Factors Affecting Satisfaction Regarding Maternity Services Among Postnatal Mothers in a Tertiary Hospital of Kathmandu

Background Maternal satisfaction towards care provided during pregnancy, childbirth and puerperium is one of the key outcome measures for quality of care. In order to provide satisfactory maternity services health workers should focus on mother-friendly care. Various factors may affect on mothers' satisfaction regarding maternity services.The objective of this study was to assess the factors affecting satisfaction regarding maternity services among postnatal mothers. Materials and Methods A descriptive, cross-sectional study was conducted in postnatal ward of Kathmandu Medical College Teaching Hospital. A total of 180 postnatal mothers were purposively selected for the study. Ethical clearance was obtained from the institutional review committee of Kathmandu Medical College. Face to face interview technique was used to collect the data using pre – designed structured questionnaire. Data collection was done from June to July 2019. Data were analysed using Statistical Package for Social Science 20.0 version. Both descriptive and inferential statistics were used for data analysis. Results Majority (83.9%) of the mothers were satised with overall maternity services. The level of satisfaction was higher in (82.8%) environmental factor, (80%) health care delivery system of hospital and (73.3%) communication. There was signicant association between sexes of current child with maternal satisfaction. Mothers having current child male were more satised with maternity services provided by the hospital (COR: 4.90 with 95% CI: 1.97, 12.18) Conclusion The study concluded that majority of postnatal mothers were satised with maternity services provided at hospital. Current child male was signicantly associated with satisfaction level of mothers on maternity services.


Introduction
Quality maternal care is directly related to the possibility of mothers for timely and appropriate treatment in order to achieve desired outcomes. The use of services and outcomes are the result not only of the provision of care but also of women's experience of that care. Unfortunately, quality of care received by mothers and babies in developing countries is often reported as poor [1]. Satisfaction with healthcare services is dened as "the extent to which the patients seeking treatment experience positive perception of the care provided by the nursing or medical staff. "When patients are satised with the care provided by the healthcare staff, they are more likely to utilize health services in future. Providing high quality of care in maternity services involves giving mothers the best possible medical care and outcome during pregnancy, labor, and postnatal period [2]. Satisfaction is one of the most frequently reported outcome measures for quality of care so assessment of satisfaction with maternity services is crucial [3]. Maternity services are focused on the health of women during antenatal, natal and postnatal period. Globally, all most all (99%) maternal deaths take place in developing and low-income countries due to poor utilization of available services [4]. Labour and delivery is a crucial experience in women's life because it has great impact on physical, mental and emotional health. A pleasant experience during childbirth is important for both maternal and neonatal health and well-being. Thus it is essential for the health care providers to providing best support to childbearing women [5]. In Nepal, ndings of a facility-based survey showed majority of the women were satised with care received at the facility, provider's skill, being involved in decision-making process, cleanliness, information received and condentiality. To bring about positive experience of women, maternity care in Nepal should focus on improvement in physical environment along with improving the attitude and communication skill of service providers [6]. Overall 45.1% of mothers were satised with the perinatal care in a study carried outin tertiary hospitals of western Nepal. In that study main factors associated with satisfaction were type of hospital, religion, education, parity, number of living children, mode of delivery, gestational age at birth, maternal condition after delivery, newborn health condition, and duration of stay at the hospital [7].

Materials and Methods
Descriptive cross sectional study was conducted to nd out the factors affecting satisfaction regarding maternity services among postnatal mothers of postnatal ward of Kathmandu Medical College, Teaching Hospital. Data collection was done from June and July 2019. For the ethical consideration, approval for the study was obtained from institutional review committee of Kathmandu Medical College, permission for data collection was taken from the concerned authority of hospital and written consent was obtained from each respondents of the study. The study population consisted of postnatal mothers who gave birth at hospital and were about to be discharged from the hospital. Mothers who were admitted in the hospital after home delivery, having intrauterine fetal death, severely ill client and not willing to participate in the study were excluded from the study. Sample size was calculated based on prevalence of similar study [8]. The sample size was calculated by formula 2 2 Z pq/e with the desired precision of 5% (95% condence interval at an allowable error of 5%) prevalence of maternal satisfaction = 0.61. To reduce nonresponse rate, additional 5% was taken. The sample size was 180. Total 180 postnatal mothers who met the inclusion criteria during data collection period were selected for the study by using non probability purposive sampling technique. Face to face interview technique was used to collect the data using pre designed structured questionnaire. Questionnaire was divided into three parts: part I consist of socio demographic characteristics of mother, part II consist of obstetric characteristics of mothers and part III consist of ve point Likert scale to measure the satisfaction of mothers regarding maternity services on different factors. Score 5 was given for very satised, 4 was satised, 3 for neither satised nor dissatised, 2 for dissatised and 1 for very dissatised. Total score was 130. Out of 130, ≤78 was considered dissatised and >78 was considered satised [9].All the collected data were entered in Microsoft excel 2010 and were analysed using Statistical Package for Social Science (SPSS) 20.0 version. Both descriptive and inferential statistics were used for data analysis. Sociodemographic and obstetrical information of the respondents were presented in frequency and percentage. Chi square test was used to reveal the association between demographic and obstetric variables with satisfaction regarding maternity services among postnatal

Discussion
Satisfaction is one of the most frequently reported outcome measures for quality of care so assessment of satisfaction with maternity services is crucial [3]. Satisfaction depends on quality healthcare provided to clients. Maternal satisfaction with pregnancy and childbirth is not only

Puspa Parajuli et.al. Original Article
mothers considering p -value <0.05 as signicant. The strength of association between demographic and obstetric characteristics was measured by odd ratio at 95% condence intervals.

