.

 Motivating Factor

Women who have experienced good quality antenatal care in the past pregnancies are likely

to come back for the service and recommend the services to other women. These women will

have heightened perception of antenatal services because of the past experience.

2.3 Empirical Review

A study conducted by Sholeye et al. (2019) on client perception of antenatal care services at

primary health centers in an urban area of Lagos, Nigeria. About 300 women were selected

through systematic random sampling from three PHC’s offering full maternal services inn

Mushin. Data was collected with the aid of interviewer administered semi structural

questionnaires. Data analysis was done using 14.00.

The mean age of respondent was 30.68 ± 6.74. Most respondents (42.5%) were aged between

20 and 29 years. About 92.0% of respondents perceived the environmental conditions of

service delivery as good, 52.2% felt the record retrieval system was good while 1.7% felt it

was poor. Perceived as being good by 66.6% of respondents while 33.0% felt the service was

poor.

Nwaeze et al. (2020) carried out a study on the perception and satisfaction of antenatal care

service among pregnant women at the University College Hospital Ibadan, Nigeria. A cross-

sectioned design using a structured questionnaire was used. The study subjects were 239

pregnant women presenting for antenatal care at the study centre. The result showed that 74%

25
of the women were aged 25-34 years; majority of the respondents (86%) had tertiary

education while 49.4% were skilled workers. In 57.7% of women, the gestational age was

between 13 and 27 weeks while 66.1 were para 1-4. The commonest investigation done at the

clinic was packed cell volume (PCV) estimation (99.2%). Human immunodeficiency virus

(HIV) screening was done in 77% of the respondents.

In addition, Lamadah and Elsaba (2021) carried out a study on women’s satisfaction with

quality of antenatal care. It was conducted in primary health centre in Al-Madinah Al-

Menawarh, KSA. Research design used for the study was a descriptive design. A simple

random selection of six primary health centres which affiliated to the ministry of health was

done. The study subjects were 150 pregnant women attending the previously mentioned

health care centres. An interviewing assessment sheet was designed by the researcher to

collect the data.

The result showed that more than two third of the clients (68.0%) and slightly less than two

thirds of them (62.0%) respectively were satisfied with provider-client interaction and quality

of antenatal care services. In addition, it can be observed that the older, low educated

housewives women and those who had smaller number of children were more satisfied with

health care provider’s interaction and the quality of antenatal care services provided to them.

Onasoga et al. (2020) studied factors influencing utilization of antenatal care services among

pregnant women in Ife Central L.G.A, Osun State Nigeria. Stratisfied technique was used to

select 102 pregnant women from Ife central Local Government Area of Osun State. Data

were collected using a questionnaire. Both descriptive and inferential statistics were used to

analyze the data generated and level of significance was set at 5% (0.05). The finding

revealed that majority of respondents 85 (83.3%) knew the services rendered at antenatal

26
clinic and had adequate knowledge on the importance of antenatal care. The finding also

revealed that majority of the respondents 58 (56.9%) attend ANC regularly, 56 (57.1%)

booked for antenatal care in the first trimester and attend on appointment days after booking.

The study also showed that majority of the respondents opined that affordability of antenatal

services, schedule of antenatal care, lack of knowledge about the existing services in ANC

and husband’s acceptance of the services as the major factors influencing its utilization.

2.4 Summary of Literature Review

Antenatal Care (ANC) means “care before” and includes education, counseling, screening,

treatment, monitoring and promoting the well being of the mother and foetus. It was

discussed with a conceptual review which includes definition, activities, benefits,

perceptions, factors and satisfaction of antenatal care. The literature review provides a

comprehensive understanding of antenatal care and how the women perceive it in the

theoretical review. Antenatal care was explained with reviews of reports and works made by

different authors and also the result of their study in empirical review.

