Tayelgn et al. BMC Pregnancy and Childbirth 2011, 11:78
http://www.biomedcentral.com/1471-2393/11/78
RESEARCH ARTICLE
Open Access
Mothers’ satisfaction with referral hospital
delivery service in Amhara Region, Ethiopia
Azmeraw Tayelgn1, Desalegn T Zegeye2* and Yigzaw Kebede2
Abstract
Background: A woman’s satisfaction with the delivery service may have immediate and long-term effects on her
health and subsequent utilization of the services. Providing satisfying delivery care increases service utilization. The
objective of this study is to assess the satisfaction of mothers with referral hospitals’ delivery service and identify
some possible factors affecting satisfaction in Amhara region of Ethiopia.
Methods: A hospital-based cross-sectional survey that involved an exit interview was conducted from September
to November 2009 in three referral hospitals in Ethiopia. A total of 417 delivering mothers were enrolled in the
study. Client satisfaction was measured using a survey instrument adopted from the Donabedian quality
assessment framework. We collect data systematically from every other postnatal woman who delivered in the
referral hospitals. Multivariate and binary logistic regression was applied to identify the relative effect of each
explanatory variable on the outcome (satisfaction).
Results: The proportion of mothers who were satisfied with delivery care in this study was 61.9%. Women’s
satisfaction with delivery care was associated with wanted status of the pregnancy, immediate maternal condition
after delivery, waiting time to see the health worker, availability of waiting area, care providers’ measure taken to
assure privacy during examinations, and amount of cost paid for service.
Conclusions: The overall satisfaction of hospital delivery services in this study is found to be suboptimal. The study
strongly suggests that more could be done to assure that services provided are more patient centered.
Background
One of the Millennium Development Goals (MDG5) is
to reduce the maternal mortality ratio by 3/4 between
1990 and 2015. Pregnancy and childbirth claim the lives
of an estimated half a million of women globally each
year [1]. More than half of these deaths occur in Africa
[1]. Ethiopia is one of the countries that have highest
maternal mortality rates (MMR) in the world which is
estimated to be 673/100,000 live births [2]. Part of this
mortality is attributed to poor delivery care [3].
The Ethiopian government and international organizations are working for making hospital delivery services
accessible and usable for all pregnant women but still
the proportion of births attended by a skilled birth
attendant is about 18.4% [4] in 2009 which was much
lower than the average level in developing countries in
* Correspondence: zdesalegn@gmail.com
2
Department of Epidemiology and Biostatistics, University of Gondar, P.O.Box
196, Gondar, Ethiopia
Full list of author information is available at the end of the article
general (59%), Sub-Saharan regions (44%), and very far
from MDG target of 90% coverage [1,3]. The reasons
forwarded by researchers for the higher maternal mortality, and lower coverage of skilled delivery in Ethiopia
include mothers’ unhappy health institutional delivery
experience [3,5].
In Ethiopia, dire health institutional delivery experience limits women’s ability to seek care for subsequent
pregnancies [3,5]. A midterm assessment of the third
Ethiopian Health Sector Development Program (HSDP
III) also identified poor quality skilled birth attendance
as one of the critical bottlenecks for improving the
lower utilization of hospital delivery [5]. Many studies
have been conducted on quality of maternity care with
hospital and health centers in Ethiopia [6,7]. These studies suggest that the quality of maternity care in Ethiopia is poor. This includes not only the quality of clinical
care but also gender sensitivity, preservation of dignity
and cultural sensitivity [5,7]. These factors together with
© 2011 Tayelgn et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
Tayelgn et al. BMC Pregnancy and Childbirth 2011, 11:78
http://www.biomedcentral.com/1471-2393/11/78
the community level factors explain the extremely low
utilization of health services for delivery [3,6,7].
