Complications of pregnancy and childbirth cause more deaths and disabilities than any other reproductive health problems in African countries, including Nigeria (World Health Organization [WHO], 2016). Skilled antenatal care and birth attendance have been advocated globally as the most crucial solution to reduce complications during pregnancy and childbirth. Antenatal care presents an opportunity for recognition and appropriate intervention for some of the causes of maternal mortality in developing countries, especially in rural areas. The maternal mortality rate in Nigeria is among the highest in the world ranked 10 out of 183 countries, between 1999 and 2015 (WHO, 2016). Nigeria is a leading contributor to the maternal death figure in Africa, south of the Sahara, not only because of the size of its population but also because of the high maternal mortality ratio. Nigeria's maternal mortality ratio of 1:100 is higher than the regional average, with an estimated 59 000 annual maternal deaths. Nigeria, which has approximately two percent of the world's population, contributes almost 10% of the world's maternal deaths (Federal Ministry of Health, 2011).
Satisfaction has been one outcome measure of quality of care. A study on satisfaction of maternal health services reflects quality of antenatal care service provided to the patients. Satisfaction is a reflection of the patient's judgment of different domains of healthcare, including technical, interpersonal and organisational aspects (Matejic et al, 2014). Satisfaction with different aspects of antenatal care services improves health outcomes, continuity of care, adherence to treatment and relationship with the health provider (Matejic, 2014). Patient satisfaction has been linked to the quality of services, currency, accuracy, relevance, format, utilisation of services given, and the extent to which specific needs are met. A satisfied patient is likely to come back for the services and recommend same services to others. There are various factors associated with patients' satisfaction. These include attitude of staff, cost of care, time spent at the hospital, privacy, confidentiality, availability of qualified health professionals and doctor communication (Khanam et al, 2012; Galle et al, 2015). Satisfaction and dissatisfaction indicate clients' judgment about the strengths and weaknesses, respectively, of the service.
Some studies have reported that women may generally express satisfaction with the quality of services despite some inconsistencies between received care and their expectations of the facilities (Oladapo et al, 2008; Nnebue et al, 2014). Oladapo, et al (2008) and Nnebue et al (2014) reported in their studies that women were satisfied with the care received, interpersonal relationship and the infrastructures for providing care. Health education and communication in the local language are also stressed to improve client satisfaction. In order for pregnant women to achieve a high level of satisfaction, awareness/knowledge of antenatal care information is essential, they need to be aware of available information, demonstrate knowledge and understanding in the specific areas, and utilise such information and services accordingly. There are different factors that could be responsible for satisfaction among patients. Patients with lower expectations tend to be more satisfied. Demographic characteristics such as age, educational attainment and socio-economic status are some of the factors considered to influence measured satisfaction ratings (Melese et al, 2014).
‘Women may generally express satisfaction with the quality of services despite some inconsistencies between received care and their expectations’
Studies have shown that there are differences in utilisation of antenatal care services within countries, especially between rural and urban areas. Some of the reasons include lack of awareness about antenatal care services, cost of services, lack of husband's/partner's consent and long distance to the health facility (Nwogu, 2009; Abubakar et al, 2011; Sina, 2016). Utilisation is the action or making practical and effective application of knowledge (Regassa, 2011). The term can also be described as the act of using materials, sources, products and services to make things function and this can lead to better performance and less risk of damage. Antenatal care utilisation means effectively using the services provided to pregnant women. Utilisation of antenatal care services has been shown to improve not only maternal outcomes but fetal outcomes as well. The inadequate utilisation of antenatal care is greatly contributing to persisting high rates of maternal and neonatal mortality in Nigeria (Adewoye et al, 2013).
According to Fagbamigbe and Idemudia (2015), affordability, availability and accessibility of antenatal care providers are the hurdles to antenatal care utilisation in Nigeria. The authors advised that financial and other barriers to antenatal care use quality improvement of these services that could affect women's satisfaction and utilisation. Antenatal care providers are surest ways to increasing antenatal care services coverage in Nigeria. Consequently, from the foregoing, it could be imagined that a good level of utilisation of antenatal care services may lead to satisfaction with antenatal care services among pregnant women. Based on this assumption, the study intends to investigate the influence of utilisation on satisfaction with antenatal care services among pregnant women in Lagos, Nigeria.
Methods
The study adopted a survey research design. The population of the study was 18 437 pregnant women, according to Health Service Commission statistics (2016). A multistage sampling technique was used to determine the sample size of 1 500 pregnant women from six general hospitals in Lagos. A simple random sampling technique was first used to select three out of six zones. Thereafter, two general hospitals were selected from each zone. Six general hospitals were used for the study, namely Lagos Island Maternity, Onikan Health Centre, Gbagada General Hospital, Randle General Hospital, Alimosho Maternal and Child Health Hospital, and Ifako Ijaiye Maternal and Child Health Hospital. Finally, convenient sampling technique was used to select 1 500 respondents for the study. A validated questionnaire was used for data collection. The Cronbach's alpha reliability coefficients for the constructs range from 0.94–0.97. The return rate was 87%.
