Background
Methods
Study design and participants
Study setting
Theoretical framework and research instrument
Data collection
Outcome measures
Covariates
Statistical analysis
Results
Socio-demographic characteristics of the mothers
Variables | Frequency | Percentage (%) |
---|---|---|
Median age (IQR) 25.0 (11.0) years | ||
Age in years by categories (range 14–49) | ||
≤ 19 years | 828 | 21.9 |
20–34 years | 2411 | 63.8 |
≥ 35 years | 539 | 14.3 |
Completed educational level | ||
None | 982 | 26.0 |
Primary | 2327 | 61.6 |
Secondary or higher | 469 | 12.4 |
Marital status | ||
Married | 2289 | 60.6 |
Single | 1398 | 37.0 |
Divorced/Widowed | 91 | 2.4 |
Occupational status | ||
Housewife | 1810 | 48.0 |
Subsistence farmer | 1747 | 46.2 |
Student | 114 | 3.0 |
Employed | 107 | 2.8 |
Religion | ||
Zionist | 1503 | 39.8 |
Other Protestants | 1583 | 41.9 |
Catholics | 507 | 13.4 |
Others | 185 | 4.9 |
Socio-economic status | ||
Poorest | 450 | 11.9 |
Poorer | 681 | 18.0 |
Poor | 856 | 22.7 |
Less poor | 902 | 23.9 |
Least poor | 733 | 19.4 |
Data missing | 156 | 4.1 |
Obstetric characteristics
Variables | Frequency | Percentage (%) |
---|---|---|
Parity (n = 3778) | ||
One | 1037 | 27.4 |
Two to four | 1937 | 51.3 |
Five and more | 804 | 21.3 |
Districts where the mothers gave birth (n = 3778) | ||
Bilene-Macia | 871 | 23.1 |
Chibuto | 588 | 15.6 |
Chokwe | 314 | 8.3 |
Magude | 359 | 9.5 |
Manhiça | 1109 | 29.3 |
Xai-Xai | 537 | 14.2 |
Distance from home to the nearest health facility, km (n = 3753) | ||
< 1.0 | 619 | 16.5 |
≥ 1.0 to < 2.5 | 1108 | 29.5 |
≥ 2.5 to < 5.0 | 895 | 23.9 |
≥ 5.0 to < 7.5 | 433 | 11.5 |
≥ 7.5 | 698 | 18.6 |
Mean of transportation from home to the health facility (n = 3778) | ||
Walking | 1900 | 50.3 |
Taxi mini bus | 1127 | 29.8 |
Private car | 557 | 14.7 |
Ambulance | 161 | 4.3 |
Motorcycle/tuktuk/bicycle | 33 | 0.9 |
Time took from home to the health facility (n = 3778) | ||
< 30 min | 1633 | 43.2 |
≥ 30 min to < 1 h | 1495 | 39.6 |
≥ 1 h to < 3 h | 537 | 14.2 |
≥ 3 h | 37 | 1.0 |
Don’t know | 76 | 2.0 |
Type of health facility where the mothers gave birth (n = 3778) | ||
Type II health centre * | 2268 | 60.0 |
Type I health centre ** | 621 | 16.4 |
Hospital | 889 | 23.6 |
Referred to hospital (n = 3778) | ||
Yes | 309 | 8.2 |
No | 3469 | 91.8 |
Duration of labour (n = 3400) | ||
< 12 h | 682 | 20.0 |
≥ 12 to < 24 h | 764 | 22.5 |
≥ 24 h | 1954 | 57.5 |
Type of childbirth (n = 3778) | ||
Spontaneous vaginally | 3619 | 95.8 |
Ventouse | 19 | 0.5 |
Caesarean section | 140 | 3.7 |
Presence of companion throughout the childbirth (n = 3778) | ||
Yes | 2095 | 55.5 |
No | 1683 | 44.5 |
Type of companion (n = 2095) | ||
