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Client Satisfaction with Abortion Service and Associated Factors among Clients Visiting Health Facilities in Jimma Town, Jimma, South West, Ethiopia

Sena Belina Kitila

Jimma University, Department of Nursing and Midwifery, Ethiopia

Fekadu Yadassa

Jimma University, Department of Nursing and Midwifery, Ethiopia

Corresponding Author:
Sena Belina Kitila
Lecturer, Jimma University College of Public Health and Medical Sciences
Nursing and Midwifery, Jimma, Addis Ababa, Oromia 378, Ethiopia
Tel: +251912112666;
E-mail: [email protected]
 
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Abstract

Background: Having a child outside marriage is not uncommon in many countries and it is not inevitable that unwanted/non-marital or teenage pregnancy ends in abortion. 46 million women around the world have induced abortions each year, 78 % of whom live in developing countries. Ethiopia is among countries where unwanted pregnancy is challenging. Client satisfaction is the level of satisfaction that clients experience having used service. The aim of this study was to assess clients’ satisfaction with abortions service among adolescent visiting health facilities in Jimma town.

Methods: Facility based cross sectional study was employed. The data was collected through face to face administered questionnaire from 228 clients and 28 service providers.

Results: Of 228 study subjects 54(23.7%) were not satisfied with the service. Being primary student 21.9 %, UOR of 0. 219; history of family planning use 2.064, UOR of 2.064, information on availability of the service 3.317, UOR of 3.317, history of abortion 3.232 times more likely to be satisfied with the service, UOR of 3.232 respectively but those live with friends 35.3% , UOR of 0. 353, used injectable 23.0%, UOR of 0.230, utilized surgical abortion 28.5% times less likely to be satisfied with the service, UOR of 0. 285 respectively. However; multi-variate logistic regression showed being preparatory and above were 22.0% times less likely to be satisfied than those less than preparatory [AOR (95% CI) = 0.004 (0.079 0.619)] and those had medical abortion were 23.6 % times more likely to be satisfied than those had surgical methods [AOR (95% CI) = 0.001 (0. 118, 0.471)] .

Conclusions and recommendation: One fourth of the clients were not stratified with the service, the predictors were educational level, with whom they live, information about the service, history of previous abortion, information about family planning, history of family planning use and types of uterine evacuation done. Hence, relevant authorities have to facilitate and develop a system to control it. Further studies in terms of clinical observation are also recommended.

Keywords

Abortion, client satisfaction, adolescent, Jimma town

Abbreviations

AOR: Adjusted Odd ratio; BBHC: Bocho Bore Health Center; CI: Confidence Interval; CSA: Central Statistics Authority; EDHS: Ethiopian Demographic Health Survey; FGAE: Family Guidance Association Ethiopia; JH2HC: Jimma Higher 2 Health Center; JHC: Jimma Health Center; JUSTH: Jimma University Specialized Teaching Hospital; KMs: Kilo meters; MKHC: Mendera Kochi Health Center; MOH: Minster of Health, NGO: Non-Governmental, OR: Odd ratio; SHGH: Shanen Gibe Hospital; UNFPA: United Nations Population Fund; UNICEF: United Nations Children's Education Fund; WHO: World Health Organization

Background

Adolescence (Age 10-19 years) is transitional stage of physical and psychological development that occurs from puberty to adulthood. One of the contributions of research in the quality field has been its attempt to define what is meant by quality care.1

Access to quality, safe abortion services prevents mortality and morbidity among women and constitutes an integral part of comprehensive reproductive health. There is a proven link between unsafe abortion and increased maternal mortality and morbidity as well as higher healthcare costs2 46 million women around the world have induced abortions each year, 78 % of whom live in developing countries but maternal mortality from abortion is a preventable, as evidenced by statistics from countries with either access to legal, safe abortion or effective harm reduction models.2,3

Patient satisfaction is an important and commonly used indicator for measuring the quality in health care as it affects clinical outcomes, patient retention, and medical malpractice claims. Patient satisfaction is thus a proxy but a very effective indicator to measure the success of care providers and facilities.4

