Quality of perinatal care: Experiences of clients and providers in three district hospitals ofWestern Uganda – A mixed methods study

Abstract

Background: It is anticipated that closing the quality gap through provision of effective antenatal, intrapartum and postnatal care for mothers and newborns in facilities will reduce morbidity and mortality. Mothers’ and health care providers’ experiences play a vital role in achieving quality care during the perinatal periods.

Purpose: To assess the health care providers’ (HCPs) and clients’ experiences on quality of perinatal care at three district hospitals in Bunyoro region, Western Uganda.

Methods: A convergent parallel mixed methods study design was utilized to explore experiences of 1) mothers as they sought antenatal, intrapartum, and postnatal care; and 2) care providers. Consecutive sampling was used to select 872 postnatal women at discharge, while purposive sampling was employed to select 54 care providers to participate in the study using structured questionnaires and interview guides. Quantitative data was analyzed descriptively, and qualitative data analyzed using inductive thematic analysis.

Results: Most women rated their interactions with the HCPs as trustworthy (80.5%), respectful (74.5%), and devoted (77.4%). All women were examined during antenatal, and 94% examined during childbirth. Most received medications during antenatal (99.5%) and childbirth (82.6%). Medical histories and care were recorded for 94.4% of women using standardized tools (98.2%). However, only 26.4% felt fully supported in transitioning care, while 37.4% faced difficulties. Additionally, over half of the HCPs were dissatisfied with the available physical infrastructure (75.9%) and resources (61.1%). Three themes emerged: good care provision, receiving information about care, and provider and client satisfaction.

Conclusions: Women had a positive experience contrary to that of the health care providers, which was influenced by a lack of an enabling environment. The limited environment also impacted women’s ability to transition in care. The presence of an enabling environment may enhance the quality of care provided to pregnant women.