Evaluation of utilization of maternal and child health services in el-minia district

  Population growth is a major challenge in most developing coun-tries. This high rate of growth is the result of an imbalance between infant mortality and fertility (Youssef, 2005). In Egypt growth rate was 1.9 (WHO, 2005), so this study was conducted on two MCH centers to identify the pattern of utilization of MCH services and determine the reasons of dissatisfaction of the clients.

About half million women in developing countries die annually due to pregnancy and childbirth. Maternal mortality risk in the poorest countries can be 200 times that of developed countries. Inappropriate timing and spacing, too many pregnancies, unsafe abortion, and insufficient prenatal care and care during delivery contribute to high maternal mortality in developing countries (WHO, 1990). The current study showed that one fourth of the females attended rural center prev-iously experienced abortion, however this figure was higher than that of the urban center (18.5%), this result can be explained by a multitude of factors as higher prevalence of consanguinity in rural than urban area, prevailing anemia among rural women, work over load of rural women and low coverage by antenatal care. Yassin (2000a) reported a higher prevalence of abortion in rural upper Egypt (40.6%). In Alexandria, consanguinity frequ-ency was 68.8% among couples with reproductive losses (Mokhtar & Abdel-Fattah, 2001).

  The most common reasons for taking children to a private physician in cases of serious illness rather than to a physician at a government health clinic were confidence in physician's ability and convenience (Herman et al.,1994). In this study about one third of mothers in the urban center and 18.5% of mothers in the rural center consulted private doctors for curative services, this difference might be attributed to economic abilities.

The first-time mother's coping with child care is affected by the social support received from their social network and from the public health nurses at the child welfare clinic (Tarkka et al., 1999). Egypt began training of physicians in case manage-ment of diarrhea and acute respiratory infection in the 1980s and 1990s respectively (Langsten et al., 2005), under five years mortality was 26.2/1000 live births (WHO, 2005), however in a study carried out in upper Egypt, Yassin (2000b) reported that under five years mortality rate was 130.8 per 1000 live births and the leading causes of mortality were: diarrhoeal diseases (39.4%), acute respiratory infection (26.8%), comb-ined episode of both (5.1%), febrile illnesses including meningitis (10.6%), neonatal causes (12.6%), and accidents (2.5%). Diarrheal morbidity is still unacceptably high in rural Upper Egypt. The current study revealed that 11.5% of  attendants  of rural center and 8% of  attendants  of urban center gave history of under five years mortality.

The most cost effective mix of interventions were chosen by WHO, these were  the community based newborn care package, followed by antenatal care (tetanus toxoid, scree-ning for pre-eclampsia, screening and treatment of asymptomatic bacteriuria and syphilis); skilled attendance at birth. (Adam et al., 2005). In Egypt the coverage of ANC was 70% (WHO, 2005), in this study about fifth of the rural women and 14.9% of urban women did not receive any form of antenatal care. In rural center about 50% of ANC and 16.9% of deliveries were done at the center while in urban center 38.7% of ANC was done in the center and 46.4% of ANC was done in other health facility and only 8.8% of deliveries were carried out in the center. About 60% of mothers used curative services in the rural center and about one third of the studied sample in the urban center used this services which indicate higher utilization of the rural than the urban center.

A trained person attends only 20% of births in developing countries (WHO, 1990). In Egypt 73% of births was attended by skilled health personnel (WHO, 2005), the results of this study showed that most of deliveries of clients of the urban center were attended by health personnel while in rural center, about 15% of deliveries were attended by non professional birth attendants.

Contraception use increases the birth interval by increasing the time until the next conception with a subsequent decline in fertility (Youssef, 2005). Numerous commonly used medical contraception methods have been presented, most of them are described only in general. The importance of selecting a method individually for every patient, taking into accounts her request, efficacy and safety of the method, was particularly emphasized (Debski, 2007).