On the other hand, one of the problems continuously faced these days is lack of quality health care and gaining client satisfaction, which are of responsibilities of the higher authorities and staffs in the health care system.5 Evaluating the clients satisfaction with health services is clinically relevant, as satisfied patients are more likely to comply with treatment, take an active role in their own care, continue using medical care services and recommend center‘s services to others. 6 A satisfied patient will recommend center‘s services expressing their satisfaction to four or five peoples, while a dissatisfied will complain to twenty or more.7 The quality of RH care is critical in determining whether the service meets clients’ expectations or not, for instance the have choice of services, get accurate and complete information, technically competent care, good interaction with providers, continuity of care, and constellation of related services.8

A study conducted in Maharashtra and Rajasthan on Comprehensive Abortion Care showed as most of the quality dimensions have a positive and the predictors were provider behavior, assurance regarding follow-up, medical information and waiting time in obtaining services, background factors, is residence.9

The study conducted in Mexico City where the Six domains of quality of care (client-staff interaction, information provision, technical competence, post abortion contraceptive, accessibility and facility env’t) were assessed and findings showed respectfulness, protecting privacy , sufficiency of information , good technical skill , convenience of working hours , waiting time and cleanness of the facility were associated with higher overall scores.10

Study conducted in Tigray showed only 40.6% of clients were satisfied and this satisfaction was associated with educational, occupational status, laboratory prescription and toilet access. Only 48 % of them were informed about availability of family planning and supplied with, 88.3% of the clients did not get opportunity to pose questions or concerns.11 Quality maternal care must be appropriate, satisfactory, low cost and accessible service that makes women capable of choosing a healthy life.12

In countries where provision of abortion is restricted or low quality or inaccessible, women often resort to unsafe methods that results in complications, long-term health problems or even death as abortion care” is more than just an abortion procedure and it is a comprehensive approach comprising: counseling, safe abortion services and other RH services, like diagnosis and treatment of STIs or addressing needs of women subjected to violence.3

To the knowledge of the investigators, there is no study on client satisfaction with abortion services in the study area where the abortion service utilization was prevalent, and different higher institution like Jimma University which has more than 40 thousand students, Jimma University Teaching and specialized hospital, Jimma teacher training College, South west Military campus. Thus, this study is proposed to assess the clients’ satisfaction with the services among clients coming the facilities for abortion and post abortion services

Methods and subjects

The study was conducted in Jimma town health facilities from April - May 2015. Jimma town is one of the towns in Oromia located 352 Kms Southwest of the capital city Addis Ababa. The total projected population of the town from 2007 Central Statistical Agency (CSA) census report is 128,330. The governmental health institutions in Jimma town are 2 hospitals and 4 health centers and Non-governmental working on maternal health like Family Guidance association Ethiopia and Marie Stopes International. Total number of women of child bearing age as estimated from the total populations of town in the 2007 population and housing census of Ethiopia comprises 33,373.13

Facility based cross-sectional with quantitative method of data collection was used. The population for this study are all sampled adolescent visiting health institutions in the town for abortion and post abortion sleeted by simple random sampling after allocating the sample size proportionally for each of health facilities in the town and all abortion service providers at each selected facilities purposively based on their position, closeness to activities, experiences to assess the facility related issues like presence of protocol on the service provision, mechanism they use to control quality, training , qualification as the clients are not know / tell us the points. The data was collected by four Midwives , diploma in qualification who have previous experience on data collection using pre-tested semi structured questionnaire ( the questionnaire consist of both close and open ended ) adapted from Donabedian’s Model of quality, Bruce’s Quality of service Model and Bergström quality of maternal care and questions were grouped according to the particular objectives that they address and 3 point Likert Scale which ranges between 1 and 3; scale( 1= Agree , 2 =Neutral , 3= Disagree) the scores for each domain were calculated by summing the answers to all items in each domain :interpersonal skill (10-30), technical quality (5-15), physical env’t (4-12) , organization of health care (8-24) and clients' overall and component wise satisfaction was classified into two categories satisfied and dissatisfied by using cut of point calculated using the demarcation threshold formula: {(total highest score-total lowest score)/2} + Total lowest score.14,15

Data was analyzed using SPSS version 20.0. In addition to descriptive statistics, chi-square test and bivariate analysis were employed to see association between dependent and independent. Then variables having association were entered in to binary logistic regression to obtain OR and the CI and also multivariable logistic regression analysis was carried out to assess strength of statistical association of satisfaction and the determining variables. The strength of statistical association is measured by AOR and 95% confidence intervals. Statistical significance is declared at P<0.05. Finally the result was presented using tables, figures and charts

Ethical considerations

A copy of research proposal was submitted to College of Health Science research coordinating office of Jimma University. Ethical clearance from Jimma University, College of Health Science Institutional Review Board and permission from respective authorities and verbal consent of respondents’ was obtained before the data collection. To get full co-operation, respondents were reassured about the confidentiality of their response. They also ensured their voluntarily participation and right to take part or terminate at any time they wanted.