Satisfaction is a meaningful output indicator of quality
health care [8-10]. Various studies have reported that
satisfied service users are more likely to utilize health services, comply with services and follow ups, and continue
with the health care [11-14]. Satisfaction with childbirth
experience is important to the woman, infant’s health
and well-being, and mother-infant relationship. Studies
reported that a mother’s positive perception of birth
experience has been linked to positive feelings toward
her infant and adaptation to the mothering role [15-17].
A community based study conducted in Kenya among
women who delivered in health facilities showed that
over half (56%) of women are satisfied with delivery care
[11].
Despite having many studies done elsewhere, there is
paucity of data concerning mother’s satisfaction with
childbirth services in referral hospitals in Ethiopia.
Hence, this study was conducted to show Ethiopian case
at referral level in Amhara region of Ethiopia.
Page 2 of 7
deliveries attended in the 1 st and 2nd quarter of 2009.
Data were collected from every other postnatal woman
who received delivery care in the three hospitals.
Data collection instrument
The data collection instrument was closed-ended questionnaire. Delivery service satisfaction related questions
were adopted from the Donabedian quality assessment
framework [8] and presented using a 5- scale likert scale
(1-very dissatisfied, 2-dissatisfied, 3-neutral, 4-satisfied,
and 5-very satisfied).
The first draft of the English questionnaire was translated to Amharic language by independent translators
then back to English language to check for consistency.
The questionnaire was pre tested on 40 postnatal mothers
at the University of Gondar Teaching and Referral Hospital one month prior to the actual data collection.
Data collection
Study design
Six female nurses who were fluent in Amharic and who
were not working in the study sites were recruited for
data collection. Three days (two days theoretical and
one day practical) training was given before the actual
data collection.
A hospital-based cross-sectional survey was conducted
from September 2009 to November 2009.
Data analysis
Methods
The sample size for this study was determined using
single population proportion formula considering the
assumptions: Proportion of delivering mothers satisfied
with hospital delivery care service as 56% (p = 0.56)
[11]. Level of significance to be 5% (a = 0.05), Z a/2 =
1.96 and margin of error to be 5% (d = 0.05). Adding
non responses rate of 10%, a total sample size of 417
delivering mothers were included.
The completed questionnaires were checked for completeness and consistency by the investigators. Data was
entered, cleaned and analyzed using SPSS version 16
(SPSS Inc., Chicago). During analysis, the responses of
‘very satisfied’ and ‘satisfied’ were classified as satisfied
and responses of ‘very dissatisfied’, ‘dissatisfied’ and
‘neutral’ as unsatisfied. Neutral responses were classified
as dissatisfied considering that they may represent a
fearful way of expressing dissatisfaction. This is likely
because the interview was undertaken within the hospitals and mothers may have been reluctant to express
their dissatisfaction feeling of the services they received.
For the overall satisfaction level, those who were satisfied in greater or equal to 75% of the items were categorized under “satisfied” and those who were satisfied in
less than 75% of the items were categorized as “un satisfied”. Descriptive statistics was computed for the study
variables. Frequency distribution tables were used to
describe most of the findings and graphs were also
plotted for some. To determine factors associated with
mother’s satisfaction bivariate binary logistic regression
and multivariate stepwise logistic regression were
applied. Adjusted odds ratio was used to determine the
strength of association between selected variables.
Sampling Procedure
Ethical considerations
The total sample size was allocated proportionally to
each of the hospitals by reviewing the number of
The study proposal was approved by Institutional
Review Board of the College of Medicine and Health
Study area
This study was conducted in three public referral hospitals of Amhara region, northwest Ethiopia. These three
referral hospitals were University of Gondar Teaching
and Referral Hospital (UOGTRH), Felege Hiwot referral
hospital (FRH), and Dessie referral hospital (DRH). Each
referral hospital’s catchment population is estimated to
be 5-7 million people.
Study population
Selected mothers who visited the three referral hospitals
for delivery service during the data collection period
were the study population.
Sample size
Tayelgn et al. BMC Pregnancy and Childbirth 2011, 11:78
http://www.biomedcentral.com/1471-2393/11/78
Sciences of the University of Gondar. Informed oral
consent was obtained from each study participant. Confidentiality was assured by making the questionnaire
anonymous.
