title: The patient-provider relationship and antenatal care uptake at two referral hospitals in Malawi: A qualitative study.
abstract: BACKGROUND
  Approximately 90% of Malawian women attend antenatal care at least once during their pregnancies; however, most mothers first present during months five and six and do not adhere to the World Health Organization's recommended four visits. The objective of this study was to explore the role the patient-provider relationship has on antenatal care uptake.
  
  
  METHODS
  A qualitative study, consisting of interviews with 20 urban pregnant mothers and eight health workers, was conducted from September to December 2014. Two large tertiary care hospitals in the Central and Southern regions of Malawi were selected as study sites.
  
  
  RESULTS
  Several factors influenced antenatal care attendance. Significant barriers reported included the patient-provider relationship, clinic wait times, family and friend support, distance from home to the clinic, transportation, cost, and number of visits. The patient-provider relationship appears to have a large impact on antenatal clinic participation. Mothers indicated that health workers often mistreat or demean them during visits. Additionally, health workers revealed that, due to staff shortages, patients often do not receive the care they deserve.
  
  
  CONCLUSIONS
  The results of this study suggest that, in addition to other factors, healthcare provider attitudes influence antenatal clinic attendance. Improving the patient-provider relationship may increase antenatal clinic attendance and decrease pregnancy complications during pregnancy. Professional development opportunities and quality improvement programmes are would help improve patient care and health outcomes while the continued staff shortages in the country are addressed.
authors.affiliation: School of Public Health, Loma Linda University, Loma Linda, California, USA.
authors.forename: J
authors.initials: J
authors.lastname: Roberts
authors.affiliation: School of Public Health, Loma Linda University, Loma Linda, California, USA.
authors.forename: D
authors.initials: D
authors.lastname: Sealy
authors.affiliation: School of Public Health, Loma Linda University, Loma Linda, California, USA.
authors.forename: H Hopp
authors.initials: HH
authors.lastname: Marshak
authors.affiliation: University of Malawi, College of Medicine, Chichiri Blantyre 3, Malawi.
authors.forename: L
authors.initials: L
authors.lastname: Manda-Taylor
authors.affiliation: School of Public Health, Loma Linda University, Loma Linda, California, USA.
authors.forename: P
authors.initials: P
authors.lastname: Gleason
authors.affiliation: School of Public Health, Loma Linda University, Loma Linda, California, USA; University of Malawi, College of Medicine, Chichiri Blantyre 3, Malawi.
authors.forename: R
authors.initials: R
authors.lastname: Mataya
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008295:Malawi; D008875:Middle Aged; D009035:Mothers / Q000523:psychology*; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011248:Pregnancy Complications; D011295:Prenatal Care / Q000706:statistics & numerical data*; D011369:Professional-Patient Relations; D036301:Qualitative Research; D011787:Quality of Health Care; D012959:Socioeconomic Factors; D055815:Young Adult