The patient-provider relationship and antenatal care uptake at two referral hospitals in Malawi: A qualitative study|
Roberts, J.; Sealy, D.; Hopp Marshak, H.; Manda-Taylor, L.; Gleason, P. & Mataya, R.
In post-stroke patients, impairment of quality of life (QOL) has been
associated with functional impairment, age, anxiety, depression, and
fatigue. Good social support, higher education, and better socioeconomic
status are associated with better QOL among stroke survivors. In Africa,
studies from Nigeria and Tanzania have reported on post-stroke QOL.
Approximately 90% of Malawian women attend antenatal care at least
once during their pregnancies; however, most mothers first present during
months five and six and do not adhere to the World Health Organization’s
recommended four visits. The objective of this study was to explore the
role the patient-provider relationship has on antenatal care uptake.
A qualitative study, consisting of interviews with 20 urban pregnant
mothers and eight health workers, was conducted from September to
December 2014. Two large tertiary care hospitals in the Central and
Southern regions of Malawi were selected as study sites.
Several factors influenced antenatal care attendance. Significant barriers
reported included the patient-provider relationship, clinic wait times, family
and friend support, distance from home to the clinic, transportation, cost,
and number of visits. The patient-provider relationship appears to have
a large impact on antenatal clinic participation. Mothers indicated that
health workers often mistreat or demean them during visits. Additionally,
health workers revealed that, due to staff shortages, patients often do not
receive the care they deserve.
The results of this study suggest that, in addition to other factors, healthcare
provider attitudes influence antenatal clinic attendance. Improving the
patient-provider relationship may increase antenatal clinic attendance
and decrease pregnancy complications during pregnancy. Professional
development opportunities and quality improvement programmes are
would help improve patient care and health outcomes while the continued
staff shortages in the country are addressed.