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Reproductive Health
Published in: Reproductive Health 1/2018

Open Access 01-12-2018 | Research

Patient and provider determinants for receipt of three dimensions of respectful maternity care in Kigoma Region, Tanzania-April-July, 2016

Authors: M. M. Dynes, E. Twentyman, L. Kelly, G. Maro, A. A. Msuya, S. Dominico, P. Chaote, R. Rusibamayila, F. Serbanescu

Published in: Reproductive Health | Issue 1/2018

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Abstract

Background

Lack of respectful maternity care (RMC) is increasingly recognized as a human rights issue and a key deterrent to women seeking facility-based deliveries. Ensuring facility-based RMC is essential for improving maternal and neonatal health, especially in sub-Saharan African countries where mortality and non-skilled delivery care remain high.
Few studies have attempted to quantitatively identify patient and delivery factors associated with RMC, and none has modeled the influence of provider characteristics on RMC. This study aims to help fill these gaps through collection and analysis of interviews linked between clients and providers, allowing for description of both patient and provider characteristics and their association with receipt of RMC.

Methods

We conducted cross-sectional surveys across 61 facilities in Kigoma Region, Tanzania, from April to July 2016. Measures of RMC were developed using 21-items in a Principal Components Analysis (PCA). We conducted multilevel, mixed effects generalized linear regression analyses on matched data from 249 providers and 935 post-delivery clients. The outcomes of interest included three dimensions of RMC—Friendliness/Comfort/Attention; Information/Consent; and Non-abuse/Kindness—developed from the first three components of PCA. Significance level was set at p < 0.05.

Results

Significant client-level determinants for perceived Friendliness/Comfort/Attention RMC included age (30–39 versus 15–19 years: Coefficient [Coef] 0.63; 40–49 versus 15–19 years: Coef 0.79) and self-reported complications (reported complications versus did not: Coef − 0.41). Significant provider-level determinants included perception of fair pay (Perceives fair pay versus unfair pay: Coef 0.46), cadre (Nurses/midwives versus Clinicians: Coef − 0.46), and number of deliveries in the last month (11–20 versus < 11 deliveries: Coef − 0.35).
Significant client-level determinants for Information/Consent RMC included labor companionship (Companion versus none: Coef 0.37) and religiosity (Attends services at least weekly versus less often: Coef − 0.31). Significant provider-level determinants included perception of fair pay (Perceives fair pay versus unfair: Coef 0.37), weekly work hours (Coef 0.01), and age (30–39 versus 20–29 years: Coef − 0.34; 40–49 versus 20–29 years: Coef − 0.58).
Significant provider-level determinants for Non-abuse/Kindness RMC included the predictors of age (age 50+ versus 20–29 years: Coef 0.34) and access to electronic mentoring (Access to two mentoring types versus none: Coef 0.37).

Conclusions

These findings illustrate the value of including both client and provider information in the analysis of RMC. Strategies that address provider-level determinants of RMC (such as equitable pay, work environment, access to mentoring platforms) may improve RMC and subsequently address uptake of facility delivery.
Appendix
Available only for authorised users
Footnotes
1
Women were asked if they had any complications during labor and delivery. The most common self-reported complications included postpartum hemorrhage, prolonged labor, retained placenta, malpresentation, and lacerations.
 
2
The variable for SES was developed using principal components analysis (PCA); household assets and characteristics were weighted based on their contribution to the first principal component and summed to create an index score representing five levels of relative household wealth [61].
 
3
Providers were asked, “Have you received pre-service training in […]?”; “Have you received in-service training in […]?”; and “Have you conducted […] in the last 3 months?” for the following 25 items: 1) Focused antenatal care; 2) Routine labor and delivery care; 3) Use the partograph; 4) Active management of the third stage of labor; 5) Manual removal of the placenta; 6) Beginning intravenous fluids; 7) Checking for anemia; 8) Administering intramuscular or intravenous magnesium sulfate for the treatment of server pre-eclampsia or eclampsia; 9) Administering intravenous antibiotics; 10) Administering misoprostol or other uterotonic; 11) Bimanual uterine compression (external); 12) Bimanual uterine compression (internal); 13) Suturing an episiotomy; 14) Suturing vaginal lacerations; 15) Suturing cervical lacerations; 16) Vacuum extractor; 17) Forceps; 18) C-section; 19) A blood transfusion; 20) Adult resuscitation; 21) Resuscitating a newborn with bag and mask; 22) Basic Emergency Obstetric and Neonatal Care (BEmONC); 23) Advanced Emergency Obstetric and Neonatal Care; 24) Administering antiretrovirals (ART) for Prevention of Mother-to-Child Transmission (PMTCT); and 25) Rapid diagnostic testing for HIV. Responses were summed to create four indices.
 
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Metadata
Title
Patient and provider determinants for receipt of three dimensions of respectful maternity care in Kigoma Region, Tanzania-April-July, 2016
Authors
M. M. Dynes
E. Twentyman
L. Kelly
G. Maro
A. A. Msuya
S. Dominico
P. Chaote
R. Rusibamayila
F. Serbanescu
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Reproductive Health / Issue 1/2018
Electronic ISSN: 1742-4755
DOI
https://doi.org/10.1186/s12978-018-0486-7

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