{"paper_id":"d5938dfa-6e68-485d-8672-ed5b06b30940","body_text":"Post natal Care services utilization and satisfaction of Women in Afar Region, Awash Fentale District, \nEthiopia\nDr.Getachew Weldeyohannes 1 .Prof.Thanyani. Gladys 2. \n1Yekatit 12 Hospitals, Department of Public Health, College of Medicine, Addis Ababa, Ethiopia\n2University of South Africa, Department of Health Studies,\nEmail address:gechwy2001@yahoo.com (G.W.Tedla), lumadtg@unisa.ac.za (T.G.Lumadi), \n*1 Correspondence Author: gechwy2001@yahoo.com (G.W.Tedla)\nAbstract\nBack ground: The percentage of women receiving a postnatal checkup within two days of delivery \nis higher in urban areas than in rural areas. In Afar region it was 11.6%, which is the lowest among \nall regional states in Ethiopia\nAim: The aim of this study is to assess the post natal care services utilizations and satisfactions of \nWomen in Afar Region, Awash Fentale District.\nMETHOD: A quantitative, descriptive , cross-sectional study design was used for this study. Data \nwere collected using a structured questionnaire administered to 422 women aged 15 to 49 years \nthrough a stratified sampling technique.  Data was entered, analyzed and interpreted using SPSS \ncomputer program. Binary logistic regression model was used to identify the factors that influence \nmaternal health care services utilization.\nResult\nThis study revealed that 43% of the respondents were not satisfied with the care and attention given \nby the health care providers and approximately 52% of the respondents were not satisfied with the \ncleanliness of the health facilities. Regardless of the level or degree of income, husbands’ income \nwas statistically significant and earning less income among husbands might lead women to have \nless PNC services utilization. Another independent variable that showed statistical significance was \nwatching television .Women who never watched television were 58% less likely to use PNC \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted February 1, 2024. ; https://doi.org/10.1101/2024.01.31.24302088doi: medRxiv preprint \nNOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.\n\nservices compared to women who watched television every day (AOR=0.414and p-value=0.008), \nwhich is less than p=0.05.\nConclusion: husbands’ income and watching television were statistically significant and earning \nless income among husbands might lead women to have less PNC services utilization. Much \nemphasis should also be given to care, attention of mothers and the cleanliness of the healthcare \nfacilities in Awash Fentale woreda. \nKey terms: Awash Fentale woreda; Post natal care services utilization; PNCS, MHCS preferences; \nwomen’s satisfaction.\nIntroduction\nThe percentage of women receiving a postnatal checkup within two days of delivery is higher in \nurban areas than in rural areas. The percentage of women who had a postnatal checkup in the first \ntwo days after birth in Afar Region was 11.6%, which is the lowest among all regional states in \nEthiopia (1). A similar study conducted in Swaziland indicated that the utilization of PNC services \nwas high among women who have had less than six children. The rate of PNC services utilization \nwas low among women who have had six or more children (16.8%) (2). According to Atiya (3), the \nmain factors identified as influencing satisfaction and dissatisfaction were caregivers and client \ninteraction, the characteristics of the setting, the involvement of clients in the caring process, the \nnurses’ perception of client characteristics, the outcome of labor for both mother and baby, the \nacceptability of alternative places for delivery, and the respondents’ expectations and perceptions of \nhospital delivery. Of all these factors, however, caregiver attitude was seen as the strongest factor in \ndetermining maternal satisfaction with care”.