Page 3 of 7
Table 1 Socio Demographic Characteristics of delivering
mothers in referral hospitals of Amhara Region, Ethiopia,
September - November 2009 (n = 417)
Total(n = 417)
Characteristics
N (%)
Results
Age (in years)
Socio-demographic characteristics
< 20 years
37(8.9)
A total of 417 delivering mothers from three referral
hospitals participated in the exit survey with 146 (35%)
of the women obtained from the UOGTRH, 150(36%)
from FRH and the rest 121(29%) from DRH.
The mean ± SD age of the mothers was 25.9 ± 5.2
years. One hundred and twenty eight (30.7%) were with
no formal education. The majority (89.2%) were married. One hundred thirty five (32.3%) were house wives
while 86(20.7%) were government employees. Two hundred ninety six (71%) mothers came from urban areas.
Three hundred and forty (81.5%) were Amhara by ethnicity. About three fourth (302) of the delivering mothers
were Orthodox Christians by religion (Table 1). The
median household income of the delivering mothers was
765 ETB (47.8USD). Three hundred ninety one mothers
(98.3%) paid for the service received. The average payment by mothers was 157 ETB.
20-34 years
350(83.9)
35-49 years
Marital status
30(7.2)
Married
372(89.2)
Obstetrics characteristics of delivering mothers
For 47.5% of women, this was the first delivery, 42.2%
had had 2-5 deliveries; and 10.3% of women had had 5
or more deliveries. Nearly a quarter of women had had
an unwanted birth. About 64.5% of the mothers’ do not
have previous health facility delivery experience. The
majority (84.2%) had one or more ANC visits and 15.8%
did not attend ANC. Over a fifth of women (21%) had a
self-reported complication in pregnancy. Normal vaginal
delivery was the commonest mode of delivery (53.7%)
followed by assisted delivery (24.5%) and caesarean section (21.8%) (Table 2).
Single
39(9.4)
Divorced
6(1.4)
Ethnicity
Amhara
340(81.5)
Tigray
36(8.7)
Oromo
Agew
9(4.5)
6(1.4)
Others
16(3.9)
Religion
Orthodox
302(72.5)
Muslim
107(25.6)
Protestant
8(1.9)
Educational Status
No formal education
Grade1-6
128(30.7)
69(16.5)
Grade7-12
158(37.9)
Above-12
62(14.9)
Occupation
House wife
135(32.3)
Government employee
86(20.7)
Farmer
78(18.7)
Merchant
Student
51(12.2)
42(10.1)
Others
25(6.0)
Residence
Urban
296(71.0)
Rural
121(29.0)
Mothers’ satisfaction on delivery care
Hospital delivery took place
The proportion of mothers who were satisfied with
delivery care in this study was 61.9%. Dissatisfaction was
highest (74.7%) among women delivering at UOGTRH.
Of all satisfaction levels, client privacy related satisfaction (46.7%), health facility distance related satisfaction
(51.4%), and amount of cost paid related satisfaction
(52.7%) were the first three least values (Figure 1).
Results of multivariate stepwise logistic regression
indicated that health facility related factors and health
providers’ characteristics were important predicators of
the overall maternal satisfaction.
Women’s satisfaction with delivery care was associated
with wanted status of the pregnancy [AOR = 2.2,95%
CI:1.2,3.93)], favourable immediate maternal condition
after delivery [AOR = 2.1,95%CI: 1.12,3.93)], short
UOGTRH
146(35)
FRH
DRH
150(36)
121(29)
waiting time [AOR = 2.9, 95%CI: 1.14,7.58)], perceived
availability of waiting area [AOR = 6.3,95%
CI:3.33,11.88)], care providers measure taken to assure
privacy during examinations [AOR = 2.1, 95%CI:
1.13,3.83)], and amount of cost paid for service [AOR =
1.9 95% CI:1.15,3.60)] (Table 3 and 4).
