RESUMO
BACKGROUND: In Ethiopia only 53% of induced abortions were performed in a health facility. Even though efforts have been made to improve comprehensive abortion care (CAC), still several health facilities fail to provide the services. Even in facilities where such care is provided, significant numbers of clients report their dissatisfaction with the service. Hence, this study sought to assess availability and readiness to meet the need for CAC, client satisfaction with the service and associated factors in public health facilities of East Shawa Zone, from March 1 to July 31, 2020. METHOD: Cross-sectional study was conducted taking a random sample of 30 health facilities and 900 women who received CAC and providers who delivered the services. Data were collected using interviewer-administered questionnaire and observational checklist. The analysis was performed using Stata-13. Descriptive summaries were used to characterize study participants, to determine service availability and readiness of facilities. The levels of satisfaction were estimated using proportion with a 95% confidence interval (CI). Multilevel ordinal logistic regression analysis was performed to identify factors associated with service satisfaction. The magnitude of association was estimated by adjusted odds ratios (AOR) with a 95% CI, and a p-value < 0.05 was used to declare statistical significance. RESULTS: The study found that all health facilities fulfilled at least three-fourth (75%) of the requirements that ensure CAC services availability. However, the percentage of facilities that fulfilled at least three-fourth of equipment was 60%; medicines, 56.7%; and basic amenities, 46.7%. Overall, 19.3% of women (95% CI 16.9%, 22.0%) reported very high level of satisfaction with CAC services. The levels of Satisfaction with the services were associated with being treated with second trimester abortion (AOR) = 2.07; 95% CI 1.03, 4.15) and having good procedure outcome (AOR = 2.09; 95% CI 1.09, 4.15), being treated by younger service provider, less than 35 year old (AOR = 8.58; 95% CI 3.66, 20.12), by a nurse (AOR = 2.96; 95% CI 1.49, 5.87), provider with three to five years of experience (AOR = 0.46; 95% CI 0.23, 0.92) and with the availability of essential medicines (AOR = 4.34; 95% CI 1.06, 18.20). CONCLUSIONS: The availability of essential medicines was below the standards set by World Health Organization. The levels of satisfaction with CAC is comparably lower than other studies findings and affected by the availability of essential medicines, procedure outcome, and gestational age of terminated pregnancy, the health care provider's age, profession and years of experience.
In Ethiopia only 53% of induced abortions were performed in a health facility. Even though efforts have been made to improve Comprehensive Abortion Care (CAC), still several health facilities fail to provide the services. Even in facilities where such care is provided, large proportions of clients report their dissatisfaction with the service. Hence, the study sought to assess service availability and readiness to meet the need for CAC, client satisfaction with the service and associated factors in public health facilities of East Shawa Zone, from March 1 to July 31, 202. The study relied on snapshot of information, investigated at a particular point-in-time within the study period. It was conducted on randomly selected sample of 30 health facilities, 900 women who received CAC and providers who delivered the services. Data were collected using face-to-face interview and checklist-based observations, and analyzed using computer software. Proportions were used to summarize the data regarding the characteristics of study participants, availability and readiness of facilities. Factors affecting women's satisfaction with CAC services were identified by comparing the proportions of service satisfaction among different groups of women, providers and facilities. The current study findings revealed that all health facilities fulfilled at least three fourth of material requirements that ensures the availability of CAC services. However, the percentage of facilities that fulfilled at least three fourth of equipment was 60%; medicines, 56.7%; and basic amenities, 46.7%. Among participated women, 19.3% of participants were reported very high level of satisfaction with CAC services. The higher chance of being satisfied with the service was observed among women who were treated for abortion within the second trimester of pregnancy, women treated by younger service provider, a nurse or provider with fever years of experience. Similarly the chance of being satisfied was higher among women who were treated in facilities where availability of essential medicines was not a problem and had good treatment outcome. Based on the study findings; it was concluded that, the availability of basic amenities and medicines was below the minimum standards set by World Health Organization. The level of satisfaction with CAC is comparably low and affected by the availability of medicines, the procedure outcome, the gestational age of terminated pregnancy, the health care provider's age, profession and years of experience.
