Women's perception of quality of maternity services: a longitudinal survey in Nepal.
BACKGROUND
In the context of maternity service, the mother's assessment of quality is central because emotional, cultural and respectful supports are vital during labour and the delivery process. This study compared client-perceived quality of maternity services between birth centres, public and private hospitals in a central hills district of Nepal.


METHODS
A cohort of 701 pregnant women of 5 months or more gestational age were recruited and interviewed, followed by another interview within 45 days of delivery. Perception of quality was measured by a 20-item scale with three sub-scales: health facility, health care delivery, and interpersonal aspects. Perceived quality scores were analysed by ANOVA with post-hoc comparisons and multiple linear regression.


RESULTS
Within the health facility sub-scale, birth centre was rated lowest on items 'adequacy of medical equipment', 'health staff suited to women's health' and 'adequacy of health staff', whereas public hospital was rated the lowest with respect to 'adequacy of room', 'adequacy of water', 'environment clean', 'privacy' and 'adequacy of information'. Mean scores of total quality and sub-scales health facility and health care delivery for women attending private hospital were higher (p < 0.001) than those using birth centre or public hospital. Mean score of the sub-scale interpersonal aspects for public hospital users was lower (p < 0.001) than those delivered at private hospital and birth centre. However, perception on interpersonal aspects by women using public hospital improved significantly after delivery (p < 0.001).


CONCLUSIONS
Overall, perception of quality differed significantly by types of health facility used for delivery. They rated lowest the supplies and equipment in birth centres and the amenities and interpersonal aspects in the public hospital. Accordingly, attention to these aspects is needed to improve the quality.
School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal. rkarkee@gmail.com.
Rajendra
R
Karkee
Andy H
AH
Lee
Paras K
PK
Pokharel
D000293:Adolescent; D000328:Adult; D016550:Birthing Centers / Q000592:standards*; D002983:Clinical Competence; D003142:Communication; D004865:Equipment and Supplies, Hospital / Q000592:standards; D005260:Female; D019538:Health Care Surveys; D016304:Hospitals, Private / Q000592:standards*; D006779:Hospitals, Public / Q000592:standards*; D006797:Housekeeping, Hospital / Q000592:standards; D006801:Humans; D008137:Longitudinal Studies; D008427:Maternal Health Services / Q000592:standards*; D009390:Nepal; D017060:Patient Satisfaction; D010362:Patients' Rooms / Q000592:standards; D010465:Perception; D010564:Personnel, Hospital / Q000592:standards; D011247:Pregnancy; D018907:Privacy; D011369:Professional-Patient Relations; D011787:Quality of Health Care; D014867:Water / Q000592:standards; D055815:Young Adult
D014867:Water