GROUP VERSUS INDIVIDUAL ANTENATAL CARE: WOMEN’S SATISFACTION IN FOUR HEALTH CENTERS IN RWANDA

Abstract

ABSTRACT Background: Satisfaction with antenatal care can increase the use of antenatal care (ANC) services and subsequently lead to positive maternal and fetal outcomes. The group ANC model was recently introduced in a few health facilities in Rwanda. It is not known whether women are more satisfied in this model compared to the conventional Individual ANC model in the Rwandan setting. Aim: To assess pregnant women‟s level of satisfaction in GANC versus IANC, and describe factors associated with satisfaction with ANC in four health centers in Rwanda. Methods: A convergent parallel mixed methods design was employed. Four hundred fifty-three participants were recruited from Muhima, Kabusunzu, Rangiro and Yove health facilities. An interviewer administered questionnaire with items on socio demographic characteristics, obstetric and health setting factors was used. Satisfaction was measured using 10 questions developed by Patil et al and validated in Malawi and Tanzania. Four focus group discussions (FGD) involving 27 pregnant were conducted. Statisfaction was determined using means and compared using an independent t-test. Percentage of women satisfied in GANC and IANC were also calculated using 60% as the cutoff score for satisfation. Multivariable logistic regression was used determine factors associated with women‟s satisfaction in ANC and a p-value of 0.05 was considered signficant. A deductive content analysis approach was used for qualitative data. Results: The mean age of women was 29 (SD±6.0) years in GANC and 29 (SD±5.9)in IANC. Overall satisfaction was 48.2%, the mean satisfaction in IANC was of (24.37, SD±8 and (31.46, SD ±1.35) in GANC, p<0.001. Not being employed (AOR 1.791, CI 95% [1.78-2.724]), gravidity of less than 5 (AOR 1.626, CI 95% [0.929-2.848]), a waiting time of ≤1 hour (AOR 4.255, CI 95% [2.656-6.814]) were strongly associated with satisfaction in ANC. Themes related to satisfaction included less waiting time, good provider attitudes, health education during ANC and involvement of women in ANC. Conclusion: Women who attended in the GANC model were more satisfied with ANC than women in IANC model. Women were more satisfied with ANC if they were not employed, having pregnancy less than 5, waiting for less or equal to 1 hour. However, poor/fair health center cleanliness was associated with women‟s dissatisfaction with ANC. Less waiting time and good provider attitude were perceived to increase satisfaction with ANC.