The researcher obtained ethical approval for this study from the Babcock University Health Research Ethical Committee and from the Health Service Commission. In addition, permission was sought by the researcher from the antenatal clinic heads to collect data from the respondents. The researcher obtained the informed consent from the respondents after thorough explanation of the research. It was also established that there was no benefits attached to the study except for the purpose of research. The participants were also informed that they are free to pull out of the study at any time without negative consequence. The respondents were also assured of privacy and confidentiality of the information obtained from them. The data were examined for completion, coded and entered into the Statistical Package for Social Sciences version 20. The data was analysed using descriptive and inferential statistics (frequency distribution, simple percentage, mean and standard deviation). Regression analysis was used to establish the influence of variable for hypothesis at 0.05 level of significance.
Results
Table 1 presents the demographic characteristics of the respondents used for this study. The results showed that most of the respondents (85.6%) were in their reproductive years ie ages 23–37. About two-thirds of respondents (61.5%) were Yorubas. The vast majority (90%) of respondents (pregnant women) was married. Majority of the respondents were Christians (72.1%) while (97.7%) of the respondents had post-secondary education. Some (51.2%) of the respondents were middle income individuals, that is $40 000 NGN–$170 000 NGN per month and employed (75.6%).
| Variable | Category | Frequency (n), n=1 316 | Percentage (%) |
|---|---|---|---|
| Age | 18−22 | 103 | 7.8 |
| 23−27 | 375 | 28.5 | |
| 28−32 | 489 | 37.2 | |
| 33−37 | 262 | 19.9 | |
| 38−42 | 67 | 5.1 | |
| 43−49 | 20 | 1.5 | |
| Ethnicity | Yoruba | 809 | 61.5 |
| Hausa | 79 | 6.0 | |
| Igbo | 338 | 25.7 | |
| Others | 90 | 6.8 | |
| Marital status | Single | 106 | 8.0 |
| Married | 1 184 | 90.0 | |
| Widowed | 18 | 1.4 | |
| Divorced | 8 | 0.6 | |
| Religion | Christianity | 949 | 72.1 |
| Islam | 338 | 25.7 | |
| Traditional | 19 | 1.4 | |
| None of the above | 8 | 0.6 | |
| Others | 2 | 0.2 | |
| Educational qualification | Primary | 30 | 2.3 |
| Secondary | 241 | 18.3 | |
| NCE | 145 | 11.0 | |
| OND | 141 | 10.7 | |
| HND | 235 | 17.9 | |
| BSc | 434 | 33.0 | |
| Masters | 66 | 5.0 | |
| PhD | 17 | 1.3 | |
| Missing | 7 | 0.5 | |
| Income status | <$40 000 NGN per month | 587 | 44.6 |
| $41 000 NGN−$70 000 NGN per month | 366 | 27.8 | |
| $71 000 NGN−$100 000 NGN per month | 212 | 16.1 | |
| $101 000 NGN−$130 000 NGN | 58 | 4.4 | |
| $131 000 NGN−$170 000 NGN | 38 | 2.9 | |
| $171 000 NGN−$200 000 NGN | 33 | 2.5 | |
| $201 000 NGN and above | 22 | 1.7 | |
| Occupation | Civil servant | 295 | 22.4 |
| Self-employed | 562 | 42.7 | |
| Unemployed | 146 | 11.1 | |
| Student | 99 | 7.5 | |
| Trader | 138 | 10.5 | |
| Others | 2 | 0.2 | |
| Missing | 74 | 5.6 | |
| Total 1 | 316 | 100.0 |
Table 2 reveals level of satisfaction with antenatal care services among pregnant women in Lagos. The results showed that the level of satisfaction with antenatal care services among pregnant women in Lagos was high (M=4.32, SD=0.88) on a scale of five. For all parameters measured level of satisfaction with antenatal care services was high; respondents were particularly satisfied with blood pressure monitoring in pregnancy (M=4.40), blood testing activities (M=4.39), urine testing (M=4.35), health education provided on adequate diet during pregnancy (M=4.38), personal hygiene (M=4.38) and exclusive breastfeeding (M= 4.35). They were also highly satisfied with information on urine testing (M=4.35).