Results

The data were collected from a total of 228 adolescent visiting health institutions in Jimma town for abortion and post abortion services that makes the response rate 97.4% and 28 abortion service providers from April to May 2015. The results are presented under subheadings as follows;

Socio demographic characteristics the participants

Two hundred eight (91.2%) of the participants were in age group of greater than 17 years with mean of 20.78, std. deviation 2.55, minimum 14 and maximum 24 . As to marital status, 133 (58.3 %) were married. Regarding ethnicity, religion, level of education, residence and occupation, 129 (56.6%) were Oromo, 110 (48.2%) were Muslim, 74 (32.5 %) were preparatory and above by education level, 150 (65.8%) were from Jimma Town and 81 (35.5%) were student by occupation respectively. As to the monthly income of the participants 53 (55.8%) had ≤ to 650 birr mean of 1048.33, std. deviation 817.94, minimum 100 and maximum 4889 (Table 1).

Characteristics N(n=228) %
Name of Health facility Higher 2 HC 5 2.2
Jimma Health center 19 8.3
JUSTH 87 38.2
Shanen Gibe hospital 14 6.1
FGA 41 18.0
Marie Stopes International Ethiopia 62 27.2
Age Classification £17years 20 8.8
>17 years 208 91.2
Marital status Married 133 58.3
Single 90 39.5
Others† 5 2.2
Level of education No formal education 48 21.1
Primary(1-8) 66 28.9
Secondary(9-10) 40 17.5
Preparatory and  above 74 32.5
Religious Muslim 110 48.2
Orthodox 76 33.3
Protestant 36 15.8
Other†† 6 2.6
Ethnicity Oromo 129 56.6
Amhara 33 14.5
Guragae 22 9.6
Kefa 20 8.8
Others††† 24 10.5
Residence Jimma town 150 65.8
Out of Jimma town 78 34.2
Respondents' occupation Gov’tal employer 22 9.6
Some job /private 59 25.9
Student 81 35.5
Other†††† 66 28.9
Monthly Income (N=120) Less than or equalizes to  650 53 55.8
Greater than 650 67 44.2
Table 1: Distributions of study participants by their socio demographic characteristics, Jimma town, April - May 2015.

Personal related factors

As to the personal related factors 269(74.1%) were visited the health facility for abortion, 62 (27.2%) of the participants stated as their reason for abortion was low socio economic status, the most selected procedure was medical abortion which accounts for 145 (63.6%), 86 (37.7%) were not know their care provider by profession and only 92 (40.4%) of them were live with their family (Table 2).

Characteristics N(n=228) %
Current health status Good 216 94.7
No good 12 5.3
Reason for visiting Abortion 169 74.1
PAC 59 25.9
Reason  for Abortion Rape 16 7.0
Incest 5 2.2
Medical case(deformity, mental problem) 5 2.2
Low socio economic status 62 27.2
Not to disrupt education 50 21.9
Partner refused to accept pregnancy  23 10.1
Other* 67 29.3
Types of uterine evacuation done Medical Abortion 145 63.6
MVA/EMA(surgical) 83 36.4
Sex of care provider Male 115 50.4
Female 113 49.6
Profession of service providers Doctor any type 50 21.9
HO 4 1.8
Nurse any type 67 29.4
Midwife any type 21 9.2
I don’t know 86 37.7
With whom they live Family 92 40.4
Relatives 16 7.0
Friend 25 11.0
Other** 95 41.7
Table 2: Distributions of participants by their personal characteristics, Jimma town, April - May 2015.

Previous Experience of the participants

As to the previous experience of the participants 179 (78.5%) had information on availability of abortion service, 31 (13.6%) had history of previous abortion, 110 (48.2%) had first sexual intercourse at age ≤ 17 years, 45 (19.7%) of them had greater than one sexual partners, 201 (88.2%) had information about family planning of this 136 (67.7%) had history of contraceptive use (Table 3).

