What determines client satisfaction on labor and delivery service in Ethiopia? systematic review and meta-analysis

Introduction The uptake of Health services, maternal and newborn health care outcomes are dictated by the satisfaction of clients on the service provided. Client satisfaction is one of the vital indicators to measure the quality of service. However, it is not well addressed and little evidence is existed in Ethiopia. Therefore, the purpose of this systematic review aimed to assess the prevalence and determinant of client satisfaction on labor and delivery service in Ethiopia. Methods This study has included published and unpublished articles. The main databases PubMed, Embase, EBSCO, Medline, CINHAL, Poplin, and the search engine like Google and Google scholar were used from June1-30/2020. Studies with observational study design which are conducted in English language and met the eligibility criteria were included in the review. Meta-analyses with random effects were performed. Data synthesis and statistical analysis were conducted using OpenMeta and CMA version 2 software. Results The pooled prevalence of client satisfaction on labor and delivery service in Ethiopia was 73.5% [95% CI [64.9%, 82.1%]. The pooled odds ratio showed a negative association between client satisfaction on labour and delivery service with Promptness of care [OR = 0.25; 95% CI: (0.18, 0.34), P = 0.0001], Free service charge [OR = 0.70; 95% CI: (0.57, 0.86), P < 0.0007], Privacy during examination [OR = 0.25; 95% CI: (0.10, 0.64), P < 0.004], Respectful maternal care [OR = 0.40;95% CI: (0.19, 0.83), P = 0.01], Plan to delivered at health facility [OR = 0.49; 95% CI: (0.37, 0.66), P < 0.00001] and ANC follow-up [OR = 0.39; 95% CI: 0.24, 0.63, P < 0.0001]. Conclusions This review revealed that client satisfaction on labor and delivery service in Ethiopia was 73.5%. Besides poor care of providers on the antepartum, intrapartum and lack compassionate and respectful care affects client satisfaction on labor and delivery service in Ethiopia.

Respectful maternal care, Plan to deliver at health facility, and fee service charge were significant 39 predictors for client satisfaction on Labor and delivery service in Ethiopia.

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Keywords: Client satisfaction, labor, and delivery, Ethiopia, systematic review, Meta-analysis.  There is substantial improvement in access to essential health services, nevertheless, emotional  Several studies show that most women had faced so many problems during labor and delivery 65 including insulting and lack of Compationate and respectful care by care providers. In such a way 66 by one or another, the right of the women was diminished and the practice of the providers become 67 unethical [11][12][13][14][15][16].     Outcome: client/women/mother satisfaction on labor and delivery service 102 Eligibility criteria 103 The study participants has been postnatal mothers/women in Ethiopia. The investigators 104 encomposs observational studies that have been conducted at a facility/community setting in 105 different parts of Ethiopia on the client/women/mother satisfaction on labor and delivery service.    Advanced search strategies were applied in major databases to retrieve relevant findings closely 119 related to client/women/mother satisfaction on labor and delivery service in Ethiopia. The search 120 was conducted with the aid of carefully selected keywords and indexing terms.

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The search strategy included "Factors" OR "Associate" OR "related factors "OR "determinants" 122 OR "Predictors" AND "client satisfaction "OR "women satisfaction" OR "mother satisfaction''   of the tool and categorized as high-, moderate-, and low quality. A high-quality score above 80%, 165 moderate-quality between 60%-80%, and low-quality below 60%. Studies with a score greater 166 than or equal to 60% were included. This critical appraisal was conducted to assess the internal 167 validity (systematic error) and external validity (generalizability) of studies and to reduce the risk 168 of biases.

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Strategy for data synthesis 170 The findings of the included studies were first presented using a narrative synthesis. Study  Meta-analysis was conducted using OpenMeta and CMA version 2 software to compute the pooled 176 prevalence and determinates with client satisfaction on labor and delivery service.   (Table 1). 205 The pooled approximation of the magnitude of client satisfaction in Ethiopia was 73.5% [95%CI

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[64.9%,82.1%] (Fig.2).  charged for the service were 0.70 times less likely satisfied as compared to clients who had 236 received care free of charge (Fig 5). likely satisfied as compared to those who maintained privacy. But considerable heterogeneity was 245 found too high (I 2 = 92%), hence the random effect model was assumed in the analysis. Sensitivity 246 was done of analysis but did not bring significant change in the overall summary results of OR 247 (Fig 6).  providers. In this review and meta-analysis, we found several determinants that had a significant 306 association with client satisfaction on labor and delivery service in Ethiopia. The current review 307 indicated that National policy, structural and process play a significant role in client satisfaction 308 on labor and delivery service. This meta-analysis shows that client satisfaction on labor and 309 delivery service was positively associated with, respectfulness of providers, promptness of care, 310 privacy, plan to deliver at the facility, free service charge, and ANC follow-up. 311 This review revealed that the client who received respectful maternal care by providers was  Besides, free service charge was among the determinants contributing to client satisfaction on 327 labor and delivery service in Ethiopia [33,49]. This review found was a similar study conducted in 328 Kenya, Nepal, and Gambia [28,29,48]. This might be due to most clients were poor socioeconomic 329 status, so it facilitates room to use the money for other needs that may arise during their pregnancy-330 child birth process. In contrast a study in India it was revealed that service charge for labor and 331 delivery service was positively associated with client satisfaction [47].

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The review revealed that promptness of care was associated with client satisfaction. [44,45,49,51]. 333 This was in line with a study in Oman, Nigeria, Bangladesh and India and systematic review in 334 developing countries [36,37,39,52]. The possible reason might be it is the time when the client 335 needs special attention and time makes to receive the quality of standard service.

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In this review ANC follow-up was associated with client satisfaction [45,53,54]. The possible 337 reason might be due to care received by the same providers who followed during ANC and similar 338 environment so it makes it women-friendly.

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The plan to delivered at the health facility was positively associated with client satisfaction This review identified determinates for client satisfaction on Labor and delivery service in 345 Ethiopia. Based on our review waiting time, cost of the service, Respectfulness of the providers, 346 Privacy, plan to deliver at the health facility and ANC follow-up all increased client satisfaction 347 on Labor and delivery service. This meta-analysis has certain limitation, all of the studies included 348 were cross-section so that it restricts us to do cause-effect analysis. The included study has different 349 in the quality of study which is observed by heterogeneity. If we request, we can avail all the data we used.