Beyond Coverage; Quality of Care for Women with Major Obstetric Indications and its Determinants in Harar Town Public Health Facilities: A Cross-Sectional Study

Abstract

Background: Ethiopia has Made Progress in expanding coverage of comprehensive Emergency Obstetric care (CEmOC) services. However, maternal mortality remains high at 412/ 100,000 live births. Most studies has focused on coverage and utilization of EmOC, with limited evidence on the quality of care received by women with major obstetric complications. Objective: The aim of this study was to assess quality of care for women with major obstetric indications and its determinants in Harar town public health facilities from March 20 - April 25/ 2023. Methods: A facility based Cross sectional study was conducted among 349 postpartum women who experienced major obstetric complication in two public hospitals providing CEmOC. Data on perceived quality of care and determinants was collected via interviews. Health facility inputs were assessed through provider surveys. Data analysis was performed using statistical package for social science version 26. Logistic regression was used to identify determinants of quality of service. Results: The overall Quality of Care with CEmOC was 65.3%. the degree of satisfaction emerged as the most influential predictor (B = 7.295, p < 0.000, 95% CI: 6.44-8.14). Effective pain management (B = 2.22, p < 0.001, 95% CI: 1.80 to 2.64), Preservation of dignity (B = 0.57, p <0.001, 95% CI: 0.36 to 0.77), family involvement in care (B = 1.24, p = 0.015, 95% CI: 1.04 to 1.63), Using ambulance transport B = -2.12, p < 0.001, 95% CI: -2.65 to -1.60), significantly predicted perceived quality. Conclusion: In conclusion, the overall quality of comprehensive emergency obstetric care was suboptimal, with only 65.3% Quality Percentage. The regression model provides valuable insights into the factors influencing Quality Percentage. Notably, Means of Transportation, Medication Availability, Pain Management, Family Involvement, Dignity and Respect, and Degree of Satisfaction are significant predictors. These results can guide interventions and improvements in healthcare services to enhance quality of care.