Figure 2 displays responses to questions exploring the
willingness of delivering mothers to recommend the
hospital to family or friend. Overall, 69.1% of women
were very likely to recommend the hospital where they
Tayelgn et al. BMC Pregnancy and Childbirth 2011, 11:78
http://www.biomedcentral.com/1471-2393/11/78
Table 2 Obstetrics characteristics of respondents in
referral hospitals of Amhara Region, Ethiopia,
September-November 2009(n = 417)
Obstetric characteristics
Total (n=417) N(%)
Parity (number including the new baby)
One
198(47.5)
Two to five
176(42.2)
More than five
43(10.3)
Reason for visit
Planned delivery
342(82.0)
Referral delivery
75(18)
Wanted status of pregnancy
Wanted
308(73.9)
Unwanted
109(26.1)
Mode of delivery
Spontaneous vaginal delivery(SVD)
224(53.7)
Assisted delivery
Caesarean section(C/S)
102(24.5)
91(21.8)
Immediate maternal condition after delivery
Normal
328(78.7)
With complications
89(21.3)
Fetal outcome
Live birth
374(89.7)
stillbirth
43(10.3)
ANC follow up
Yes
351(84.2)
No
66(15.8)
Page 4 of 7
delivered to others. Only 57.5% of women who deliver
at University of Gondar Teaching and Referral Hospital
were willing to recommend the hospital to a family or a
friend. On the contrary Felege Hiwot Referral Hospital
was recommended by 83.3% of the mothers who delivered there. This shows a statistically significant difference with X 2 of 24.1 and p < 0.001. Thinking about
their experience, only 287(68.8%) of the delivering
mothers are likely to deliver in the hospital where they
deliver again.
Discussion
This paper presents a study that estimated the level of
mothers’ satisfaction with referral hospitals’ maternity
care in Amhara Region of Ethiopia. The overall proportion of mothers who were satisfied with delivery care in
this study was 61.9%. This percentage is very low compared to other studies in developing countries - 92.5%
in Côte d’Ivoire [18] but it is comparable to a study in
Nairobi, Kenya-56% [11] and greater than a study in Sri
Lanka 48% [12]. This variation may be because of a real
difference in quality of services provided, expectation of
mothers or the type of health facilities. Studies conducted in Canada [19], Kenya [11] and Sir Lanka [12]
suggest that services dealing with referred patients or
complicated deliveries yield less satisfaction.
In this study delivering mothers satisfactions was predicted by wanted status of the pregnancy, immediate
Figure 1 Major dimensions of care and average satisfaction scores by postnatal mothers delivered in 3 Referral hospitals in Amhara
Region, Ethiopia.
Tayelgn et al. BMC Pregnancy and Childbirth 2011, 11:78
http://www.biomedcentral.com/1471-2393/11/78
Page 5 of 7
Table 3 Socio-demographic characteristics associated with mothers’ satisfaction in referral hospitals of Amhara
Region, Ethiopia, September-November, 2009
Satisfied
Unsatisfied
COR (95% CI)
AOR (95% CI)
Age (in years)
< 20 years
20(4.8)
17(4.1)
1.00*
1.00*
20-34 years
35-49 years
216(51.8)
22(5.3)
134(32.1)
8(1.9)
1.4(0.69,2.71)
2.3(0.83,6.59)
0.7(0.28,1.99)
1.5(0.35,6.21)
Marital Status
Single