27
 CHAPTER THREE

RESEARCH METHODOLOGY

This section of the study shows a thoughtful and systemic estimation of the specific method

with which necessary data relating to the Research problem is collected and analyzed. It

provides the procedural framework for the conduct of the study and helps to describe the

scope of the research as well as the purpose and boundary of the study. It is discussed under

the following:

1. Research design

2. Setting

3. Target population

28
 4. Sample and sampling technique

5. Instrument for data collection

6. Validity of instrument

7. Reliability of instrument data

8. Method of data collection

9. Ethical consideration

3.1 Research Design

Research design is a plan of action regarding events, which upon implementation enables the

researcher adopt the survey Design in carrying out the study Ejifugha (2020) states that a

survey is an attempt to gather information or data from members of a population with regard

to one or more variables. The research design adopted for the study is the descriptive survey

method; it deals with the factual description of perception and satisfaction with quality of

antenatal care among pregnant women in Holley Memorial Hospital Ochadamu.

3.2 Setting

This study will be conducted in Holley Memorial Hospital Ochadamu, Kogi State which

came into existence in 1946 with health professionals who came into Nigeria as missionaries

having special interest in the care of patient with leprosy. They were also interested in the

prevention of the spread of leprosy and other associated tropical disease conditions. To this

effect they established a leprosarium. The hospital has developed with time with different

wards including the maternity/antenatal ward.

3.3 Target Population

29
The population of this study we consists of all the women that attend antenatal clinic at

Holley Memorial Hospital Ochadamu. The target population for this study is 220 women

which represented the total number of women that attended antenatal cleaning from January

to May 2024.

3.4 Sample and Sampling Technique

This means a portion of the population used for the study. According to Nwana (2019), if

population is a few hundred, a 40% sample size is used. Thereby calculation; simple random

sampling was used to select 100 women (respondents) on eight clinic days.

3.5 Instrument for Data Collection

According to Polit et al. (2020), the instruments for data collection the instrument for data

collection is the formal document used to gather information in research. The data was

collected by the use of questionnaire which was structured in a way that the researcher can

easily and quickly elicit the information needed to address the research questions as well as

achieved the primary purpose of the study. The questions were closed ended items in made

into sections A to section D as they relate to the Research of objectives.

3.6 Validity of Instruments

Validity of instruments according to Chinweuba et al., (2019) is defined as the ability of a

instrument to measure what is supposed to measure. The questionnaire drafted by the

researcher was submitted to the supervisor who went through it carefully and made

corrections to ensure content validity after which it was confirmed valid and capable of

collecting the desired result for the study.

30
3.7 Reliability of Instrument Data

Reliability according to chinweuba et al., (2019) is consistency of an instrument in collecting

the same data that means appropriateness for use overtime. The instrument was used on 20

mothers attending antenatal care clinic in Life Hospital Nnewi who were not part of the study

for pilot study. Test-retest method was used in which the second test was conducted after a

week interval from the first test. Responses from the questionnaire were analyzed using

person product moment correlation. Coefficient and a reliability of 0.8 were obtained

indicating that the instrument was reliable.

3.8 Method of Data Collection and Analysis

This is the technique the researcher employed in collection of data. An introductory letter

written by the researcher was attached to the questionnaire which stated the purpose of the

research and assured confidentiality of information provided. The researcher obtained

permission from the Chief Nursing Officer in charge to use the antenatal mothers. She

presented a letter of introduction endorsed by the Head of Nursing department with the

researcher's letter of request for data collection. With the help of Nurses on duty, the

researcher issued 100 questionnaires to available respondents within six weeks. Before the

distribution, the researcher introduced himself and aim of the study of the research to the

respondents. The completed questionnaires were then collected with return rate of 100

percent. Data obtained from the questionnaire were presented in frequency table and

percentage. The research question three was then converted to a four-point response scale

where HS, S, FS, and NS were assigned a number ranging from 4(HS) to 1(NS)

With 2 as the computed mean, this ensure that any factor or variable with the mean of 2.5 or

above was regarded as positive while others with mean below 2.5 regarded as negative.

31
3.9 Ethical consideration

The researcher maintained the following ethical considerations during the course of the study;

Letter of Identification: An identification letter was obtained from the head of nursing

department of the college.

