title: Determinants of perceived quality of obstetric care in rural Tanzania: a cross-sectional study.
abstract: BACKGROUND
  Patients' reported opinions of the health system need to be understood in order to provide patient-centered care. We investigated determinants of women's ratings of the quality of care during their most recent facility delivery.
  
  
  METHODS
  We conducted a census of all deliveries in the 6 weeks to 12 months preceding the survey, in villages served by 24 primary care clinics in rural Pwani Region, Tanzania. Women who had delivered children in a study facility were included in this analysis (n = 855). We interviewed women about demographic and obstetric factors and the quality of their obstetric care using a structured questionnaire. We created a composite index of perceived quality from six quality questions. We also assessed the functioning of the local health clinic using structured surveys. We used a multi-level model to analyze factors associated with women's rating of the quality of care during delivery.
  
  
  RESULTS
  14% of respondents rated the overall quality of care received during delivery as excellent. Women who listened to the radio daily reported lower quality composite scores (β: -0.99, p < 0.001). Women who reported receiving more services in ANC had higher quality scores (β: 0.46, p = 0.001), as did women receiving more delivery services (β: 0.55, p < 0.001). Women who reported disrespect and abuse during delivery had significantly lower quality scores (β: -4.13, p < 0.001).
  
  
  CONCLUSIONS
  A woman's expectations and prior and current experiences influence her perception of the quality of care she received. Health facility characteristics did not influence ratings of overall quality. Focusing on improving the process rather than inputs of service delivery during ANC visits and delivery may increase perceived quality of delivery care in low-resource settings.
  
  
  BACKGROUND
  ISRCTN17107760.
authors.affiliation: Health Policy & Management, Columbia University, 600 W, 168th St, New York, NY 10032, USA. el2646@columbia.edu.
authors.forename: Elysia
authors.initials: E
authors.lastname: Larson
authors.forename: Sabrina
authors.initials: S
authors.lastname: Hermosilla
authors.forename: Angela
authors.initials: A
authors.lastname: Kimweri
authors.forename: Godfrey M
authors.initials: GM
authors.lastname: Mbaruku
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Kruk
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D003710:Demography; D005260:Female; D006302:Health Services Research; D006801:Humans; D008427:Maternal Health Services / Q000592:standards*; D010043:Outcome and Process Assessment, Health Care; D017060:Patient Satisfaction; D011247:Pregnancy; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012423:Rural Health; D019035:Rural Health Services / Q000592:standards*; D011795:Surveys and Questionnaires; D013636:Tanzania