\nMaterial and Method:\nStudy area, period and design\nThe study was conducted in Awash Fentale district, in the Afar Region of North East of Ethiopia, \nfrom January to March 2020. Awash Fentale is found in Zone 3 of the Afar National Regional \nState, Ethiopia, which is 200km from Addis Ababa. \nThe total population of Awash Fentale distric for the year 2017 was 37,219 populations, of which \n17,880 are women and 19,339 are men. For this study the researcher used a quantitative, \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted February 1, 2024. ; https://doi.org/10.1101/2024.01.31.24302088doi: medRxiv preprint \n\ndescriptive, cross-sectional design and a stratified random sampling was applied. In the stratified \nsampling, the sampling frame is divided into homogeneous and non-overlapping subgroups (called \n“strata”), and a simple random sample is drawn within each subgroup. The variables  commonly \nused for stratification was ethnicity. This Stratification ensured that all levels of the identified \nvariables were adequately represented in the sample. Study subjects were selected by simple \nrandom sampling from each stratum.\nSample size determination and procedure\nThe sample size required for this study was determined using a single population proportion \nformula with the following assumptions; the proportion of postnatal care utilization in Awash \nFentale district was assumed to be 50% (p = 0.5) level of significance 5% (α = 0.05), Z α/2 = 1.96, \nabsolute precision or margin of error 5% (d = 0.05) and non-response rate 10%. Using the formula \nn = [Z α/2*p(1-p)]/d2 = 1.962*0.5 (1–0.5)/0.052, the sample size n was calculated to be 380. Finally, \nconsidering a 10% contingency rate for non-responses, the final sample size was calculated as 422.\nData collection Procedure\nData were collected using standardized structured questionnaires. The data were collected using \nquestionnaires developed and included all the relevant variables to meet the objectives of the study. \nPrior to the development of the questionnaires, similar studies focusing on factors that influence the \nutilization of maternal healthcare services were reviewed and a few modifications were made to the \nprepared questionnaires to address the set objectives. Before the actual data collection, the data \ncollectors were provided with the location and the number of women to interview based on the \nproportion of their ethnicity. The households of the respondents, regardless of their place of \ndelivery, were obtained from the Maternal and Child Health (MCH) Department of Awash Health \nCentre. All women aged 15 to 49 years who gave birth within the past two years and who had been \nliving there for at least one year (but not visitors) were eligible for the interview. The data collectors \nwere required to do only one revisit and those households missed during the second visit were \nassumed as non-respondents. The study respondents were randomly selected from their ethnic strata \nand the number of respondents in each ethnic group who were interviewed by the data collectors \nwere proportionally allocated by the researcher. During the data collection, the researcher consulted \nthe heads of Awash Fentale Health Office and Awash Fentale Health Centre and some community \nmembers to make the data-collection process more effective. In this study, verbal face-to-face \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted February 1, 2024. ; https://doi.org/10.1101/2024.01.31.24302088doi: medRxiv preprint \n\ninterviews were administered using structured questionnaires. The questionnaires were developed \nin English and translated into Amharic and Afar language and further explanations were given for \nbetter understanding of enumerators and respondents.\nData quality control\nThe questionnaires were prepared separately according to the nature of participants. Data collectors \nand supervisors were recruited and received training for three consecutive days. The questioning \ntool was pretested prior to the actual data collection to check its appropriateness and the familiarity \nof the data collectors with the tool. The data collectors collected the data under continuous \nsupervision and guidance by the supervisors and investigators.\nEthics\nEthical clearance certificate was obtained from the University of South Africa \n(Ref:HSHDC/594/2017) and from the Afar National Regional State Bureau of Health \n(Ref:A/HIC/719/10). A permission letter to contact the list of women was obtained from Awash \nFentale Health Centre which has the authoritative power and responsibility of leading the healthcare \nfacilities. \nA written informed consent form was designed and was signed by each respondent before \ncompleting the questionnaire: The researcher respected the rights of the respondents to abstain from \nparticipation or to withdraw consent to participate at any time without reprisal. The participants \nwere informed that the information they provided might not be