Non Plagiarism: Plagiarism was avoided by referencing others whose works were consulted

in the course of the study.

Confidentiality: Information from the respondents were treated with utmost confidentiality

and used only for the study. Only the researcher had access to the information supplied by the

respondents.

Anonymity: The researcher maintained privacy throughout the data collection process and

thereafter, not including self identity information like name and address of respondents.

Voluntary Participation: The researcher explained in details all the important information

about the questionnaire of the study to respondents, they gave their informed consent and

participation was voluntary.

Respect for respondents: This was done by approaching them courteously and giving every

respondent fair treatment to gain their confidence and cooperation.

32
 CHAPTER FOUR

DATA ANALYSIS

This chapter discussed the finding and results as shown from the data analysis. This data was

analyzed in accordance with the research questions using frequency distribution tables

presented in percentages. One hundred and forty questionnaires were distributed ad same

collected.

Section A: Demographic data

Table 1: showing demographic data of respondents

33
 S/N Response item Frequency Percentage (%)

1. Age in years

A. 20-24 15 15

B. 25-29 52 52

C. 30-34 25 25

D. Above 35 8 8

Total 100 100

The table above showed that 15 (15%) of the respondents fall within the range of 20-24years,

52 (52%) fall within the range of 25-29 years, 25 (25%), fall within the range of 30-34 years

and 8 (8%) were above 35 years.

Table 2: showing respondents’ marital status

2. Marital status Frequency Percentage (%)

A. Single 10 10

B. Married 85 85

C. Divorced 5 5

D. Total 100 100

From table 2 above, 10 (10%) of the respondents were single, 86 (90%) were married while 5

(5%) were divorced.

Table 3: showing respondents’ educational background

34
 3. Educational background Frequency Percentage (%)

A. Primary 6 6

Secondary 13 13

Tertiary 81 81

Others specify - -

Total 100 100

From the table above, 6 (6%) of the respondents stopped at the primary level of education,

13(13%) of the respondents stopped at the secondary level of education while 81 (81%) went

to tertiary institution.

Table 4: showing respondents’ number of pregnancy

4. How many pregnancies have you Frequency Percentage (%)

had?

A. First 53 53

B. Second 28 28

C. Third 12 12

D. Fourth 7 7

Total 100 100

35
From table 4, 53 (53%) of the respondents have had their first pregnancy, 28 (28%) have had

their second pregnancy, 12 (12%) have had their third pregnancy while 7 (7%) have had their

fourth pregnancy.

Table 5: showing respondents’ religion

5. Religion Frequency Percentage

A. Christianity 67 67

B. Islam 33 33

C. Pagan - -

Total 100 100

From the above table 67 (67%) of the respondents were Christians and 33 (33%) were
Muslims.

Section B: Research Question 1

What is the perception of pregnant women towards the quality of antenatal care
services?

Item 6 to 10 from the questionnaire provided answer to research question 1

Table 6: showing respondents’ response on the number of antenatal care visit they wish
to attend before delivery

S/N Responses Frequency Percentage (%)

A. 4 times 26 26

36
 B. 5 times 22 22

C. More than 6 times 52 52

Total 100 100

Table 6 above showed that 26 (26%) of the respondents wish to attend antenatal visits 4
times, 22 (22%) wish to attend antenatal visits 5 times while 52 (52%) wish to attend
antenatal visit more than 6 times.

Item 7: Do you attend antenatal visit late?

Table 7: showing if the respondents attend antenatal visits late

S/N Respondents Frequency Percentage (%)

A. Yes 40 40

B. No 60 60

Total 100 100

Table 7 above shows that 40 (40%) of the respondents attend antenatal care visits late while
60 (60%) of the respondents does not.

Item 8: If yes, why?

