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ABSTRACT

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Antenatal care is an important health service which detects and sometimes reduces the risk of complications among pregnant women. The quality of care is likely to influence effective utilization and compliance with interventions.
This study evaluated clients’ was to ascertain the perception of and satisfaction with the quality of Antenatal services among pregnant women at the Specialist Hospital, Sokoto and determined levels of client satisfaction.
Women presenting for antenatal care at the study centre were interviewed in a cross-sectional design using a structured questionnaire. Items in the questionnaire included sociodemographic and obstetric variables, assessment of quality of amenities, waiting time and level of satisfaction. Data analysis was done using frequency tables, and chart
The clinic services were regarded as good in 81.1% of respondents; the only significant association with patient satisfaction was the desire to register in the same facility in the next pregnancy.
There is a high overall level of satisfaction with antenatal services among pregnant women in Specialist Hospital Sokoto. Policy makers and health providers should however address improvement of amenities, reduction of waiting time and ensure that health interventions are available for all clients.

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CHAPTER ONE

INTRODUCTION

1.1 Background of the Study
Antenatal care (ANC) is an important part of preventive medicine and professionals providing this service can reduce the risk of complications through education, counseling and various interventions. The proportion of Nigerian women that receive antenatal care and those that are delivered by skilled birth attendants has however remained far from acceptable (UNFPA Nigeria, 2008).
For many years, high standards of care were considered a luxury particularly in developing countries where service coverage was largely inadequate (Chakraborty N. et al, 2003 and Mensch, 1993). Quality of health care is seen as a factor closely related to effectiveness, compliance and continuity of care particularly for ethical reasons (Asadi-Lari, 2004). Women’s perceptions of antenatal visits significantly influence their assessment of quality of services that are provided (Kamil A, 2013). As a result of this new focus, measurement of customer satisfaction has become equally important in assessing system performance.
Patient satisfaction has traditionally been linked to the quality of services given and the extent to which specific needs are met. Satisfied patients are likely to come back for the services and recommend services to others (Zaky HH, 2007).
Various factors including attitude of staff, cost of care, time spent at the hospital and doctor communication have been found to influence patient satisfaction in previous studies (Ofovwe CE, 2005 and Al-Doghaither AH, 2000).
Routine obstetric ultrasound has been considered one of the factors that improved antenatal care and outcome of pregnancy worldwide (Vangeenderhuysen, 2002; Kongnyuy, 2007; Williams, 2005 and Gammeltoft , 2007). Although, the access to and utilization of this technology is not universal in developing countries, however, it has potential to reach all parts of the low income areas due to its user friendliness, high sensitivity and specificity, safety and is more relatively cheap to maintain than other forms of technology (Hofmeyr, 2009 and Maru, 2010). In Nigeria, the use of obstetric ultra-sonography is on the rise, however, there are mal-distribution within and between the different parts of the country with its impact less felt among the rural areas largely due to lack of basic infrastructure such as power and skilled health workers (National Population Commission (NPC)[Nigeria] and ICF Macro., 2009). Moreover, the utilization of ultrasound may be hampered by literacy level of women especially in Sokoto state where adult female literacy rate stood at 30% and this might be contributory to the low (40%) ante-natal service utilization (National Population Commission (NPC)[Nigeria] and ICF Macro., 2009) which would have availed pregnant women an opportunity for ultrasound scan (Health Reform Foundation of Nigeria, 2007). Furthermore, despite the documented merits of using obstetric ultrasound in developing countries (Harris, 2009; Hofmeyr, 2009 and Seffah, 2009), it is important to note that there were misconceptions from health care users and providers with potential for grave consequences (Gammeltoft , 2007 and Yeboah, 2010). The ultrasound experience among women varies from comforting the pregnant woman about the well-being of the fetus, to convincing them to adopt behaviors and practices that will ensure healthy growth and development of the fetus thereby facilitating early bonding (Bashour, 2005 and Georgsson, 2008). The commonest expectation women have from routine scans such as fetal sex and the expected date of delivery ultrasound (Eurenius, 1997 and Lalor, 2007) seem to have over shadowed the medical and obstetric indications for scanning with many women citing fetal sex and the expected date of delivery as the main reason for obstetric ultrasound making them less prepared to cope with negative findings (Bashour, 2005) or how to deal with a false negative scan (Clement, 1998). Thus when pregnant women lack factual information on the strengths and limitations of obstetric ultrasound, they are likely to adopt attitudes and behaviors that could adversely affect their exploitation of this technology and such misperception may be passed to other potential users which may undermine the proactive use of this technology. In order to develop positive health messages regarding the use of obstetric ultrasound, there is need to first identify knowledge gaps among users in order to develop messages that will not only address observed gaps but to identify the most appropriate medium to reach the majority of potential users based on their identified common characteristics which this study aims to achieve. Hence the theoretical framework for this study was based on the theory of reason action (TRA) that presupposes humans are rational and that the behaviors being explored are under volitional control, thereby providing a construct that links individual beliefs, attitudes, intentions, and behavior (Glanz, 2008). The TRA model underscores the need to first understand audience behavioral, normative and control beliefs that influence their intention to adopt or act in a desired behavior which will then guide the development of health messages that will persuade them to change these beliefs.

1.2 Statement of the Problem
The problem of this study is to ascertain the perception of and satisfaction with the quality of Antenatal services among pregnant women at the Specialist Hospital, Sokoto because many hospital in the country did not give proper care to pregnant women.
1.3 Objective of the Study
The study objective was to ascertain the perception of and satisfaction with the quality of Antenatal services among pregnant women at the Specialist Hospital, Sokoto. The study also sought to correlate patient’s satisfaction with future use of maternity services in the hospital and also to assess pregnant women’s perception of care and satisfaction during and after obstetrics ultrasound scan.
1.4 Research Questions
The research question of this study are stated below:
1. What is the perception of and satisfaction with the quality of Antenatal services among pregnant women at the Specialist Hospital, Sokoto?
2. What is the perception of pregnant women’s on care and satisfaction during and after obstetrics ultrasound scan?
1.5 Scope/Delimitation of the Study
1. Is to examine the assessment of pregnant woman level of satisfaction with antenatal service at specialist hospital.
2. Inadequate Time: time factor constitutes the major limitation of this research study. It relates to the fact that the time for research work was short because it was combined with lectures, studies and examination.
3. Negative attitude of respondent: the problem facing the researcher with regards to the respondents relates to the non-cooperation and uncompromising attitude some respondents in giving

1.6 Definition of Terms
Antenatal care (ANC): is an important part of preventive medicine and professionals providing this service can reduce the risk of complications through education, counseling and various interventions.
Pregnancy, also known as gestation, is the time during which one or more offspring develops inside a woman. A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy can occur by sexual intercourse or assisted reproductive technology.
Adolescence: (from Latin adolescere, meaning ‘to grow up’) is a transitional stage of physical and psychological development that generally occurs during the period from puberty to legal adulthood (age of majority).

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