Antenatal care satisfaction in a developing country: a cross-sectional study from Nigeria.

BACKGROUND: Utilization of Antenatal Care (ANC) is very low in Nigeria. Self-reported patient satisfaction may be useful to identify provider- and facility-specific factors that can be improved to increase ANC satisfaction and utilization. METHODS: Exit interview data collected from ANC users and facility assessment survey data from 534 systematically selected facilities in four northern Nigerian states were used. Associations between patient satisfaction (satisfied, not-satisfied) and patient ratings of the provider's interactions, care processes, out-of-pocket costs, and quality of facility infrastructure were studied. RESULTS: Of 1336 mothers, 90% were satisfied with ANC. Patient satisfaction was positively associated with responsive service (prompt, unrushed service, convenient clinic hours and privacy during consultation, AOR 2.42, 95% CI 2.05-2.87), treatment-facilitation (medical care-related provider communication and ease of receiving medicines, AOR 2.03, 95% CI 1.46-2.80), equipment availability (AOR 1.10, 95% CI 1.01-1.21), staff empathy (AOR 1.82, 95% CI 1.03-3.23), non-discriminatory treatment regardless of patient's socioeconomic status (AOR: 1.87, 95% CI 1.09-3.22), provider assurance (courtesy and patient's confidence in provider's competence, AOR 1.48, 95% CI 1.26-1.75), and number of clinical examinations received (AOR 1.28, 95% CI 1.10-1.50). ANC satisfaction was negatively impacted by out-of-pocket payment for care (vs. free care, AOR 0.44, 95% CI 0.23-0.82). CONCLUSIONS: ANC satisfaction in Nigeria may be enhanced by improving responsiveness to clients, clinical care quality, ensuring equipment availability, optimizing easy access to medicines, and expanding free ANC services.