Table 8: showing respondents’ reason for attending late

S/N Response Frequency Percentage (%)

A. Lack of benefit of antenatal 5 5

care

B. Limited facility access 48 48

C. Uncertainty about 6 6

37
 pregnancy

D. Laziness to go for many 41 41

visits

Total 100 100

Table 8 above showed that 5(5%) of the respondents attend late to antenatal visits due to lack

of benefits of antenatal care, 48 (48%) attend late due to limited facility access, 6 (6%) attend

late due to uncertainty about pregnancy while 45(45%) attend late due to laziness to go for

many visits.

Item 9: If no why?

Table 9: showing why respondents do not attend late

S/N Respondents Frequency Percentage (%)

A. To acquire knowledge from health 42 42

topics discussed

B. To go home early 20 20

C. To have enough time to do all 6 6

38
 investigations

D. To be the first person to be seen by 32 32

the doctor

Total 100 100

From table 9 above 42 (42%) of the respondents do not attend antenatal care visit late

because they want to acquire knowledge from the health topics discussed, 20 (20%) do not

attend late because they want to go home early, 6 (6%) do not attend late because they want

to have enough time to do all investigations while 32 (32%) do not attend late because they

want to be the first to be seen by the doctor.

Item 10: How would you rate the antenatal care services given in the antenatal care

clinic?

Table 10: showing how the respondents rates the antenatal care services given

S/N Responses Frequency Percentage (%)

A. Adequate 27 27

B. Very adequate 61 61

C. Not adequate 12 12

D. No idea - -

Total 100 100

From the table above, 27 (27%) of the respondents rated antenatal care services given in the

clinic as adequate, 61 (61%) rated the antenatal care services given as very adequate while 12

(12%) rated the antenatal care services given as not adequate.

Section C: Research question 2

39
What are the providers’ processes of care in delivering antenatal services in Holley

Memorial Hospital Ochadamu

Table 11: Frequency and scoring of activities performed during ANC consultation

ACTIVITY MAXIMUM MAXIMUM TOTAL PERCENTAG

SCORE PER OBTAINABL SCORE E (%)

OBSERVATI E SCORE

ON

Seat offered 25 30 25 83.3

Interest shown 27 30 27 90

Non interruption of 26 30 26 86.6

woman’s speech

Politeness 28 30 28 93.3

Asking about women’s 24 30 24 80

concern

Door closed during 14 30 14 46.6

consultation

Explanation before 18 30 18 60

examination

Explanation of 20 30 20 66.6

diagnosis

Explanation of use of 22 30 22 73.3

prophylactic drugs

Any history

History of malaria 19 30 19 63.3

40
 History of UTI 15 30 15 50

Blood pressure 22 30 22 73.3

Measurement

Checking of 25 30 25 83.3

haemoglobin

Checking of urine for 26 30 26 86.6

protein

Prophylactic drugs 26 30 26 86.6

Checking eyes for 27 30 27 90

pallor

Checking legs for 27 30 27 90

oedema

Checking weight 28 30 28 93.3

Checking foetal heart 30 30 30 100

General health 26 30 26 86.6

education

Nutrition education 25 30 25 83.3

Malaria prevention 26 30 26 86.6

health education

Total 526 660 526 79.7

The most frequent activity carried out during ANC consultations are: showing interest (90%),

asking about women’s concern (80%) and checking of foetal heart rate (100%) while the least

activity done was closing the door during consultation (46.6%).

41
Section D: Research Question 3

What is the level of client’s satisfaction with antenatal care services provided in Holley

Memorial Hospital Ochadamu?

Table 12: Frequency distribution antenatal care history of the respondents

Gestational age Frequency Percentage (%)

1st trimester 18 18

2nd trimester 29 29

3rd trimester 53 53

Total 100 100

Gestational age at booking Frequency Percentage (%)

1st trimester 58 58

2nd trimester 24 24

3rd trimester 18 18

Total 100 100

Number of Antenatal visits so far Frequency Percentage (%)

2 11 11

3 28 28

4 43 43

5 6 6

6 7 7

7 3 3

8 2 2

Total 100 100

42
Most of the client’s were in their 3rd trimester (53%) while most of them booked at their 1st

trimester (58%) and majority have had 4 ANC visits (43%).

