title: Antenatal care strengthening in Jimma, Ethiopia: a mixed-method needs assessment.
abstract: OBJECTIVE
  We assessed how health system priorities matched user expectations and what the needs for antenatal care (ANC) strengthening were for improved maternal health in Jimma, Ethiopia.
  
  
  METHODS
  A questionnaire survey among all recent mothers in the study area was conducted to study the content of ANC and to identify the predictors of low ANC satisfaction. Further, a qualitative approach was applied to understand perceptions, practices, and policies of ANC.
  
  
  RESULTS
  There were no national guidelines for ANC in Ethiopia. Within the health system, the teaching of health professional students was given high priority, and that contributed to a lack of continuity and privacy. To the women, poor user-provider interaction was a serious concern hindering the trust in the health care providers. Further, the care provision was compromised by the inadequate laboratory facilities, unstructured health education, and lack of training of health professionals.
  
  
  CONCLUSIONS
  Health system trials are needed to study the feasibility of ANC strengthening in the study area. Nationally and internationally, the leadership needs to be strengthened with supportive supervision geared towards building trust and mutual respect to protect maternal and infant health.
authors.affiliation: Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Rolighedsvej 25, 1958 Frederiksberg C, Denmark ; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Oester Farimagsgade 5, P.O. Box 2099, 1014 Copenhagen K, Denmark.
authors.forename: Sarah Fredsted
authors.initials: SF
authors.lastname: Villadsen
authors.affiliation: Department of International Health, Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen N, Denmark.
authors.forename: Britt Pinkowski
authors.initials: BP
authors.lastname: Tersbøl
authors.affiliation: Department of Obstetrics and Gynaecology, College of Public Health and Medical Sciences, Jimma University, P.O. Box 378, Jimma, Ethiopia.
authors.forename: Dereje
authors.initials: D
authors.lastname: Negussie
authors.affiliation: Department of Population and Family Health, Jimma University, P.O. Box 378, Jimma, Ethiopia.
authors.forename: Abebe
authors.initials: A
authors.lastname: GebreMariam
authors.affiliation: JUCAN Research Collaboration, Jimma University, P.O. Box 378, Jimma, Ethiopia.
authors.forename: Abebech
authors.initials: A
authors.lastname: Tilahun
authors.affiliation: Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Rolighedsvej 25, 1958 Frederiksberg C, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Friis
authors.affiliation: Department of Obstetrics and Gynaecology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark.
authors.forename: Vibeke
authors.initials: V
authors.lastname: Rasch
mesh_terms: D000293:Adolescent; D000328:Adult; D005002:Ethiopia; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000523:psychology / Q000592:standards; D007231:Infant, Newborn; D008875:Middle Aged; D009035:Mothers; D020380:Needs Assessment; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult