Tessema Gizachew Assefa, Mahmood Mohammad Afzal, Gomersall Judith Streak, Assefa Yibeltal, Zemedu Theodros Getachew, Kifle Mengistu, Laurence Caroline O
School of Public Health, The University of Adelaide, Adelaide, Australia.
Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
PLoS One. 2017 Jun 16;12(6):e0179167. doi: 10.1371/journal.pone.0179167. eCollection 2017.
Over the last two decades, while contraceptive use has improved in Ethiopia, the contraceptive prevalence rate remains low. In addition to socio-demographic and cultural factors, the quality of care in Family Planning (FP) services is an important determining factor of FP utilization. However, little research exists on the determinants of quality of care in FP services in Ethiopia. This study aims to identify the client and facility level determinants of quality of care in FP services in Ethiopia.
This study was based on the first Ethiopian Services Provision Assessment Plus (ESPA+) survey conducted in 2014. A total of 1247 clients nested in 374 health facilities were included in the analysis. Multilevel mixed-effects logistic regression modelling was conducted. The outcome variable, client satisfaction, was created using polychoric principal component analysis using eleven facets that reflect client satisfaction.
The results showed that both client-level and facility-level factors were associated with quality of care in FP services in Ethiopia. At the client-level; provision of information on potential side effects of contraceptive method (AOR = 5.22, 95% CI: 2.13-12.80), and number of history and physical assessments (AOR = 1.19, 95% CI: 1.03-1.34) were positively associated with client satisfaction, whereas waiting times of 30 minutes to two hours (AOR = 0.11, 95% CI: 0.03-0.33) was negatively associated with client satisfaction. At the facility-level; urban location (AOR = 4.61, 95% CI: 1.04-20.58), and availability of FP guidelines/protocols for providers (AOR = 4.90, 95% CI: 1.19-20.19) had positive significant effect on client satisfaction.
Quality improvement programs in FP services in Ethiopia should focus on shortening waiting times and provision of information about the potential side effects of contraceptive methods. It is also important to improve health providers' skills in thorough client history taking and physical assessment. Further distribution and implementation of best practice guidelines for providers working in the FP services must be a priority.
在过去二十年里，虽然埃塞俄比亚的避孕措施使用情况有所改善，但避孕普及率仍然很低。除了社会人口和文化因素外，计划生育（FP）服务的护理质量是影响FP服务利用率的一个重要决定因素。然而，关于埃塞俄比亚FP服务护理质量的决定因素的研究很少。本研究旨在确定埃塞俄比亚FP服务护理质量的客户和机构层面的决定因素。
本研究基于2014年进行的首次埃塞俄比亚服务提供评估升级版（ESPA+）调查。分析纳入了嵌套在374个卫生机构中的1247名客户。进行了多层次混合效应逻辑回归建模。使用反映客户满意度的11个方面，通过多因素主成分分析创建了结果变量——客户满意度。
结果表明，客户层面和机构层面的因素都与埃塞俄比亚FP服务的护理质量相关。在客户层面，提供避孕方法潜在副作用的信息（调整后的比值比[AOR]=5.22，95%置信区间[CI]：2.13-12.80）以及病史和体格检查的次数（AOR=1.19，95%CI：1.03-1.34）与客户满意度呈正相关，而等待30分钟至两小时（AOR=0.11，95%CI：0.03-0.33）与客户满意度呈负相关。在机构层面，城市地区（AOR=4.61，95%CI：1.04-20.58）以及为提供者提供FP指南/协议（AOR=4.90，95%CI：1.19-20.19）对客户满意度有显著的积极影响。
埃塞俄比亚FP服务的质量改进计划应侧重于缩短等待时间，并提供有关避孕方法潜在副作用的信息。提高卫生服务提供者全面了解客户病史和进行体格检查的技能也很重要。必须优先进一步分发和实施针对从事FP服务的提供者的最佳实践指南。