Table 13: Frequency distribution of obstetric history of the respondents

Number of present pregnancy Frequency Percentage (%)

1 31 31

2 43 43

3 16 16

4 and above 10 10

Total 100 100

Number delivered Frequency Percentage (%)

0 16 16

1 41 41

2 25 25

3 12 12

4 and above 6 6

Total 100 100

Ever had a miscarriage? Frequency Percentage (%)

Yes 16 16

No 84 84

Ever had a stillbirth? Frequency Percentage (%)

Yes 12 12

No 88 88

Total 100 100

43
The gravidity of most clients was 2 (43%), most of the respondents have delivered once

(41%). Only 16 (16%) have had miscarriage and 12 (12%) have had stillbirth.

Table 14: Respondents ANC experience in the index pregnancy

Preference of ANC check up Frequency Percentage (%)

More check-up 13 13

Fewer check-up 25 25

Number of check-up just right 62 62

Total 100 100

Expectations of check up Frequency Percentage (%)

More than expected 15 15

Less than expected 27 27

Expected 58 58

Total 100 100

Time in between check up Frequency Percentage (%)

Too short 17 17

Too long 26 26

Perfect time 57 57

Total 100 100

Waiting time Frequency Percentage (%)

Less than 1hr 20 20

More than 1hr 80 80

Total 100 100

Happy with waiting time Frequency Percentage (%)

44
 No 80 80

Yes 20 20

Total 100 100

Time spent with provider Frequency Percentage (%)

Less than 30mins 67 67

30mins to 1 hour 18 18

More than 1 hour 15 15

Total 100 100

Majority of the respondents (62%) agree that the number of check up is just right and most

(58%) also believe that their expectation from the check up is expected. Few clients (57%)

agree that the time between check up is too short and most (80%) responded that they had to

wait for more than 1 hour to see a health care provider while majority (80%) are not happy

with the waiting time. However, majority of the respondents (67%) attest to spending less

than 30mins with the healthcare provider and would prefer a little more time with the

healthcare provider.

Table 15: Respondents’ satisfaction with different aspects of ANC

Satisfied with the Highly Satisfied (%) Fairly satisfied Not satisfied

following satisfied (%) (%) (%)

Waiting time 8 12 35 45

Ability to discuss problem 37 28 16 19

45
 Amount of explanation 41 29 18 12

given

Examination and treatment 45 22 15 18

given

Privacy from others during 53 29 12 6

treatment

Privacy from others during 45 22 16 17

discussion

Availability of medicines 52 33 9 6

Convenience of hours of 44 32 14 10

service

Neatness of facility 42 32 15 11

Majority of the clients were very dissatisfied with the waiting time (45%) but were satisfied

with the ability to discuss problem (37%) and with the different aspect of ANC in Holley

Memorial Hospital Ochadamu.

Table 16: Respondents’ satisfaction with ANC received

Respondents’ satisfaction No (%) Yes (%) I don’t know Total

(%)

Will you come back in your 22 70 8 100

next pregnancy?

Will you recommend the 19 68 13 100

facility?

46
 Respondents’ satisfaction Satisfied (%) Dissatisfied Indifferent Total

(%) (%)

General satisfaction 66 26 8 100

Overall satisfaction 88 7 5 100

Majority of the clients agreed to come back to the facility in their next pregnancy (70%) and

(68%) agreed to recommend the facility to others. Overall, 88% of the clients were satisfied

with ANC given while 7% were not satisfied.

47
 CHAPTER FIVE

5.1 DISCUSSION OF FINDINGS

The importance of human resource for health cannot be overemphasized for there to be high

quality service provision. It is evident in the study that a lot still need to be done in the area of

health manpower. There was adequate information on how to recognize and precede in some

danger signs of pregnancy. This is in contrast with findings in a study in Gambia were

roughly 80% of the women reported that they had not been told how to recognize or manage

certain danger signs during pregnancy. This probably contributed to the clients having little

worries about some pregnancy related issues when compared with facilities in similar studies

where women were not given as much information.