of direct benefit to them but was \nextremely important to inform policy makers and program designers for stimulating discussion \nabout the formulation of appropriate measures to address the factors that influence maternal \nhealthcare services utilization by women in Awash Fentale woreda. Case identification numbers \ninstead of actual names were used to ensure anonymity. Data was locked in the box and kept in the \noffice of the manager of the health center for safety from disclosure to unauthorized persons. \nStratified and simple random sampling procedure was used to ensure justice and avoid \ndiscrimination of participants. Data collectors were well orientated and obtained data from \nrespondents; homes to avoid social and economic harm.\n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted February 1, 2024. ; https://doi.org/10.1101/2024.01.31.24302088doi: medRxiv preprint \n\nValidity and reliability\nTo ensure external validity, simple random sampling of respondents was done and the sample size \nwas large enough to draw  conclusions to generalize findings to other populations. The items on the \nquestionnaire were tested to ensure reliability.\nData analysis\nThe researcher reviewed the data for logical consistencies and completeness before making data \nentries. Data were entered into SPSS and cleaned also using SPSS. The description of the study \npopulation was done by analyzing the distribution of the respondents by the variables in terms of \nfrequencies and percentages. Chi-square tests were conducted to assess any association and to \nmeasure the strength of association between independent and dependent variables. Similarly, binary \nlogistic regression was applied to assess any association and the strength of the association between \ndependent and independent variables.\nResult:\nDemographic characteristics of respondents\nThe overall response rate was 422 (100%). Of the total respondents, 156 (36.9%) were illiterate, \n228 (54%) were from Afar ethnic group, 207 (49%) were housewives, 275 (65%) were Muslims, \n406 (96.2%) were married; 266 (63%) had an income range between 1501–5000 Birr (which is \napproximately 51–172USD) per month and 164 (39.8%) were in the age group 25 – 29 years with a \nmean age of 26.9 years. About 298 (70.6%) had history of 2–5 Pregnancies (Table1). Among the \nrespondents, 56(13.3%) had history of abortion, 76 (18%) still birth and 52(12.3%) had an infant \ndeath (Table 1).\nTable 1 Socio demographic characteristics of respondents in Awash Fentale District, Afar \nRegional State, Ethiopia, \nCharacteristics of respondents Frequency Percent\nAge\nMean + SD 26.9+5\n15-19\n20-24\n35\n88\n8.3\n20.8\n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted February 1, 2024. ; https://doi.org/10.1101/2024.01.31.24302088doi: medRxiv preprint \n\n25-29\n30-34\n164\n85\n39.8\n20\n35-39\n40-44\n40\n8\n9.5\n1.9\nEducational level\nNo education 156 36.9\nPrimary education 48 11.4\nSecondary education 115 27.25\nTertiary education and above 103 24.4\nEthnicity\nAfar\nAmhara\n228\n93\n54\n22\nOromo\nWelayta\n42\n25\n10.4\n5.9\nArgoba 17 4\nTigray 8 1.9\nOthers 2 0.5\nOccupation\nNot employed 207 49.1\nGovernment employee 115 27.3\nSelf employee 55 13\nPrivate employee 19 4.5\nNGO 2 2.1\nUnspecified job 17 4\nReligion\nMuslism 275 65\nOrthodox Christian 92 22\nProtestant 44 10.4\n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted February 1, 2024. ; https://doi.org/10.1101/2024.01.31.24302088doi: medRxiv preprint \n\nCatholic 10 2.4\nTraditional believers 1 0.2\nMarital Status\nMarried 406 96.2\nCohabitating 2 0.5\nNever married 4 0.9\nWidowed 5 1.2\nDivorced 4 0.9\nIncome\n<1500 103 24\n1501-5000 266 63\n>5000 53 12.6\nPNC services utilization\nOf the 422 respondents, 234 (55.45%) had PNC visits, while 185(44.4%) did not have any PNC \nvisits. Only three (0.7%) of the women could not remember whether they had PNC visits or not. \nFigure 4.13 indicates the proportion of women who had PNC visits at a healthcare facility after \ndelivery (see figure 2).