19(4.6)
20(4.8)
1.00*
1.00*
Married
236(56.6)
136(32.6)
1.8(0.94,3.54)
0.5(0.14,1.58)
Divorced
3(0.7)
3(0.7)
1.1(0.19,5.87)
1.4(0.13,15.88)
Orthodox
173(41.6)
129(31.0)
1.00*
1.00*
Muslim
protestant
79(19.0)
5(1.2)
28(6.7)
2(0.5)
2.1(1.29,3.43)**
1.9(0.36,9.76)
1.8(0.97,3.27)
1.1(0.13,10.28)
No formal education
79(18.9)
49(11.8)
1.00*
1.00*
Grade 1 - 6
42(10.1)
27(6.5)
1.0(0.53,1.76)
0.9(0.39,2.32)
Grade 7 - 12
91(21.8)
67(16.1)
0.8(0.52,1.36)
1.6(0.66,3.95)
Diploma and above
46(11.0)
16(3.8)
1.8(0.91,3.49)
1.8(0.49,6.72)
Governmental employee
Merchant
57(14.5)
32(8.1)
29(7.3)
19(4.8)
1.00*
0.9(0.42,1.77)
1.00*
0.9(0.29,2.72)
Farmer
52(13.2)
26(6.6)
1.0(0.53,1.95)
1.5(0.40,5.34)
House wife
85(21.5)
50(12.7)
0.87(0.49,1.53)
1.5(0.55,3.96)
Student
17(4.3)
25(6.3)
0.35(0.16,0.74)
0.6(0.20,2.03)
Religion
Educational Status
Occupation
Economic status (monthly income)
≤ 765ETB(47.8USD)
134(32.1)
75(18.0)
1.2(0.82,1.80)
> 765 ETB(47.8USD)
124(29.8)
84(20.1)
1.00*
Residence
Urban
185(44.4)
111(26.6)
1.1(0.71,1.69)
Rural
73(17.5)
48(11.5)
1.00*
Yes
221(53.0)
50(12.0)
13.0(8.03,21.11)
6.3(3.33,11.88)
No
37(8.9)
109(26.1)
1.00*
1.00*
Referral
104(24.9)
59(14.2)
1.1(0.76,1.72)
Not referral
Waiting time before seeing a doctor or a nurse
154(36.9)
100(24.0)
1.00*
≤ 1 hour
247(59.2)
135(32.4)
4.0(1.89,8.40)
2.9(1.14,7.58)
> 1 hours
11(2.6)
24(5.8)
1.00*
1.00*
yes
179(42.9)
40(9.6)
6.7(4.32,10.52)
2.1(1.13,3.83)
No
79(18.9)
119(28.6)
1.00*
1.00*
154(36.9)
104(24.9)
68(16.4)
91(21.8)
2.0(1.33,2.96)
1.00*
1.9(1.15,3.60)
1.00*
Perceived presence of waiting area
Mode of visit
Privacy during examinations
Amount paid to the service
≤ 157 ETB
> 157 ETB
*Reference group.
maternal condition after delivery, waiting time before
seen by a health worker, perception about the waiting
area for mothers and relatives, health professionals measure taken to assure privacy during maternal
examinations, and service cost paid. This finding is consistent with other studies in Africa [11,12,18].
Mothers who wanted their pregnancy were more likely
to be satisfied than mothers who did not. Similar finding
Tayelgn et al. BMC Pregnancy and Childbirth 2011, 11:78
http://www.biomedcentral.com/1471-2393/11/78
Page 6 of 7
Table 4 Obstetric experiences associated with mothers’ satisfaction in referral hospitals of Amhara Region, Ethiopia,
September -November, 2009(n = 417)
Obstetric experiences
Satisfied
Unsatisfied
COR(95% CI)
AOR (95%CI)
212(50.9)
96(23.0)
3.0(1.93,4.74)*
2.2(1.20,3.93)*
46(11.0)
63(15.1)
*
1.00*
*
1.00*
142(34.0)
82(19.7)
1.7(1.04,2.77)*
1.2(0.50,2.69)
Wanted status of pregnancy
Wanted
Unwanted
Mode of delivery
SVD
*
Assisted delivery
70(16.8)
32(7.7)
2.1(1.19,3.84)*
1.5(0.60,3.93)
*
Caesarean section
46(11.0)
45(10.8)
Maternal condition
Normal
226(54.2)
102(24.4)
With complication
32(7.7)
1.00*
57(13.7)
1.00*
3.9(2.41,6.46)*
2.1(1.12,3.93)*
*
*
1.00*
1.00*
Fetal outcome
Lived
232(55.6)
142(34.1)
1.1(0.56,2.04)
Died
26(6.2)
17(4.1)
1.00*
Yes
227(54.4)
124(29.8)
2.1(1.22,3.51)*
*
1.3(0.58,3.03)
No
31(7.4)
35(8.4)
1.00*
1.00*
ANC follow up
*Reference group.