Characteristics N(n=228) %
Information on availability of abortion service Had information 179 78.5
No information 49 21.5
History of previous abortion service Had 31 13.6
No 197 86.4
Age at first sexual intercourse £17 years 110 48.2
>17 years 118 51.8
What leads for  first sexual intercourse Self-desire 134 58.8
Peer pressure 39 17.1
Parent pressure 14 6.1
Pressure of partner 32 14.0
To get pregnant 9 3.9
Number of sexual partners One 183 80.3
Greater than one 45 19.7
Information about FP Had 201 88.2
No 27 11.8
History of contraceptive use Yes 136 67.7
No 65 32.3
Type of contraceptive being used Pills 70 51.5
Injectables 36 26.5
Natural contraceptives 6 4.4
Other** 24 17.6
Table 3: Distributions of participants by their previous experience, Jimma town, April - May 2015.

Participants Satisfaction

As to the technical quality of care providers and physical environment of the health facility, the most satisfaction level indicted was the satisfactions rated on advice given by service providers (Table 4).

Variables N(n=228) %
Respect shown by service providers Dissatisfied 10 4.4
Neither  satisfied nor dissatisfied 60 26.3
Fully  satisfied 158 69.3
Concern shown by service providers Dissatisfied 10 4.4
Neither  satisfied nor dissatisfied 54 23.7
Fully  satisfied 164 71.9
Comfort shown by service providers Dissatisfied 10 4.4
Neither  satisfied nor dissatisfied 53 23.2
Fully  satisfied 165 72.4
Mutual understanding b/n them Dissatisfied 9 3.9
Neither  satisfied nor dissatisfied 61 26.8
Fully  satisfied 158 69.3
Trust on service providers Dissatisfied 9 3.9
Neither  satisfied nor dissatisfied 65 28.5
Fully  satisfied 154 67.5
Cooperation shown by service providers Dissatisfied 8 3.5
Neither  satisfied nor dissatisfied 55 24.1
Fully  satisfied 165 72.4
The opportunity given to take part in decisions Dissatisfied 10 4.4
Neither  satisfied nor dissatisfied 31 13.6
Fully  satisfied 187 82.0
Adequacy of information given by service providers Dissatisfied 12 5.3
Neither  satisfied nor dissatisfied 56 24.6
Fully  satisfied 160 70.2
Clearness of explanation & forwardness Dissatisfied 12 5.3
Neither  satisfied nor dissatisfied 67 29.4
Fully  satisfied 149 65.4
Equity of treatment Dissatisfied 10 4.4
Neither  satisfied nor dissatisfied 33 14.5
Fully  satisfied 185 81.1
Table 4: Distributions of participants by their level of Satisfaction with art of care/interpersonal skill, Jimma town, April - May 2015.

Regarding the Organization of health care system, location of the clinic, waiting time of clinic, working hours of clinic, not easiness of getting laboratory service are among the dissatisfying factors the overall satisfaction level was classified into two categories satisfied and dissatisfied by using cut of point calculated using the demarcation threshold formula and 54(23.7%) dissatisfied (Table 5, 6).