\n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted February 1, 2024. ; https://doi.org/10.1101/2024.01.31.24302088doi: medRxiv preprint \n\nFigure 2: Proportion of women who had PNC services\n(a) Barriers to PNC services in Awash Fentale District\nIt was indicated in this study that 135 (42.2%) of the women responded they did not access PNC \nservices because they did not experience any complications after delivery while they were at home. \nThe second reason mentioned for not visiting the healthcare facility after delivery was because their \nfamily members did not allow them to visit a healthcare facility. Thirty-three (10.3%) of the \nrespondents indicated their husbands’ influence as a barrier. Long distance from the health care \nfacility, not trusting the health care facilities, and the unavailability of quality services were among \nthe major reasons mentioned by the study participants that prevented them from visiting a health \ncare facility (see Table 2).\nTable 2: Proportion of the responses regarding barriers to accessing PNC services (n=320)\nReasons not to have PNC Frequency Percentage\nHigh cost of service 10 3.1\nLong distance 22 6.9\nLong waiting time 13 4.1\nNo complication 135 42.2\nDo not trust healthcare facility 22 6.9\nUnavailability of quality service 22 6.9\n55%\n44%\n0.70% 0.30%\nYes\nNo\nDon’t remember\n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted February 1, 2024. ; https://doi.org/10.1101/2024.01.31.24302088doi: medRxiv preprint \n\nHusband did not allow it 33 10.3\nFamily did not allow it 43 13.4\nPrevious bad experience at a healthcare facility 5 1.56\nLittle respect from healthcare workers 15 4.7\nTotal responses 320 100.00\n Women’s satisfaction with maternal health care services\nRespondents who had PNC visits were asked whether they had been satisfied with the care they \nreceived. Out of 385 women who responded to this question, 200 (52%) were satisfied with the care \nand attention they received from the healthcare provider, while 166 (43.1%) responded that they \nwere not satisfied with the care and attention they received from the healthcare provider. Only 32 \n(8.3%) said that they did not remember. With regard to the attitude of health personnel, 153 \n(39.7%) of the respondents were satisfied with the attitude of the health personnel in providing \nmaternal health care services, while 200 (52%) were not satisfied. Less than half (n=170; 44%) of \nthe respondents claimed that they were satisfied with the cleanliness of the healthcare facility, while \nmore than half 200 (52%) answered that they were not satisfied with the cleanliness of the \nhealthcare facility. The respondents were also asked about their satisfaction pertaining to the \namount of privacy they had and the medication they received. Only 135 (35%) of the respondents \nwere satisfied with the privacy they had and only 82 (21.3%) were satisfied with the medication \nthey received (see Table 2). \nTable 3: Women’s satisfaction with maternal health care services (N=385)\nFrequency Percentage\nSatisfaction\nYes No Do not remember Yes No Do not remember\nThe care and attention \nfrom staff\n200 166 19 52 43.1 4.9\nThe attitude of healthcare \npersonnel\n153 200 32 39.7 52 8.3\nThe cleanliness of the \nhealthcare facility\n170 200 15 44.1 52 3.9\nThe amount of privacy 135 223 27 35 58 7\n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted February 1, 2024. ; https://doi.org/10.1101/2024.01.31.24302088doi: medRxiv preprint \n\nThe medication provided 82 248 55 21.3 64.4 14.3\n Other health-related issues\nIn this subsection, aspects including women’s decision making, reading newspapers or magazines, \nand the frequency of listening to the radio or watching television are presented.\n(a) Decision making\nThe study participants were asked about their decision-making process while seeking health care. \nThe study found that 158 (37.4) of the women responded that they made decisions regarding \nseeking health care with their partner, while 141(33.4%) indicated that their husband or partner \ndecided for them, 72 (17%) decided alone regarding their health care and 38 (9%) decided along \nwith another person. For only 13 (3.1%) of the participants, someone else decided for them (see \nFigure 3).\nFigure .3: Proportion of respondents regarding their decision making\n(b) Reading newspapers or magazines\nOf the 422 respondents, 328 (77.7%) reported that they did not read either newspapers or \nmagazines at all, while 43 (10.2%) read newspapers or magazines less than once a week and 36 \n(8.5%) read newspapers at least once a week. Only 15 (3.6%) of the participants read either a \nnewspaper or a magazine every day (See Figure 4).  \n17\n37.40\n9\n33.40%\n3.10%0%\n5%\n10%\n15%\n20%\n25%\n30%\n35%\n40%\nRespondent alone Respondent and \npartner jointly\nRespondent and \nanother person\nHusband or partner Someone else\n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted February 1, 2024. ; https://doi.org/10.1101/2024.01.31.24302088doi: medRxiv preprint \n\nFigure 4: Frequency of reading newspapers or magazines\n(c) Frequency of listening to the radio among the study respondents\nMore than half (n=250; 59.2%) of the participants reported that they never listened to the radio at \nall. Seventy-two (17%) respondents listened to the radio less than once a week and 53 (12.6%) \nlistened to the radio at least once a week. Only 47(11%) participants listened to the radio almost \nevery day (see figure 5).\n3.60%\n8.50%\n10.20%\n77.70%\nAlmost every day\nAt least once a week\nLess than once a week\nNot at all\n11.10%\n12.60%\n17%\n59.20%\nAlmost every day\nAt least once a week\nLess than once a week\nNot at all\n0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% 70.00%\n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted February 1, 2024. ; https://doi.org/10.1101/2024.01.31.24302088doi: medRxiv preprint \n\nFigure 5: Frequency of listening to the radio\n(d) Frequency of watching television\nThe study revealed that 266 (63%) of the participants watched television every day, while 95 \n(22.5%) did not watch television at all. Moreover, 35(8.3%) women watched television less than \nonce a week and only 26 (6.2%) women watched television at least once a week (see Figure 6).\nFigure 6: Frequency of watching television among the study participants\nFactors associated with PNC visits\nOn the bivariate analysis, the independent variables that showed associations with PNC services, \nincluding place of delivery, husbands’ income, reading newspapers, ever attending school, \nwatching television, and the adequacy of ANC visits, were statistically significant. These \nindependent variables were again tested together using multivariate analysis to avoid the effects of \nconfounding factors. Before the multivariate analysis was conducted, those variables that were \nthought to affect PNC services were checked on binary logistic regression using bivariate analysis \n(see Table 4). \n63\n6.20 8.30\n22.50\n0%\n10%\n20%\n30%\n40%\n50%\n60%\n70%\nAlmost every day At least once a week Less than once a week Not at all\n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted February 1, 2024. ; https://doi.org/10.1101/2024.01.31.24302088doi: medRxiv preprint \n\nTable 5.10: Factors associated with PNC visits of mothers in Awash Fentale District, 2020\nPNC  Utilization\nVariable Yes No  COR (AOR) (95% CI) P-value\nPlace of \ndelivery\nHome 24 54 0.27(0.16-0.46)**    0.615(0.306 1.235)  0.17\nHealthcare \nfacility\n210 130                   1                1\nEver attending \nschool\nYes 161 73 1 1\nNo 100 84 0.533(0.358-0.796)*                       1.316(0.736-2.353)               0.354\nHusbands’ \nincome\n≤1,500 ETB  35 65 0.208(0.076-0.571)* 0.186(0.117-0.681) 0.001        \n1,501-5,001ETB 156 109   0.572(0.215-1.52)     0.535(0.116-2.48)   0.024      \n              \n≥5,001 ETB              44 10 1\n   \n1              \n     \nReading \nnewspapers\nNot at all            5 10 2.45(0.82-7.334)      2.163(0.625-7.48)   0.22\n Less than once a \nweek\n25 11  2.778 (0.81-9.529)  1.907 (0.485-7.506) 0.356\nOnce a week 25 18 4.54(1.256-16.456)* 4.311(0.947-19.031) 0.059\nEvery day                                               179 145 1 1\nWatching \ntelevision\nNot at all  172 92 0.276(0.168-0.453) 0.414(0.216-0.795)** 0.008\n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted February 1, 2024. ; https://doi.org/10.1101/2024.01.31.24302088doi: medRxiv preprint \n\nLess than once a \nweek             \n15 11 *0.401(0.196-0.821)*                   0.413(0.177-0.963)*            0.041*            \nOnce a week   15 20 0.729(0.322-1.653)  1.139(0.404-3.2111) 0.805     \nEvery day        32 61 1 1   \nThe findings of this research study revealed that women whose husbands had an income of≤1,500 \nETB were 81.4% less likely to use PNC services compared to women whose husbands’ income was \nabove 5,001 ETB, with an AOR of 0.186 and \np-value of 0.001. A similar statistical association was also seen among women whose husbands’ \nincome was 1,501-5,001 ETB, with an AOR of 0.383 and p-value of 0.024, which is less than the \ncut-off point of p=0.05. Therefore, regardless of the level or degree of income, husbands’ income \nwas statistically significant and earning less income among husbands might lead women to have \nless PNC services utilization.