The observation of processes of care revealed poor practice of the minimum procedures to be

done in antenatal consultations. In almost all the facilities, doors were not closed during

consultation, no explanation given before examination or about diagnosis and also on the

importance of taking prophylactic drugs. Consulting while the doors are open does not

guarantee confidentiality and this was reported in a study were there was always interruption

by another health worker, a visitor or even a stranger during a consultation. Similarly, not

explaining the importance of prophylactic drugs may lead to poor adherence and its possible

side effects. However, blood pressure measurements, checking the foetal heart and urine for

protein were never missed just like in most studies on antenatal women. The availability of

instruments for measuring these and the common knowledge on the importance of this in

pregnancy must be contributory to providers not missing them. Group health talk is good but

not enough thereby it should be complimented by in depth interaction with the clients during

one on one consultation. It is during this time that issues like birth preparedness, complication

48
readiness, etc. should be discussed and the woman put in the right perspective on what she

should do and be doing.

A very important aspect of quality is client satisfaction with service provision and there are

many determinants to that. This study has an overall client satisfaction of 88% with 70% and

68% of the clients admitting willingness to come back in subsequent pregnancies and

recommend the facility to someone else respectively. This is quite reasonable though there

are still many areas of dissatisfaction that needs to be emphasized. Waiting time is a big

problem that needs to be handled very well. This is a big source of dissatisfaction to women

and was also reported in some other works, though Fawole et al. in their work had a lot of the

women rating the waiting time as appropriate.

Many respondents had to wait longer than one hour before being attended to but it is worth

noting that the time they responded that they wait includes the time usually devoted to group

health talk. Not having staff could contribute to long waiting time. Other major sources of

dissatisfaction identified were inability to discuss problem with health providers contrary to

findings by Shoyele et al. and lack of privacy during discussion consistent with a work in

Gambia. Lack of privacy is a reflection of the practice of leaving the doors open in most

consultation and inability to discuss problems well with the client can be linked to shortage of

staff which may make the providers to always be in a hurry to see everybody.

Findings from this study shows good quality with regards to process of care and very good

quality with regards to structural and outcome attribute of quality. There was a high level of

client satisfaction with antenatal care received 88%. A significant association was observed

between client satisfaction and marital status, educational level and occupational group but

no association was observed with parity. The gap in health worker’s level of availability in

49
health facilities for antenatal care seems to be addressed especially in the area of training to

expand worker’s capacity. Regular in-service training is highly recommended, supervision

and various form of motivation to boost the productivity of the available workers. The

observation of processes of care revealed poor practice of the minimum procedures to be

done in antenatal consultations.

The importance of high quality antenatal care cannot be overemphasized as it will not only

ensure women attendance to the clinic but will also contribute in combating maternal

mortality which is high in this part of the world. Clients’ perspective of quality of care with

regards to their satisfaction with service provision is also vital part that should always be

considered to have an improved service delivery.

5.2 Implications of finding to nursing

The findings of this studies when communicated well will assist in planning and educating

pregnant women attending antenatal care services.

5.3 Limitation of the study

This study would have covered other larger scales but was limited due to financial constraint

and lack of time.

5.4 Summary and Conclusion

The main objective of this study was to determine the perception and satisfaction of women

of child bearing age towards the quality of antenatal care services in Holley Memorial

Hospital Ochadamu, while the specific objectives were to: determine the perception of

pregnant women towards the quality of antenatal care services in Holley Memorial Hospital

50
Ochadamu; to determine the level of satisfaction of antenatal care services among pregnant

women in Holley Memorial Hospital Ochadamu and to determine the level of client

satisfaction with antenatal services provided in Holley Memorial Hospital Ochadamu.

There is no doubt that the antenatal care services provided in the hospital is very good despite

some observed shortcomings. Lack of enough manpower is a very big challenge to providing

adequate antenatal service especially the lower cadre of staff. This is very important as

everybody has a role to play at different stages in accessing care.