Mother-in-law | 971 | 46.3 |
Mother | 341 | 16.3 |
Husband/partner | 106 | 5.1 |
Friend/neighbour | 119 | 5.7 |
Others | 558 | 26.6 |
Outcome (n = 3778) | ||
Livebirth | 3691 | 97.7 |
Stillbirth | 87 | 2.3 |
Experiences of care and level of satisfaction with the services
Likert scores | Bad/No/Not satisfied | Neither good or bad/Undecided/ Neutral | Good/Yes/ Satisfied | |
---|---|---|---|---|
n (%) | n (%) | n (%) |
N
| |
[1,2] | [3] | [4,5] | ||
Overall satisfaction with the services | ||||
Overall, taking everything into account, how are the services in the facility where you gave birth to your last baby? | 116 (3.1%) | 169 (4.5%) | 3493 (92.5%) | 3778 |
If you now reconsider your birth experience, would you recommend a family member to deliver in the health facility where you gave birth? | 144 (3.8%) | 77 (2.0%) | 3557 (94.2%) | 3778 |
Structure* | ||||
How do you feel about the sanitation of the health facility? (How clean was it?) | 76 (2.0%) | 123 (3.3%) | 3579 (94.7%) | 3778 |
Process of care/Interaction with the healthcare providers** | ||||
How did you feel about the way you were welcomed at this health facility? | 88 (2.3%) | 61 (1.6%) | 3629 (96.1%) | 3778 |
How do you feel about the time taken to attend to you during your delivery? | 151 (4.0%) | 147 (3.9%) | 3480 (92.1%) | 3778 |
How do you feel about the answers you received to your questions during your delivery? | 31 (2.3%) | 47 (3.4%) | 1293 (94.3%) | 1371 |
How would you rate the experience of how clearly the health providers explained things to you such as why something needed to be done? | 114 (3.0%) | 319 (8.4%) | 3345 (88.5%) | 3778 |
How would you rate the knowledge and competence of health workers at this facility for this delivery? | 120 (3.2%) | 120 (3.2%) | 3538 (93.6%) | 3778 |
How would you rate the experience of being helped by the health providers to feed your baby after your delivery? | 907 (44.7%) | 112 (5.5%) | 1009 (49.8%) | 2028 |
Provision of respect and privacy***
| ||||
During your delivery, how would you rate the experience of being respectfully treated? | 94 (2.5%) | 124 (3.3%) | 3560 (94.2%) | 3778 |
How would you rate the way privacy was respected during the physical examination? | 125 (3.3%) | 219 (5.8%) | 3434 (90.9%) | 3778 |
No
|
Yes
| |||
n
(%)
|
n
(%)
|
N
| ||
Other questions related with the structure and process of care | ||||
*If you needed special medicines during the delivery were you able to get the medicines the health provider prescribed? | 40 (8.2%) | 449 (91.8)% | 489 | |