\nDiscussion\nAlthough there is no sufficient literature available that deals with husbands’ income as a factor that \ninfluences PNC services, a study conducted in Swaziland revealed that women in the rich quintile \nused PNC services more compared to those in the middle wealth quintile (4). A similar research \nfinding in Kenya showed that women from households earning more than US$1 a day were six \ntimes more likely to seek PNC services within two days after delivery compared to those women \nfrom households earning US$1 and less (5). \nAnother independent variable that showed statistical significance was watching television. Women \nwho never watched television were 58% less likely to use PNC services compared to women who \nwatched television every day (AOR=0.414 and p-value=0.008), which is less than p=0.05. Women \nwho watched television less than once a week were also 58.7% less likely to use PNC services \ncompared to those women who watched television every day (AOR=0.0413 and p-value=0.041). \nTherefore, not watching television at all and watching television less than once a week were \nstatistically associated with PNC services utilization. However, a study conducted in Tigray \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted February 1, 2024. ; https://doi.org/10.1101/2024.01.31.24302088doi: medRxiv preprint \n\nsuggested that women who received information about PNC services from health extension workers \nand a midwife/nurse were 24.87 and 37 times more likely to utilize PNC services respectively \ncompared to women who obtained information from other sources (6). Since obtaining information \nfrom healthcare workers was not considered as a factor of PNC services utilization in this study, it \nwould be difficult to compare and contrast with the current findings. Despite the fact that the study \nconducted in Afghanistan excluded PNC, the findings revealed that media exposure (watching \ntelevision) was strongly associated with both ANC and SBA utilization (7).\nWomen’s Satisfaction with maternal health care services\nClient satisfaction is considered one of the desired outcomes of health care and it is directly related \nwith the utilization of health care services, as it reflects the gap between the expected and the actual \nexperience of the service from the client’s point of view (8).\nWomen who had either PNC visits were asked whether they were satisfied with the care they had \nreceived. In this study, 200 (52%) of the respondents were satisfied with the care and attention they \nreceived from the health care provider. A similar study conducted in Gamo Gofa Zone showed that \n76% of the women were satisfied with the care they received from the health care provider (9). The \nreason for this higher degree of satisfaction in Gamo Gofa was thought to be the proximity of the \nhealth care facility to the women seeking maternal health care. The finding of this study is much \nlower than the findings in the literature. Long distance and long waiting time were identified as \nbarriers for maternal healthcare services utilization by healthcare workers in Awash Fentale woreda, \nwhich may underestimate the overall satisfaction.\nAnother reason may be because Awash Fentale woreda is located in a pastoralist region, therefore \nthe possibility of accessing skilled labor to give appropriate care is difficult. The healthcare \ninstitutions might therefore sometimes be forced to provide the services with under qualified \nhealthcare workers.  \nRegarding the attitude of health care personnel, 153 (39.7%) of the respondents were satisfied with \nthe attitude of the health care personnel in providing maternal healthcare services. A study \nconducted in Debre Markos showed that only 33.5% of women were satisfied with the care \nprovided. The most frequently cited reason for dissatisfaction was health care worker-related \nattitudes, followed by lack of knowledge (10).\n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted February 1, 2024. ; https://doi.org/10.1101/2024.01.31.24302088doi: medRxiv preprint \n\nLess than half (n=170; 44%) of the participants claimed that they were satisfied with the cleanliness \nof the health care facility. A study conducted in Nigeria indicated that 82.5% of women were \nsatisfied with the cleanliness of the health care facility (8). In this study, the percentage of \nsatisfaction with regard to cleanliness was very low as compared to the literature. The variation may \nbe because of a real difference in the type of health care facility or differences in the expectations of \nwomen.