The most common used method of contraception was intrauterine device (IUD), followed by the injectable then the least method was the pills, in a study carried out in urban and rural areas of Khartoum state, contraceptive pills were the most frequently used method followed by intrauterine devices and injections (Ibnouf et al., 2007), in Kenya, the most frequently used method was contraceptive pills followed by injectable and IUD (Miller et al.,1991).

Living in a community, in which women have widespread health service contact, is related to both prenatal care use and subsequent modern contraceptive use (Zerai & Tsui ,2001). The majority of urban women (97.5%) and rural women (87.5%) were given the contraception methods by the center which reflected high utilization of family planning sections. The most common reason for using contraception was limiting number of children, this was in agreement with another study conducted in Egypt, it showed that families required better quality of health used MCH for limiting family size (Ahmed  & Mosley, 2002). In India, majority of women (70.5%) used a family planning method for the first time only after completing their desired family size (Chandhick et al., 2003).

Service quality is an important determinant of use of clinical contraceptive methods in Egypt. Improving quality of family planning services may help further increase use of clinical contraceptive methods and reduce fertility (Hong et al., 2006). Health education is an important component of maternal and child health services, it promotes appropriate contraceptive use for better health of the mother and child. Counseling sessions improved the couples' knowledge and practice of contra-ception, integrating family planning counseling into antenatal care in all facilities were recommended by Soliman (1999).

Regarding health services provided by the two centers (weighing, clinical examination, health education,

laboratory investigation, tetanus vaccinetion and providing medicine for sick children), attendants of the urban center were generally more satisfied than attendants of the rural center, this result was in accordance with Maharaj & Munthree (2005) who found that clients visiting urban health facilities reported greater satisfaction with services than clients visiting rural health facilities

Patient satisfaction is an important component of the quality of care. In this study, it was found that as satisfaction score grades increased the utilization rates of curative, antenatal care and natal services provided by the MCH centers increased. Satisfaction is a function of the discrepancy between what is expected and what is perceived to be actually occurring. Therefore, it is imperative to identify patients' per-ceptions to assess the extent to which these ideals are met by their institutions. Various studies have concluded that satisfied patients are more likely to continue using the medical care service, to maintain the relationship with a specified provider and to comply with medical regimen. (Fan et al., 2005).

Pareto analysis is named after Vilfredo Pareto, an Italian economist who presented a formula that showed that income was distributed unevenly, with about 80% of the wealth in the hands of about 20% of the people. In a similar way, a disproportionately large percentage of errors or defects in any process are usually caused by relatively few problems (Bonacorsi, 2007). So, it allows the user to focus on a few important factors in a process (Abd El Hamid et al., 2005) and thus screen out the less significant factors. Pareto chart method was successfully used for analysis of highly aggregated and complex data on hospitalizations of patients, (Mayer et al., 2005),  it is a tool  to identify the key issues constrai-ning performance (Seltzer et al., 1994).

was the environment, this was in agreement with Senarath  et al, (2006) who reported lower satisfaction rates with physical environment.

 

CONCLUSION:

From this study it was concluded that rural center had higher frequency of attendance regarding the curative services, ANC and delivery care while the urban center had higher attendance as regard family planning service. Despite higher utilization of the rural center, histories of abortion and under 5 years moralities as an indication of maternal needs to special health care were more prevalent among customers of rural center than those of urban center and clients of the urban center reported more satisfaction than those of the rural center. The most common causes of dissatisfaction that need to be modified were long waiting time and improper environment. Nearly 15% of deliveries of clients of rural center were attended by non skilled personnel, about half of the attendants of the family planning section used intrauterine device as a method of contraception.

- Encouraging and rewarding of any health facility which fulfill the highest rate of client attendance and satisfaction

- Improving quality of care which increase client satisfaction by reduction of the waiting time through increasing the human resources (doctors, nurses and technicians) and by arranging appointments for the clients.

- Upgrading the health services at the rural center, specific attention should be directed to the environmental conditions of the center and availability of medication

- Health education about the importance of safe delivery that should be attended by skilled person, this message can be provided through local television channels of upper Egypt governorates.

 

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