was reported in Kenya by Bazent and her colleagues
[11]. The study also showed that mothers without complication were more likely to be satisfied than mothers
with complication. Women who experience no complications may be happy that they survived and this may
result satisfaction with care [11].
Figure 2 Will you recommend the hospital to family and friends?.
In studies conducted in Oromia and Afar Regions of
Ethiopia, mothers were complaining payment for service, inadequate privacy and unfriendly attitude of care
providers [7,20]. Similarly, in this study the researchers
found privacy and cost incurred for service to be associated with mothers’ dissatisfaction. Mothers who
Tayelgn et al. BMC Pregnancy and Childbirth 2011, 11:78
http://www.biomedcentral.com/1471-2393/11/78
reported privacy during physical examination were more
satisfied than those who perceived absence of privacy.
This reflects there is privacy breach which should be
improved. The mothers’ level of satisfaction was also
related to the amount of money paid for service as
mothers who paid less than or equal to157 ETB were
more satisfied than those who paid greater than157
ETB. This might be due to the low socio economic status of the mothers or/and mothers may have paid unexpected costs such as cost for travel and charge for
supplies.
Our finding showed that nearly two-thirds of all
women were very likely to recommend the delivery care
facility to friends and family. Though this suggests that
the hospitals are providing an acceptable quality of care,
there is room for substantial improvement at University
of Gondar Teaching and Referral Hospital.
The findings of this study had limitations. First, data
are restricted to delivery experience to referral hospital
thereby limiting generalization to the overall health
facility experience of childbirth by women. Second,
potential response biases often present in patient satisfaction studies related to social desirability. We tried to
minimize this bias by interviewing mothers in a separate
room by trained nurses who are not affiliated with the
facilities studied.
Conclusions
The overall satisfaction of hospital delivery services in
this study is found to be suboptimal. The study strongly
suggests that more could be done to assure that services
provided are more patient centered.
This study also revealed several constraints in the provision of delivery care services which can be implied as
areas of possible improvement, including poor maintenance of clients’ privacy, longer waiting time, and unavailability of waiting areas.
Acknowledgements
We would like to extend our deepest gratitude to the University of Gondar
for financing this research.
Our appreciation goes to the data collectors and supervisors who helped us
in monitoring and supervising the data collection process. Our special
thanks also go to heads of the maternity wards at University of Gondar
Teaching and Referral Hospital, Felege Hiwot Referral Hospital and Dessie
Referral Hospital, and delivering mothers who participated in the study.
Author details
1
Department of Public Health, Bahir Dar University, P.O.Box 79, Bahir Dar,
Ethiopia. 2Department of Epidemiology and Biostatistics, University of
Gondar, P.O.Box 196, Gondar, Ethiopia.
Authors’ contributions
AT wrote the proposal, participated in data collection, analyzed the data and
drafted the paper. DTZ and YK approved the proposal with some revisions,
participated in data analysis and revised subsequent drafts of the paper. All
authors read and approved the final manuscript.
Page 7 of 7
Competing interests
The authors declare that they have no competing interests.
Received: 30 March 2011 Accepted: 24 October 2011
Published: 24 October 2011
References
1. WHO, UNICEF, UNFPA, WORLDBANK: Maternal mortality in 2005:Estimates
developed by WHO, UNICEF,UNFPA and the World Bank. Geneva: WHO;
2007.