**Did you feel abandoned when you needed help? | 3387 (89.7%) | 391 (10.3%) | 3778 | |
***Did the health providers ask you for consent before doing any intervention? | 319 (40.3%) | 472 (59.7%) | 791 | |
***Were you treated in a way that made you feel humiliated or disrespected? | 3539 (93.7%) | 239 (6.3%) | 3778 | |
***At any point during your stay for this delivery were you physically abused by any of the health care providers? | 3715 (98.3%) | 63 (1.7%) | 3778 |
Satisfaction outcome | Very dissatisfied | Dissatisfied | Neutral | Satisfied | Very satisfied | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
n
| % |
n
| % |
n
| % |
n
| % |
n
| % |
N
|
p
| |
Experiences during childbirth | ||||||||||||
Disrespect or humiliation | 3778 | < 0.001 | ||||||||||
Yes | 20 | 8.4% | 29 | 12.1% | 27 | 11.3% | 135 | 56.5% | 28 | 11.7% | 239 | |
No | 20 | 0.6% | 47 | 1.3% | 142 | 4.0% | 2078 | 58.7% | 1252 | 35.4% | 3539 | |
Physical abuse | 3778 | |||||||||||
Yes | 7 | 11.1% | 10 | 15.9% | 8 | 12.7% | 29 | 46.0% | 9 | 14.3% | 63 | < 0.001 |
No | 33 | 0.9% | 66 | 1.8% | 161 | 4.3% | 2184 | 58.8% | 1271 | 34.2% | 3715 | |
Abandoned when needed help | 3778 | |||||||||||
Yes | 30 | 7.7% | 60 | 15.3% | 36 | 9.2% | 202 | 51.7% | 63 | 16.1% | 391 | < 0.001 |
No | 10 | 0.3% | 16 | 0.5% | 133 | 3.9% | 2011 | 59.4% | 1217 | 35.9% | 3387 | |
Informal payment | 3778 | < 0.001 | ||||||||||
Yes | 8 | 5.1% | 8 | 5.1% | 19 | 12.1% | 72 | 45.9% | 50 | 31.8% | 157 | |
No | 32 | 0.9% | 68 | 1.9% | 150 | 4.1% | 2141 | 59.1% | 1320 | 34.0% | 3261 | |
Interventions undertaken without consent | 3778 | < 0.001 | ||||||||||
Yes | 3 | 0.9% | 10 | 3.1% | 9 | 2.8% | 101 | 31.7% | 196 | 61.4% | 319 | |
No | 0 | 0.0% | 0 | 0.0% | 9 | 1.9% | 95 | 20.1% | 386 | 78.0% | 472 | |
No intervention | 37 | 1.2% | 66 | 2.2% | 151 | 5.1% | 2017 | 67.5% | 716 | 24.0% | 2987 |
Association between satisfaction and mothers’ characteristics
Satisfaction outcome | Very dissatisfied | Dissatisfied | Neutral | Satisfied | Very satisfied | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
n
| % |
n
| % |
n
| % |
n
| % |
n
| % |
N
|
p
| |
Sociodemographic characteristics | ||||||||||||
Completed educational level | 3778 | 0.027 | ||||||||||
None | 3 | 0.6% | 5 | 1.1% | 16 | 3.4% | 258 | 55.0% | 187 | 39.9% | 469 | |
Primary | 31 | 1.3% | 52 | 2.2% | 101 | 4.3% | 1364 | 58.6% | 779 | 33.5% | 2327 | |
Secondary or higher | 6 | 0.6% | 19 | 1.9% | 52 | 5.3% | 591 | 60.2% | 314 | 32.0% | 982 | |
Marital status | 3778 | < 0.001 | ||||||||||
Married | 18 | 0.8% | 42 | 1.8% | 68 | 3.0% | 1230 | 53.7% | 931 | 40.7% | 2289 | |
Single | 22 | 1.6% | 33 | 2.4% | 96 | 6.9% | 930 | 66.5% | 317 | 22.7% | 1398 | |
Divorced/Widowed | 0 | 0.0% | 1 | 1.1% | 5 | 5.5% | 53 | 58.2% | 32 | 35.2% | 91 | |
Occupational status | 3778 | < 0.001 | ||||||||||