5.5 Recommendation

1. The following recommendations were made based on the findings of the study:

There should be a periodic assessment of quality of antenatal care as this would help for

continuous improvement in service delivery especially looking at quality from the clients’

perspective.

2. The authority should employ workers in the primary health care centers especially the

lower cadre of staff that provide allied services in the centre like personnel, pharmacy

technician etc.

3. There should be regular supervision and in-service training for the staff to keep them

abreast with recent development on best practices in patient care with regards to

things like client privacy, health education, etc.

4. There should be awareness creation on the part of the service providers on the need to

reduce client waiting time as it is a major cause of dissatisfaction and also on the part

of the government to employ more staff to meet the required minimum standard so as

to meet provider-client ratio.

51
5.6 Suggestion for further studies

More research on this topic should be embarked on to help inn discovering better ways to

improve quality of antenatal care services.

52
 REFERENCES

Adesokan, F.O (2022). Reproductive health for all ages (3 rd edition) Ekiti; Bosem

Publisher Nigeria Ltd.

Barnick, C. (2023). Obstetrics & Gynecology Antenatal care.

Bbaale, M. (2021) Factors affecting utilization of antenatal care.

Chinweuba, A., Iheanacho, P., & Agbapuowu, N., (2019). Research & Statistics in

Nursing & Related professions; Beginners guide (2 nd Ed.) Enugu EL Demak

Publishers Nigeria Ltd.

Edie, G., Obinchemti, T., Tamufor, E., Nije, M., Njamen, T. & Achidi, E. (2019)

Perceptions of Antenatal Care Services by Pregnant Women Attending

Government Health Centres in the Buea Health District, Cameroon.

Ejike, M.O., (2020). The practice of normal midwifery (new revised edition) Enugu Ecce

home and pioneers Nig, Ltd.

Fawole, A.O., Okunlola, M.A., & Adekunle, A.O., (2021) Client’s perception of the

quality of antenatal care.

Fraser, D.M. & Cooper, M.A., (2014) Myles’ Textbook for Midwives

Lamadah, S.M., & Elsaba H.A., (2021), Women satisfaction with the quality of antenatal

care, primary health care centre; Madinan AI- Menawarth KSA, Life science

journal.

53
Lino and Chompikul (2020) Assessment of quality of Antenatal care services.

Nwaeze, I.L. Enabor, O.O. Oluwasola, T.A.O. & Aimakhu, C.O. (2020) Perception and

satisfacation of antenatal care service among pregnant women, Ibadan; Ann IB

post grade med 11(1), 22-28.

Polit, D.E. Book G.I. & Hungher B.P. (2021) Essentials of nursing research methods

appraisal and utilization (5th edition), & 74 Lippincott Philadelphia.

Shoyele, O.O. Alosebe, O.A & Jeminusi O.A. (2019) Client perception of Antenatal Care

Service in Urban area Lagos; World journal of medical science 8(4), 359-364

Srivista, A. Avan B., Rajbanfship, P. & Bhattacharyyas, S. (2019). Determinants of

women satisfaction with maternal health care, London; BMC pregnancy

childbirth, 15:97

World Health Organization (WHO), United Nations Children’s Fund (UNICEF), United

Nations Population FUND (UNFPA) and the World Bank. Trends in Maternal

mortality: 2008 to 2019. Geneva: World Health Organization; 2019.

54
 United Evangelical Church

College of Nursing Ochadamu,

Ofu L.G.A.,

Kogi State.

3rd May, 2024.

Dear Respondent,

I am a student of the above named institution conducting a research study on Perception and

satisfaction of women of childbearing age towards the quality of antenatal care services in Holley

Memorial Hospital Ochadamu, Kogi State.

Kindly supply the information requested with all sincerity and answers will be treated confidentially.

Thanks in anticipation.

Yours faithfully,

Aguda Mercy Manasoko.