2. Federal Democratic Republic of Ethiopia Central Statistical Agency OM:
EDHS 2005. Addis Ababa,Ethiopia; 2006.
3. Mekonnen Y: Patterns of maternity care service utilization in Southern
Ethiopia: Evidence from a community and family survey. Ethiopian
journal of Health and Development 2003, 17(1):27-33.
4. FMOH: Health and Health Related Indicators. Addis Ababa: Policy, Plan
and Finance General Directorate, Federal Ministry of Health Ethiopia; 2010.
5. FMOH: Ethiopian health sector development programme HSDP III 2005/
06 -2010/11 (GC) (1998 - 2003 EFY) Mid-term review. Addis Ababa:
Federal Ministry of health Ethiopia; 2008.
6. Nigussie M, Haile Mariam D, Mitike G: Assessment of safe delivery service
utilization among women of childbearing age in north Gondar Zone,
North West Ethiopia. Ethiopian journal of Health and Development 2004,
18(3):145-152.
7. Fenta M: Assessment of factors affecting utilization of maternal health
care services in Ayssaita and Dubti towns, Afar regional state, North east
Ethiopia. MPH thesis Addis Ababa University; 2005.
8. Donabedian A: An Introduction to Quality Assurance in Health Care.
Oxford University Press, USA; 2002.
9. Donabedian A: The quality of care. How can it be assessed? 1988.
Archives of Pathology & Laboratory Medicine 1997, 121(11):1145-1150.
10. West away MS RP, Vanzyl D, Seager JR: Interpersonal and organizational
dimensions of patient satisfaction. International journal for quality in health
care 2003, 15(4):337-344.
11. Bazant ES, Koenig MA: Women’s satisfaction with delivery care in
Nairobi’s informal settlements. International Journal for Quality in Health
Care 2009, 21(2):79-86.
12. Senarath U, Fernando DN, Rodrigo I: Factors determining client
satisfaction with hospital-based perinatal care in Sri Lanka. Tropical
Medicine & International Health: TM & IH 2006, 11(9):1442-1451.
13. Gamble J, Creedy DK, Teakle B: Women’s expectations of maternity
services: a community-based survey. Women and Birth: Journal of the
Australian College of Midwives 2007, 20(3):115-120.
14. MacKeith N, Chinganya OJM, Ahmed Y, Murray SF: Zambian women’s
experiences of urban maternity care: results from a community survey
in Lusaka. African Journal of Reproductive Health 2003, 7(1):92-102.
15. Goodman P, Mackey MC, Tavakoli AS: Factors related to childbirth
satisfaction. Journal of Advanced Nursing 2004, 46(2):212-219.
16. Simkin P: Just another day in a woman’s life? Part II: Nature and
consistency of women’s long-term memories of their first birth
experiences. Birth (Berkeley, Calif) 1992, 19(2):64-81.
17. Simkin P: Just another day in a woman’s life? Women’s long-term
perceptions of their first birth experience. Part I. Birth (Berkeley, Calif)
1991, 18(4):203-210.
18. Delvaux TG-KV, Bosso P, Collin S, Ronsmans C: Quality of normal delivery
care in Côte d’Ivoire. Rev Afr Santé Reprod 2007, 11(1):22-32.
19. Janssen P, Klein M, Harris S, Soolsma J, Seymour L: Single room maternity
care and client satisfaction. Birth 2000, 27(4):235-243.
20. ESOG: Utilization of Emergency Obstetric Care services in three woredas
of west Shoa Zone, Oromia region, Ethiopia. Addis Ababa: Ethiopian
Society of Obstetricians and Gynecologists; 2004.
Pre-publication history
The pre-publication history for this paper can be accessed here:
http://www.biomedcentral.com/1471-2393/11/78/prepub
doi:10.1186/1471-2393-11-78
Cite this article as: Tayelgn et al.: Mothers’ satisfaction with referral
hospital delivery service in Amhara Region, Ethiopia. BMC Pregnancy and
Childbirth 2011 11:78.