\nThe participants were also asked about their satisfaction pertaining to the amount of privacy they \nhad and the medication they were provided. Only 135 (35%) of the respondents were satisfied with \nprivacy they had. A study conducted in Debre Markos indicated that approximately 98% of the \nparticipants were satisfied with the assurance of privacy (11).The difference might be attributed to \nthe fact that the study in Debre Markos was conducted in a referral teaching hospital where there \nwere a relatively sufficient number of health care professionals and better diagnosis facilities.\nIn this study, only 82 (21.3%) of the women were satisfied with the medication they were provided. \nA study conducted in Debre Markos revealed that 73% and 57% of the respondents were satisfied \nwith the explanation of healthcare providers about the drugs prescribed and their side effects \nrespectively (11). A similar study conducted in Assela Hospital in Ethiopia indicated that 87.4% of \nthe mothers were satisfied with the ordered drugs and medical supplies (12). \nThe findings of this study has a remarkable difference compared to the above mentioned studies. \nThe differences may be attributed to the type of health care facility that was selected during the \nstudy. Unlike in Assela and Debre Markos, the majority of the study participants in Awash Fentale \nworeda received maternal health care services in health care centers. Hence, this difference might \ninfluence the level of satisfaction of the participants.\nConclusion\nIn this study the utilization of post natal care in Awash Fentale district was 55.45%. Regardless of \nthe level or degree of income, husbands’ income was statistically significant and earning less \nincome among husbands might lead women to have less PNC services utilization. This research has \nalso found that 43% of women were not satisfied with the care and attention given by the healthcare \nproviders and approximately 52% of them were not satisfied with the cleanliness of the healthcare \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted February 1, 2024. ; https://doi.org/10.1101/2024.01.31.24302088doi: medRxiv preprint \n\nfacilities. Hence, much emphasis should be placed on care and attention and the cleanliness of the \nhealthcare facilities in Awash Fentale woreda. \nLimitation of the study\nWhile interpreting the findings of this research, it will be relevant to consider some of the \nlimitations of the study. It is clear that a cross-sectional study design does not allow making causal \ninferences about the relationship between ANC, DC, and PNC services and risk factors. The study \nwas also limited to Awash Fentale woreda and the findings might not reflect the situation in other \nworedas of the Afar National Regional State. Limitations on research assistant's heat exhaustion, \nlanguage and sampling bias were also considered.\nList of abbreviation\nCSA: Central Statistics Agency\nDHS: Demographic Health Statistics\nEDHS: Ethiopian Demographic Health Statistics\nMMR: Maternal Mortality Rate\nNGO: Non -Governmental Organization\nPNC: Post natal Care\nSDG: Sustainable Development Goals\nUN: United Nations\nWHO: World Health Organization\nDeclaration\nCompeting Interest\nThe authors declare that they have no competing interests\nAuthors’ Contributions\n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted February 1, 2024. ; https://doi.org/10.1101/2024.01.31.24302088doi: medRxiv preprint \n\nGW involved in designing of the study, data collection, data analysis, drafting and critically \nreviewing the manuscript. Likewise, TG involved in critically reviewing the manuscript. All \nauthors read and approved the final manuscript\nAcknowledgements\nMy special gratitude goes to my supervisor, Prof. Thanyani Gladys Lumadi, for her invaluable \nguidance and support during the whole process of the research.\nThe authors would like to thank Yekatit 12 Hospital Medical College for funding this study.\nThe researchers would also sincerely thank the study participants for their participation in the study.\nEthics Approval and Consent to Participants\nThe study protocol was performed in accordance with the ethics principles. Ethical approval was \nobtained from the institutional review board of University of South Africa. The authors obtained \nwritten informed consent from all participants.