Technical quality N(n=228) %
Modernness of Medical equipment Dissatisfied 8 3.5
Neither  satisfied nor dissatisfied 107 46.9
Fully  satisfied 113 49.6
Technical skills of service providers Dissatisfied 7 3.1
Neither  satisfied nor dissatisfied 85 37.3
Fully  satisfied 136 59.6
Thoroughness of examinations Dissatisfied 10 4.4
Neither  satisfied nor dissatisfied 101 44.3
Fully  satisfied 117 51.3
Explanation of procedures Dissatisfied 9 3.9
Neither  satisfied nor dissatisfied 86 37.7
Fully  satisfied 133 58.3
Advice given by service providers Dissatisfied 6 2.6
Neither  satisfied nor dissatisfied 58 25.4
Fully  satisfied 164 71.9
Physical environment N(n=228) %
Cleanliness of office or clinic Dissatisfied 34 14.9
Neither  satisfied nor dissatisfied 55 24.1
Fully  satisfied 139 61.0
Comfort of waiting room Dissatisfied 45 19.7
Neither  satisfied nor dissatisfied 50 21.9
Fully  satisfied 133 58.3
Attractiveness of office or clinic Dissatisfied 47 20.6
Neither  satisfied nor dissatisfied 55 24.1
Fully  satisfied 126 55.3
Atmosphere of waiting room Dissatisfied 44 19.3
Neither  satisfied nor dissatisfied 47 20.6
Fully  satisfied 137 60.1
Table 5: Distributions of participants by their level of Satisfaction with Technical quality of care providers and Physical environment of the health facility, Jimma town, April - May 2015.
Characteristics N(n=228) %
Location of the clinic Dissatisfied 28 12.3
Neither  satisfied nor dissatisfied 72 31.6
Fully  satisfied 128 56.1
Waiting time of clinic Dissatisfied 51 22.4
Neither  satisfied nor dissatisfied 90 39.5
Fully  satisfied 87 38.2
Working hours of clinic Dissatisfied 39 17.1
Neither  satisfied nor dissatisfied 87 38.2
Fully  satisfied 102 44.7
Easiness of getting laboratory service Dissatisfied 47 20.6
Neither  satisfied nor dissatisfied 61 26.8
Fully  satisfied 120 52.6
Availability of service providers Dissatisfied 24 10.5
Neither  satisfied nor dissatisfied 46 20.2
Fully  satisfied 158 69.3
Availability of  drugs (anti pain) Dissatisfied 12 5.3
Neither  satisfied nor dissatisfied 53 23.2
Fully  satisfied 163 71.5
Overall satisfaction Satisfied 174 76.3
Not satisfied 54 23.7
Table 6: Distributions of participants by their level of Satisfaction with Organization of health care system, Jimma town, April - May 2015.

Care provider’s interview

As to physical structure, facilities, equipment, only in 18 (64.3%) of the participants reported as there were written abortion care protocols in their health facility, 15 (53.6%) of them reported as there is no second-trimester abortion services at their facility, only 10 (35.7%) of them reported as their facility ordered or purchased equipment and supplies for abortion services and 20 (71.4) of them reported as their facility provides the service 24hrs, 7days/ week (Table 7).

Care providers characteristics N(n=28) %
Name of Health center Jimma Health Center 5 17.9
JUSTH 10 35.7
Shanen Gibe hospital 5 17.9
FGAE Jimma branch 4 14.3
Marie Stopes  Ethiopia 4 14.3
Profession of interviewed  care provider** Nurse any type 21 75.0
Midwife any type 7 25.0
Availability of written abortion care protocols at  facility Yes, available 18 64.3
No, not available 10 35.7
Presence of second-trimester abortion services at the facility Yes 13 46.4
No 15 53.6
Physically  access of the facility for  clients Yes, accessible 24 85.7
Not accessible 4 14.3
Physical setting of the institution to offer women adequate privacy Yes 17 60.7
No 11 39.3
Supplies  for abortion services  easily and consistently available Yes 25 89.3
No 3 10.7
Facility purchased equipment and supplies  for abortion services Yes 10 35.7
No 18 64.3
Abortion services  24hrs, 7days/ week Yes 20 71.4
No 8 28.6
Table 7: Distributions of Care provider by their responses on physical structure, facilities, availability of equipment in their health facility, Jimma town, April - May 2015.

Administrative structure and Fiscal health

As to the administrative structure and fiscal health 15 (53.6%) were reported the availability of guidelines for when, where and how abortion care is to be provided, availability of clear guidelines on technical competence needed for abortion and availability of performance indicators for evaluating health professionals (Table 8).

Administrative structure N(n=28) %
Availability of  guidelines for when, where and how abortion care is to be provided Yes 15 53.6
No 13 46.4
Official and formal process for obtaining  abortion service Yes 19 67.9
No 9 32.1
Availability of conscientious objection Yes 22 78.6
No 6 21.4
Availability of clear procedures for referring women to another provider Yes 17 60.7
No 11 39.3
Availability of clear guidelines on technical competence needed for abortion Yes 15 53.6
No 13 46.4
Availability of clear guidelines for consent for mentally ill women Yes 12 42.9
No 16 57.1
Availability of  performance indicators for evaluating health professionals Yes 11 39.3
No 17 60.7
Fiscal health
Availability of cost options (sliding scale for poor women) Yes 20 71.4
No 8 28.6
Availability of cost of abortion covered by medical insurance Yes 22 78.6
No 6 21.4
Probability of getting the service freely Yes 22 78.6
No 6 21.4
Table 8: Distributions of Care provider by their responses on Administrative structure, Fiscal health in their health facility, Jimma town, April - May 2015.