55
QUESTIONNAIRE ON PERCEPTION AND SATISFACTION OF WOMEN OF

CHILD BEARING AGE TOWARDS THE QUALITY OF ANTENATAL CARE

SERVICES IN HOLLEY MEMORIAL HOSPITAL, OCHADAMU, KOGI STATE.

SECTION A: DEMOGRAPHIC DATA

Please tick (√) where appropriate

1. Age range in years

(a) 15 – 19 [ ] (b) 20 – 24 [ ] (c) 25 – 29 [ ] (d) 30 – 34 [ ] (e) above [ ]

2. Marital status

(a) Single [ ] (b) Married [ ] (c) Divorced [ ]

3. How many percentages have you had

(a) First [ ] (b) Married [ ] (c) 3rd [ ] (d) 4th and above [ ]

4. Educational background

(a) Primary [ ] (b) Secondary [ ] (c) Tertiary [ ] (d) Others specify……………

5. Religion

(a) Christian [ ] (b) Islamic [ ] (c) Pagan [ ] (d) others specify……………

Tick (√) as many as possible

6. How many times do you wish to attend antenatal care visit before delivery

a. 4 times [ ]

56
b. 5 times [ ]

c. More than 6 times [ ]

d. Others specify ……………

7. Do you attend antenatal visit late?

a. Yes [ ]

b. No [ ]

8. If yes, why?

a. Lack of benefits of antenatal care [ ]

b. Limited facility access [ ]

c. Uncertainty about pregnancy [ ]

d. Laziness to go to many visits [ ]

e. Others specify……..

9. If no, why?

a. To acquire knowledge from health topics discussed [ ]

b. To go home early [ ]

c. To have enough time to do all the investigations [ ]

d. To be the first person to be seen by the doctors [ ]

e. Others specify [ ]

10. How would you rate antenatal care services given in ANC clinic

a. Adequate [ ]

b. Very adequate [ ]

c. Not adequate [ ]

d. No idea [ ]

57
SECTION B: Tick (√) as many as possible

11. What are the services carried out during antenatal

a. Blood pressure checking [ ]

b. Physical examination [ ]

c. Urinalysis [ ]

d. Giving herbs to drink

12. Do you think that antenatal care services has any importance

a. Yes

b. No

13. If yes, what are the importance of antenatal care services

a. To prepare for birth and parenthood [ ]

b. To collect mosquito treated net [ ]

c. It provides women and their families with advice for healthy pregnancy and safe birth

[ ]

d. To improve the survival and health of babies [ ]

e. Others specify………

SECTION C

Keys: HS= highly satisfied, S= satisfied, FS= fairly satisfied, NS= not satisfied

S/N Level of
satisfaction
4 3 2 1

Are you satisfied with, HS S FS NS

14. Care provided

58
 15. Interpersonal relationship of care providers

16. Health education given

17. Communication in local language

18. Waiting time

19. Laboratory services

20. Cost of services

SECTION D: Tick (√) as many as possible

21. What factors do you envisage that influences the perception of antenatal care services

a. Educational level [ ]

b. Marital status [ ]

c. Knowledge regarding antenatal care [ ]

d. Family support [ ]

e. Accessibility to antenatal information [ ]

f. Others specify ……….

PROCESSES OF CARE

ACTIVITY MAXIMUM MAXIMUM TOTAL PERCENTAG

SCORE PER OBTAINABL SCORE E (%)

OBSERVATIO E SCORE

Seat offered 30

Interest shown 30

59
Non interruption of 30

woman’s speech

Politeness 30

Asking about 30

women’s concern

Door closed during 30

consultation

Explanation before 30

examination

Explanation of 30

diagnosis

Explanation of use 30

of prophylactic drugs

Any history

History of malaria 30

History of UTI 30

Blood pressure 30

Measurement

Checking of 30

haemoglobin

Checking of urine 30

for protein

Prophylactic drugs 30

Checking eyes for 30

pallor

60
Checking legs for 30

oedema

Checking weight 30

Checking foetal 30

heart

General health 30

education

Nutrition education 30

Malaria prevention 30

health education

Total

61