The Health Workers and Delivery Process Related Maternal Satisfaction with Delivery Services at UDUTH Sokoto, Nigeria

Every pregnancy and child birth comes with a specific experience and none is guaranteed to be safe. Positive delivery experiences facilitate the further use of the reproductive health services and vice versa. The objective of the present investigation was to determine the maternal satisfaction towards delivery services at Usmanu Danfodiyo University Teaching Hospital Sokoto. A cross-sectional descriptive study was used. The study was conducted on a sample of 158 postnatal women at UDUTH. The study participants were selected using convenient method of sampling and the data was collected using self-administrated questionnaires. Most of the respondents are within the age range of 30-39 71(49.3%) and most of which are Hausas by tribe 57(39.6%). The finding of the study shows that, majority of the women were satisfied with all the process/health workers related factors except for the sex of health care provider who attended to them. Also, majority of the women were satisfied with most of the maternal obstetrics history related factors. However, most of them were not satisfied with assisted delivery services, complicated outcome of delivery as well as loss of child during or after delivery. In conclusion there is a high level of maternal satisfaction with delivery services in UDUTH Sokoto. The study recommended that, condition of toilets and shower rooms in the delivery room and postnatal ward should be addressed to ensure the satisfaction of maternity clients. Government should make infrastructural improvements to overcome shortages of water and electricity, toilet and shower supplies.


Target population
All mothers who gave birth in Usmanu Danfodiyo University (UDUTH) Sokoto in the labor ward and theatre at the time of data collection that fulfilled the selection criteria. 1. Women who gave birth in UDUTH within the data collection time

2.
Postnatal mothers 'who were mentally or critically well after delivery.
Exclusion criteria 1. Women who gave birth in UDUTH outside the data collection time 2.
Postnatal mothers 'who were mentally or critically ill were not included in the study subjects.

Sampling size determination
The sample size was derived from the average deliveries conducted in the month of August 2019 in the labor ward in UDUTJH Sokoto (Table 1). Therefore, the calculated sample size is 158, and a total of 158 questionnaires will be used.

Sampling technique
A convenient sampling technique was used in this study. Convenient non-probability sampling technique on the other hand is the type of sampling technique that involves the use of a target population that is available at the time of data collection without any selection criteria.
Instrument for data collection 1. The instrument used for data collection was questionnaires. The questionnaire is divided into four sections: A, B, C and D.

2.
Section A comprises of socio-demographic data of respondents.

3.
Section B comprises of research questions on structural/ health facility related to maternal satisfaction with the delivery services.

4.
Section C comprises of research questions on process/ health workers related to maternal satisfaction with the delivery services.

5.
Section D comprises of research questions on maternal obstetrics history related maternal satisfaction with delivery services.
The questionnaire is close ended type.

Method of Data Analysis
The data collected were organized and presented using descriptive statistics in the form of frequency tables. The result will be analyzed using a statistical package for social sciences (SPSS) version 20. A decision mean of 3.0 will be used to ascertain the satisfaction or non-satisfaction of the respondent to the questionnaire items.

Measurement scale:
Less than 3.0 is unsatisfied.
3.0 and above is satisfied.

Ethical consideration
Permission was obtained from the departmental research committee to carry out the study. The culture and religion of the subjects were considered and respected. Individual verbal consent was obtained from respondents after full explanation of what the project entails by the researcher in the questionnaire. Confidentiality was also maintained, and a serial number rather than names was written on the questionnaires to ensure anonymity. The copy of this research work would only be available in the department library for reference and for further study.

PRM.MS.ID.000573. 3(5).2020
However, most of them were dissatisfied with the sex of the health worker(s) who attended to them (X=2.88, SD=1.03) (   The majority of the respondents were unemployed women-41 (28.5%), students-36 (25%) and government employees-35 (24.3%). The respondents were satisfied with the number of health workers (X=3.58, SD=1.4). This is in contrast to a study done in Malawi that showed a shortage of health care workers including health professionals and issues related to their retention were important barriers to their quality of care. Similarly, the majority of the women were satisfied with the waiting time before been attended to (X=3.49, SD=1.46), this is in line with a study conducted in Assela Hospital. For the human dignity, majority of the women were satisfied with the respect and courtesy by health workers (X=4.12, SD=1.47). This is in line with a study conducted in maternity referral hospital in Addis Ababa which found the attitude of the health workers to have a relative higher satisfaction score [10]. As found in this study (X=3, SD=1.3), the above study also established women satisfaction with the amount of time spent on examination. a.
For the competency of the health workers, majority of the women demonstrated significant satisfaction (X=4.45, SD=1.04). This is in line with an Indian study that completeness of procedures, good medicine, and advice were perceived as 'good care' [11]. b.
Majority of the women are satisfied with the privacy measures provided by the health workers (X=3.84, SD=1.18). This is in line with a study from Debre Markos town indicated good level of maternal satisfaction with assurance of privacy (97.7%) [12]. c.
Majority of the women are satisfied with spontaneous vaginal delivery as a mode of their delivery (X=4.98, SD=1.41). This is in conflict with a study in Debre Markos town demonstrated that spontaneous vaginal delivery was significantly associated with reduction of satisfaction on delivery care [13][14][15][16].

d.
Majority of the women are satisfied with a normal outcome of delivery (X=4.50, SD=1.05) and live fetal birth outcome (X=4.19, SD=1.31). This is in line with a study from west-Arsi Oromiya, Assela showed that mothers with normal delivery and fetal outcome were two times more satisfied than those with complicated delivery and fetal outcome.

Implication of the Study
The results of this study will provide scientific evidence regarding mothers' satisfaction with delivery care at UDUTH as performance measurement and also as consideration of satisfaction by health policy makers might be necessary for improving the quality of mother and newborn care, and reducing maternal mortality rate (MMR) and infant mortality rate (IMR) [19][20][21][22].

Conclusion
The above result concludes that there is a high level of maternal satisfaction with health workers and service delivery in UDUTH Sokoto. The mothers were interviewed within the health centers, and they may give responses favoring the care providers resulting in social desirability bias.

b.
The cross-sectional nature of the study does not allow the study to establish causal relationship between the different independent variables and the outcome variable.

c.
Client satisfaction surveys are influenced by cultural response bias which is created by social and cultural factors that influence the way people perceive and respond to survey questions.

d.
Absence of variables in the questionnaire to capture place of previous delivery that would have aided in cross-analysis of satisfaction.