Interventional Management, Coordination and continuity the service

As to the interventional management, coordination and continuity the service almost all of the respondents reported as their facility has indicators to evaluate confidentiality, privacy, and respect during service delivery, functional referral protocols for those women needs other types of care, tailoring each woman’s care to her social circumstances and individual needs, availability PAC services, including emergency contraception and strive for continuity of care and follow up.

Association between dependent and independent variables

There were no statistically significant associations observed between client satisfaction with abortion service and client age, marital status, occupational status, residence, religion, ethnicity, current health status, age at first sexual intercourse, number of sexual partners, reason for abortion, sex of care provider, profession of service providers (Table 9).

Interventional management N(n=28) %
Indicators to evaluate  confidentiality, privacy, respect  during service delivery Yes 25 89.3
No 3 10.7
Responsiveness to cultural and social norms Yes 23 82.1
No 5 17.9
Functional referral protocols for women needing other types of care Yes 27 96.4
No 1 3.6
Coordination and continuity
Tailoring each woman’s care to her social circumstances and individual needs Yes 26 92.9
No 2 7.1
Availability PAC services, including emergency contraception Yes 27 96.4
No 1 3.6
The  facility strive for continuity of care and follow up Yes 27 96.4
No 1 3.6
Table 9: Distributions of Care provider by their responses on interventional management, coordination and continuity the service, Jimma town, April - May 2015.

On contrary there was significant statistical association (p < 0.05) between client satisfaction with the service and educational level (χ2= 20.236, p=0.000), with whom they live (χ2=9.308, p=0.025), information about family planning (χ2=4.489, p=0. 034), history of family planning utilization (χ2= 4.647, p=0.031), type of contraceptive being used (χ2=9.797, p=0 .044) types of uterine evacuation done (χ2= 15.966, p=0.000), having information on availability of service (χ2=6.275, p=0. .012), history of previous abortion service utilization (χ2=9.156, p=0. .002) (Table 10).

Factors/Variables UOR(95% )    P AOR(95%CI) P
Educational level No formal education 0.277   ( .114, .675) 0. 005** 0.205 (0.079,0.530) 0.001**
Primary(1-8) 0.219 (0.094,0.508) 0.000** 0.193(0.079, 0.469) 0.000**
Secondary(9-10) 0.245 (.092,.654) 0.005** 0.220(    0.079,0.619) 0.004**
Preparatory and  above 1   1  
With whom they live Family 1      
Relatives 0.353(0.174, 0.719) 0.004**    
Friend 0.454 (0.121,1.710) 0.243    
Other 0.492 (0.169,1.433) 0.193    
History of contraceptive use Yes 1      
No 2.064 (1.060, 4.019) 0.033**    
Type of contraceptive being used Pills 1      
Injectables  0.230(0.087,0.610) 0.003**    
Natural contraceptives 0.409(0.156,1.074) 0.070    
Other 0.338(0.110,1.038) 0.058    
Types of uterine evacuation done Medical Abortion 1   1  
MVA/EMA(surgical)  0.285(0.151,0.537) 0.001** 0.236 (0.118,0.471) 0.000**
Information on availability service Had 1      
No 3.317(1.243,8.852) 0.017**    
History of previous abortion Yes 1      
No 3.232(1.470,7.108) 0.004**    
Table 10: Bivariate and multivariate logistic regression model showing predictors of Client Satisfaction with Abortions Service among Adolescent Visiting Health Facilities in Jimma town, April - May 2015.