Housewife | 24 | 1.3% | 36 | 2.0% | 123 | 6.8% | 1220 | 67.4% | 407 | 22.5% | 1810 | |
Subsistence farmer | 16 | 0.9% | 39 | 2.2% | 37 | 2.1% | 861 | 49.3% | 794 | 45.4% | 1747 | |
Student | 0 | 0.0% | 0 | 0.0% | 5 | 4.4% | 70 | 61.4% | 39 | 34.2% | 114 | |
Employed | 0 | 0.0% | 1 | 0.9% | 4 | 3.7% | 62 | 57.9% | 40 | 45.4% | 107 | |
Obstetric characteristics | ||||||||||||
Distance to the nearest health facility in km | 3753 | < 0.001 | ||||||||||
< 1.0 | 5 | 0.8% | 12 | 1.9% | 26 | 4.2% | 259 | 41.8% | 317 | 51.2% | 619 | |
≥ 1.0 to < 2.5 | 13 | 1.2% | 16 | 1.4% | 47 | 4.2% | 541 | 48.8% | 491 | 44.3% | 1108 | |
≥ 2.5 to < 5.0 | 11 | 1.2% | 18 | 2.0% | 31 | 3.5% | 580 | 64.8% | 255 | 28.5% | 895 | |
≥ 5.0 to < 7.5 | 2 | 0.5% | 9 | 2.1% | 35 | 8.1% | 272 | 62.8% | 115 | 26.6% | 433 | |
≥ 7.5 | 9 | 1.3% | 21 | 3.0% | 29 | 4.2% | 548 | 78.5% | 91 | 13.0% | 698 | |
Mean of transportation to the health facility | 3778 | < 0.001 | ||||||||||
Walking | 30 | 1.6% | 53 | 2.8% | 79 | 4.2% | 1111 | 58.5% | 627 | 33.0% | 1900 | |
Taxi mini bus | 6 | 0.5% | 17 | 1.5% | 57 | 5.1% | 636 | 56.4% | 411 | 36.5% | 1127 | |
Private car | 3 | 0.5% | 5 | 0.9% | 25 | 4.5% | 371 | 66.6% | 153 | 27.5% | 557 | |
Ambulance | 0 | 0.0% | 1 | 0.6% | 6 | 3.7% | 76 | 47.2% | 78 | 48.4% | 161 | |
Motorcycle/bicycle | 1 | 3.0% | 0 | 0.0% | 2 | 6.1% | 19 | 57.6% | 11 | 33.3% | 33 | |
Type of Health facility | 3778 | < 0.001 | ||||||||||
Type II health centre | 29 | 1.3% | 53 | 2.3% | 90 | 4.0% | 1268 | 55.9% | 828 | 36.5% | 2268 | |
Type I health centre | 7 | 1.1% | 19 | 3.1% | 45 | 7.2% | 359 | 57.8% | 191 | 30.8% | 621 | |
Hospital | 4 | 0.4% | 4 | 0.4% | 34 | 3.8% | 586 | 65.9% | 261 | 29.4% | 889 | |
Duration of labour | 3400 | < 0.001 | ||||||||||
< 12 h | 12 | 1.8% | 23 | 3.4% | 15 | 2.2% | 369 | 54.1% | 263 | 38.6% | 682 | |
≥ 12 to < 24 h | 11 | 1.4% | 25 | 3.3% | 29 | 3.8% | 469 | 61.4% | 230 | 30.1% | 764 | |
≥ 24 h | 10 | 0.5% | 24 | 1.2% | 106 | 5.4% | 1164 | 59.6% | 650 | 33.3% | 1954 | |
Presence of companion throughout the childbirth | 3778 | < 0.001 | ||||||||||
Yes | 15 | 0.7% | 35 | 1.7% | 102 | 4.9% | 1188 | 56.7% | 755 | 36.0% | 2095 | |
No | 25 | 1.5% | 41 | 2.4% | 67 | 4.0% | 1025 | 60.9% | 525 | 31.2% | 1683 |
Estimate | Lower | Upper | |
---|---|---|---|
Overall satisfaction | |||
Type I HC | 0.05 | -0.02 | 0.13 |
Type II HC | 0.06 | 0.03 | 0.10 |
Hospital | −0.01 | −0.08 | 0.07 |
Interaction with providers | |||
Type I HC | 0.04 | −0.04 | 0.11 |
Type II HC | 0.06 | 0.02 | 0.09 |
Hospital | 0.01 | −0.07 | 0.08 |
Provision of respectful care | |||
Type I HC | 0.07 | −0.01 | 0.14 |
Type II HC | 0.06 | 0.03 | 0.10 |
Hospital | −0.02 | −0.09 | 0.05 |