Results
Socio-demographic prole of the mothers is illustrated in Table 1. Majority of the mothers (66.7%) were between age group of 20 to 30 years with the mean ± S.D = 27. 533 ± 4.10 years. According to ethnicity of mothers, Majority of mothers (45.0%) were Janjati. Likewise, Majority (72.8%) of the mothers were Hindus. Regarding educational status of the mothers, 30.6% had secondary level and 29.4% had higher secondary level. By occupation, nearly half (47.2%) of the mothers were homemaker followed by 6.1% daily labourer. Table 2 shows obstetric characteristics of the mothers, more than half (57.8%) of the postnatal mothers were primparous and 56.7% had caesarean delivery. Regarding the sex of current baby, More than half (55 %) of the mothers have malebabyand 45% have female baby. More than half (56.2) of the mothers had stayed in hospital for four and more days. Table 3shows that management and administrative factors those affect overall satisfaction and dissatisfaction of mothers in ve domain, among ve domain, 82.8% mother were satised in environmental factors of hospital and 80% of mothers were satised with health care delivery system of hospital, 73.3% of mothers were satised in communication and information techniques, 72.2% of mothers were satised with physical and staff accessibility and least 69.3% of mothers were satised with attitude and behaviour of health care provider. Majority of the mothers (83.9) were satised on maternity services provided at hospital.  important for woman but also well-being of infant.
Mother's positive experience during childbirth is directly linked towards care of infant with appropriate mothering role [3]. Socio demographic and obstetric ndings of the present study showed that majority of the respondents (47.2%) were homemaker by occupation. The ndings were consistent with the study conducted by Thapa in Kathmandu, Nepal where majority (72%) were from age group 21-30 years [9]. In this study, majority of the mothers (47.2%) were homemaker by occupation. This nding is consistent with the study conducted by Bitew which showed that majority of the respondents (47.8%) were homemaker [10]. Only 29.4%mother had completed higher secondary education. The nding is inconsistent with the study done in Bharatpur, Nepal which showed that majority of the mother (46.8%) had completed higher secondary level [11]. The nding of the study reveals that more than half (56.7%) of the mothers were primiparous and majority (55%) of the mothers have male baby. This study is consistent with the study done by Sapkota in bharatpur Nepal which showed that More than half (54.6%) of the respondents were rst gravida and 46.1% mothers have male baby [11]. The nding of this study related to satisfaction on maternity services showed that majority of the postnatal mothers (63.3%) was satised with nurses listening to their problems. This nding was consistent with the ndings of a study conducted by Melese which showed majority of the respondents (69%) were satised with nurses listening to their problems [12]. The study reveals that around two third (60%) of the postnatal mothers were satised with information about procedure and examination. In contrast to the study done by Melese showed that below half of the postnatal mothers (45.4%) were satised with information about procedure and examination [12]. Two third (65.6%) of postnatal mothers were satised with information provided at the time of discharge. Similarly, thisnding is constant with the survey report of Nepal showed that 69% respondents were satised with information received by staff about discharge [6]. In the present study, 73.3% of mothers were satised with communication and information aspect of care. This nding is inconsistent with the study conducted in Nepal by Panth showed that 91.5% of mothers were satised in informative aspect of care [9]. Regarding overall satisfaction, Majority of the postnatal mothers (83.9%) were satised on maternity services. This nding is consistent with the study done in Nepal by Panth which showed that 89.8% of mothers were satised on maternity services. In present study, there is no statistically signicant association between socio demographic variables and maternal satisfaction however; there is signicant association between sexes of current child and maternal satisfaction. This is consistent with the study conducted by Panth which showed that there is no statically signicant association between socio demographic variables with maternal satisfaction and signicant association between parity and satisfaction of postnatal mothers [9].

Conclusion
On the base of study results, it is concluded that majority of the mothers were satised with maternity services provided by Kathmandu Medical College, Teaching Hospital. The level of satisfaction was higher on environmental factors, health care delivery of hospital and communication of staff. Satisfaction level of mothers on maternity

Puspa Parajuli et.al. Original Article
services was associated with sex of current child; mothers having male child were more satised in reference to female child. The ndings of the study suggested to improve the attitude of hospital staff. The study could be done in community setting where postnatal mothers could freely express their satisfaction regarding the service they have received.