Bivariate logistic regression analysis shows being primary (1-8) student were 21.9 % times more likely to be satisfied with the service, UOR of 0. 219; those who live with friends were 35.3% times less likely to be satisfied with the service, UOR of 0. 353, those who had history of family planning utilization were 2.064 times more likely to be satisfied with the service UOR of 2.064, those used injectable contraceptive were 23.0% times less likely to be satisfied with the service, UOR of 0.230, those utilized surgical abortion for evacuation were 28.5% times less likely to be satisfied with the service, UOR of 0. 285, those who had information on availability of abortion service were 3.317 times more likely to be satisfied with the service, UOR of 3.317 , those who had history of previous abortion service utilization were 3.232 times more likely to be satisfied with the service, UOR of 3.232

However; multi-variate logistic regression showed only those their educational level was preparatory and above were 22.0% times less likely to be satisfied with the service than those their educational level was less than preparatory [AOR (95% CI) = 0.004 (0.079 0.619)] and those had medical abortion for evacuation were 23.6 % times more likely to be satisfied with the service than those had surgical methods [AOR (95% CI) = 0.001 (0. .118, 0.471)]

Discussion

Satisfaction and dissatisfaction indicate patients' judgment about the strengths and weaknesses of the service being given for them.10 From this study, almost about one fourth (23.7%) of the clients were not stratified with the service they had.

This finding was not constant with what has been observed in the study conducted in Tigray where only 40.6% of the clients were satisfied with the care they had.11 The likely explanations for this dissimilarity might be difference in sample size, hospital policies, set up, study subjects, socio-cultural difference, health care providers believes, awareness of health, guideline, information on availability of modern tools and disparity in judging satisfaction.

The opportunity given to take part in decisions, equity of treatment, advice given by service providers, availability of service providers and availability of drugs (anti pain) are the points on which the participantices are more satisfied This is constant with what have been observed in the study conducted on 2903 women attending 153 primary health care India Maharashtra and Rajasthan and Mexico on comprehensive Abortion Care were the perceived quality of services were the determined by adequacy of information provided; follow-up discussion ; average waiting time and time spent in consultation, quality of the facility, availability of doctor, availability of visual privacy during consultation, availability of waiting facility, cleanliness of facilities, clients’ background characteristics and state of residence.9,10

This study further revealed the predictors of clients’ satisfaction with abortions service and the factors that have been indicated as predictors are their educational level, with whom they live, information on availability of abortion service, history of previous abortion service utilization, information about family planning, history of family planning utilization, type of contraceptive being used and types of uterine evacuation done.

This result was similar with what had been observed in the study conducted in Tigray governmental hospitals where client satisfaction predictors were educational status and occupational status, laboratory prescription and toilet access, informed about the available family planning methods and supplied with.11

This cross-sectional study has possible limitations that may arise from client readiness and ability to provide every information about themselves and their care and care providers correctly based on which client satisfaction with abortions service was measured and; recall and social desirability bias may be introduced during data collection from the client as they were self-referent. However; measure has been taken to minimize these limitations were using questions targeted information. Moreover, the use of pretested questionnaire and both client and care providers targeted data collection were other strengths of this study.

Conclusion and recommendation

Based on the finding of the study the principal investigators have made the following conclusions and recommendation. This study showed as about one fourth of the clients were not stratified with the abortion service they had .The points on which they satisfied where includes the opportunity given to take part in decisions, equity of treatment, advice given by service providers, availability of service providers and availability of drugs (anti pain). The predictors of clients’ satisfaction with abortions service indicated in this are educational level, with whom they live, information on availability of abortion service, history of previous abortion service utilization, information about family planning, history of family planning utilization, type of contraceptive being used and types of uterine evacuation done and we recommend the responsible authorities (Jimma Zone health office, NGO working on this area), policy makers and interested body have to discuss on this issue to enhance the client satisfaction gap and to develop a system to control client satisfaction and to control factors those affect client satisfaction. Furthermore further prospective studies are recommended in terms of, observational study as it is too key for client satisfaction.

Competing Interests

There no financial and non-financial competing interests and the study was funded by the Jimma University. There have been no reimbursements, fees, funding, nor salary from any organization that depends on or influence the results of this study. The authors do not hold any stocks or shares in an organization that may in any way might be affected by this publication.

Authors' Contributions

SB: contributed in designing the study starting from title selection, prepared methodology part and designed the framework , proposal development and data analysis and wrote first draft of result. FY: approved the proposal and result with some revisions, participated in data analysis and interpretation, drafting the manuscript and revising it critically. Both of authors read and approved the final manuscript.

Acknowledgement

We would like to express our deepest gratitude to Jimma University College of Health Sciences for financially supporting us. Our appreciation also goes to our data collectors, supervisors and study participants for their valuable contribution in the realization of this study.

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