| Item Satisfaction with | VHS 5 | HS 4 | MS 3 | LS 2 | NS 1 | Mean | SD |
|---|---|---|---|---|---|---|---|
| Importance of blood pressure monitoring in pregnancy | 708 (53.8) | 416 (31.6) | 153 (11.6) | 28 (2.1) | 11 (0.8) | 4.40 | 0.82 |
| Importance of blood testing in pregnancy eg blood group, PCV etc | 756 (57.4) | 366 (27.8) | 156 (11.9) | 26 (2.0) | 12 (0.9) | 4.39 | 0.84 |
| Adequate diet in pregnancy | 739 (56.2) | 392 (29.8) | 147 (11.2) | 22 (1.7) | 16 (1.2) | 4.38 | 0.84 |
| Importance of blood supplement in pregnancy eg folic acid | 750 (57) | 369 (28) | 158 (12) | 24 (1.8) | 15 (1.1) | 4.38 | 0.85 |
| Maintenance of personal hygiene in pregnancy | 730 (55.5) | 401 (30.5) | 148 (11.2) | 23 (1.7) | 14 (1.1) | 4.38 | 0.83 |
| Exclusive breastfeeding | 708 (53.8) | 416 (31.6) | 153 (11.6) | 28 (2.1) | 11 (0.8) | 4.35 | 0.83 |
| Importance of weight and height monitoring/measurement | 724 (55) | 391 (29.7) | 158 (12) | 29 (2.2) | 14 (1.1) | 4.35 | 0.85 |
| Importance of urine testing in pregnancy | 725 (55.1) | 385 (29.3) | 162 (12.3) | 32 (2.4) | 12 (0.9) | 4.35 | 0.85 |
| Maintenance of environmental hygiene | 714 (54.3) | 406 (30.9) | 154 (11.7) | 26 (2.0) | 16 (1.2) | 4.35 | 0.85 |
| Importance of tetanus toxoid in pregnancy | 732 (55.6) | 359 (27.3) | 179 (13.6) | 32 (2.4) | 14 (1.1) | 4.34 | 0.88 |
| Preparation for delivery | 716 (54.4) | 382 (29) | 167 (12.7) | 37 (2.8) | 14 (1.1) | 4.33 | 0.88 |
| Care of the baby after birth | 700 (53.2) | 406 (30.9) | 162 (12.3) | 34 (2.6) | 14 (1.1) | 4.33 | 0.87 |
| Malaria prevention in pregnancy | 708 (53.8) | 379 (28.8) | 181 (13.8) | 38 (2.9) | 10 (0.8) | 4.32 | 0.87 |
| Importance of abdominal examination in pregnancy eg inspection, palpation etc | 679 (51.6) | 421 (32) | 163 (12.4) | 35 (2.7) | 18 (1.4) | 4.30 | 0.88 |
| Harmful practices in pregnancy | 674 (51.2) | 411 (31.2) | 180 (13.7) | 38 (2.9) | 13 (1.0) | 4.29 | 0.88 |
| Antenatal schedule classes | 660 (50.2) | 434 (33) | 177 (13.4) | 29 (2.2) | 16 (1.2) | 4.29 | 0.87 |
| Care for myself after delivery | 685 (52.1) | 391 (29.7) | 180 (13.7) | 42 (3.2) | 18 (1.4) | 4.28 | 0.91 |
| Prevention of infection in pregnancy | 661 (50.2) | 419 (31.8) | 182 (13.8) | 36 (2.7) | 18 (1.4) | 4.27 | 0.90 |
| Danger signs in pregnancy | 662 (50.3) | 403 (30.6) | 196 (14.9) | 35 (2.7) | 20 (1.5) | 4.26 | 0.91 |
| Family planning methods/choices | 589 (44.8) | 404 (30.7) | 190 (14.4) | 77 (5.9) | 56 (4.3) | 4.06 | 1.10 |
| Average weighted mean | 4.32 | 0.88 |
VHS = very high satisfaction, HS = high satisfaction, MS = moderate satisfaction, LS = low satisfaction, NS = no satisfaction, SD = standard deviation Decision rule: mean ≤ 1.49 = NS; 1.5−2.49 = LS; 2.5−3.49 = MS; 3.5−4.49 = HS; 4.5−5 = VHS
Table 3 shows the level of utilisation of antenatal care services among pregnant women in Lagos. The result revealed that the level of utilisation of antenatal care services among pregnant women in Lagos on the average was very high on a scale of five (M=4.37, SD=0.86). The level of utilisation was the highest for maintenance of personal hygiene (M= 4.45), followed by environmental hygiene (M=4.43), scheduled antenatal classes (M=4.43), urine testing (M=4.42), blood testing (M=4.42), consumption of recommended diet during pregnancy (M=4.41) and blood pressure monitoring in pregnancy (M=4.41).