\nConsent for publication\nConsent to publish is not applicable for this manuscript because there is no individual data details \nlike images or videos.\nFunding \nThis study was funded by Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia. \nAvailability of Data and Materials\nThe finding of this study is generated from the data collected and analyzed based on the stated \nmethods and materials. All the data are already found in the manuscript and there are \nsupplementary files. See the additional files.\n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted February 1, 2024. ; https://doi.org/10.1101/2024.01.31.24302088doi: medRxiv preprint \n\nTable Legends\nAuthor’s Information \nDr. Getachew W.Tedla1 .Prof.Thanyani. G.Lumadi2.\n1Yekatit 12 Hospitals, Department of Public Health, College of Medicine, Addis Ababa, Ethiopia\nUniversity of South Africa, Department of Health Studies,\nEmail address: gechwy2001@yahoo.com (G.W. Tedla), lumadtg@unisa.ac.za (T.G. Lumadi)\n REFERENCE \n1.Adedoja, O.R., Joshua, A.T. & Olasoji, I. 2020. Awareness and Perception Towards the \nUtilisation of Primary Healthcare Services in Ado-Ekiti Local Government Area, Ekiti State, \nNigeria. Benin Journal of Social Work and Community Development  Vol 1, September 2020, pp \n23-34\n3. Central Statistical Agency (CSA) of Ethiopia. 2016. 2016 Ethiopia Mini-Demographic and \nHealth Survey (EMDHS).Available at: https://dhsprogram.com/pubs/pdf/FR328/FR328.pdf.\n4. El Shiekh & Van der Kwaak, A. 2015. Factors Influencing the Utilization of Maternal Healthcare \nServices by Nomads in Sudan. Pastoralism: Research, Policy and Practice, 2015(5), 23. \nAvailable at: http://dx.doi.org/10.1186/s13570-015-0041-x.\n5. Atiya, K.M. 2016. Maternal Satisfaction Regarding Quality of Nursing Care During Labor and \nDelivery in Sulaimani Teaching Hospital. International Journal of Nursing and Midwifery, \n8(3), pp. 18–27.\n6. Tsawe, M., Moto, A., Netshivhera, T., Relesego, L., Nyathi, C. & Susuman, A.S. 2015. Factors \nInfluencing the Use of Maternal Healthcare Services and Childhood Immunization in \nSwaziland. International Journal for Equity in Health , 14(32), pp.\n1–11.\n7. Nzioki, J.M., Onyango, R.O. & Ombaka, J.H. 2017. Socio-Demographic Factors Influencing \nMaternal and Child Health Service Utilization in Mwingi: A Rural Semi-Arid District in \nKenya. American Journal of Public Health Research, 3(1), pp.21–30.\n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted February 1, 2024. ; https://doi.org/10.1101/2024.01.31.24302088doi: medRxiv preprint \n\n8. Aregay, A., Alemayehu, M., Assefa, H. & Terefe, W. 2014. Factors Associated with Maternal \nHealthcare Services in Enderta District, Tigray, Northern Ethiopia: A Cross-Sectional Study. \nAmerican Journal of Nursing Science, 3(6), p.117–125. Available at: \nhttp://www.sciencepublishinggroup.com/journal/paperinfo.aspx?journalid=152&doi=10.11648\n/j.ajns.20140306.15.\n9. Shahram, M.S., Hamajima, N. & Reyer, J.A. 2015. Factors Affecting Maternal Healthcare \nUtilization in Afghanistan: Secondary Analysis of Afghanistan Health Survey 2012. Nagoya \nJournal of Medical Science, 77(4), pp.595–607.\n10.  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Available at: \nhttps://www.hindawi.com/journals/ijrmed/2016/7095352/.\n13. Bitew, K., Ayichiluhm, M. & Yimam, K. 2015. Maternal Satisfaction on Delivery Service and \nIts Associated Factors Among Mothers Who Gave Birth in Public Health Facilities of Debre \nMarkos Town, Northwest Ethiopia. Biomedical Research International, 2015, pp.1–7.\n14. Amdemichael, R., Tafa, M. & Fekadu, H. 2014. Gynecology & Obstetrics Maternal Satisfaction \nwith the Delivery Services in Assela Hospital, Arsi Zone, Oromia Region, Ethiopia. \nGynecology Obstetrics, 4(12), 257. Available at: https://www.omicsonline.org/open-\naccess/maternal-satisfaction-with-the-delivery-services-in-assela-hospital-arsi-zone-oromia-\nregion-ethiopia-cas-2161-0932.1000257.php?aid=35831.\n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted February 1, 2024. ; https://doi.org/10.1101/2024.01.31.24302088doi: medRxiv preprint \n\n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted February 1, 2024. ; https://doi.org/10.1101/2024.01.31.24302088doi: medRxiv preprint","source_license":"CC-BY-4.0","license_restricted":false}