| Item | VHU 5 | HU 4 | MU 3 | RU 2 | NU 1 | Mean | SD |
|---|---|---|---|---|---|---|---|
| Maintenance of personal hygiene | 777 (59) | 380 (28.9) | 139 (10.6) | 13 (1.0) | 7 (0.5) | 4.45 | 0.76 |
| Maintenance of environmental hygiene | 755 (57.4) | 402 (30.5) | 133 (10.1) | 17 (1.3) | 8 (0.6) | 4.43 | 0.77 |
| Antenatal schedule classes | 787 (59.8) | 353 (26.8) | 142 (10.8) | 20 (1.5) | 14 (1.1) | 4.43 | 0.82 |
| Importance of urine testing in pregnancy | 787 (59.8) | 352 (26.7) | 134 (10.2) | 29 (2.2) | 14 (1.1) | 4.42 | 0.84 |
| Importance of blood tests (blood group, PCV etc) | 773 (58.7) | 366 (27.8) | 142 (10.8) | 25 (1.9) | 10 (0.8) | 4.42 | 0.82 |
| Adequate diet in pregnancy | 751 (57.1) | 397 (30.2) | 140 (10.6) | 18 (1.4) | 10 (0.8) | 4.41 | 0.79 |
| Importance of blood pressure monitoring in pregnancy | 764 (58.1) | 378 (28.7) | 139 (10.6) | 23 (1.7) | 12 (0.9) | 4.41 | 0.82 |
| Importance of blood supplement eg folic acid in pregnancy | 764 (58.1) | 370 (28.1) | 143 (10.9) | 27 (2.1) | 12 (0.9) | 4.40 | 0.83 |
| Importance weight and height monitoring/measurement | 756 (57.4) | 380 (28.9) | 144 (10.9) | 26 (2.0) | 10 (0.8) | 4.40 | 0.82 |
| Preparation for delivery | 755 (57.4) | 374 (28.4) | 140 (10.6) | 35 (2.7) | 12 (0.9) | 4.39 | 0.85 |
| Importance of tetanus toxoid in pregnancy | 756 (57.4) | 353 (26.8) | 166 (12.6) | 26 (2.0) | 15 (1.1) | 4.37 | 0.86 |
| Malaria prevention in pregnancy | 739 (56.2) | 393 (29.9) | 135 (10.3) | 33 (2.5) | 16 (1.2) | 4.37 | 0.86 |
| Care of the baby after birth | 752 (57.1) | 367 (27.9) | 148 (11.2) | 31 (2.4) | 18 (1.4) | 4.37 | 0.87 |
| Prevention of infection in pregnancy | 705 (53.6) | 423 (32.1) | 157 (11.9) | 20 (1.5) | 11 (0.8) | 4.36 | 0.81 |
| Exclusive breastfeeding | 733 (55.7) | 391 (29.7) | 134 (10.2) | 25 (1.9) | 33 (2.5) | 4.34 | 0.92 |
| Care for myself after delivery | 731 (55.5) | 379 (28.8) | 140 (10.6) | 45 (3.4) | 21 (1.6) | 4.33 | 0.91 |
| Harmful practices in pregnancy 692 (52.6) | 415 (31.5) | 162 (12.3) | 35 (2.7) | 12 (0.9) | 4.32 | 0.86 | |
| Abdominal examination in pregnancy (inspection, palpation etc) in pregnancy | 715 (54.3) | 387 (29.4) | 156 (11.9) | 34 (2.6) | 24 (1.8) | 4.32 | 0.91 |
| Danger signs in pregnancy | 653 (49.6) | 438 (33.3) | 171 (13) | 34 (2.6) | 20 (1.5) | 4.27 | 0.89 |
| Family planning methods/choices | 635 (48.3) | 390 (29.6) | 155 (11.8) | 64 (4.9) | 72 (5.5) | 4.10 | 1.13 |
| Average weighted mean | 4.37 | 0.86 |
VHU = very highly utilised, HU = highly utilised, MU = moderately utilised, RU = Rarely Utilised, NU = never utilised; SD = standard deviation Decision rule: mean ≤ 1.49 = NU; 1.5−2.49 = RU; 2.5−3.49 = MU; 3.5−4.49 = HU; 4.5−5 = VHU
Table 4 shows the relationship between utilisation and maternal satisfaction. Results showed that utilisation of antenatal care services significantly influenced pregnant women's satisfaction with antenatal care services in Lagos (p<0.05). Furthermore, there was a significant correlation coefficient (r =0.586) and positive slope (B=0.614) which are statistically significant as assessed by a t-test (T=26.179). This implies that utilisation of antenatal care services would lead to an increase in pregnant women's satisfaction with antenatal care services (F(1, 1313) =685.322, p<0.05).
| Item Challenging issues on satisfaction | Respondents | (%) |
|---|---|---|
| Long waiting hours in the clinic | 893 | 67.9 |
| Income/financial constraints | 752 | 57.2 |
| High cost of the service | 725 | 55.1 |
| Distance to the health centre | 732 | 55.6 |
| Level of education | 676 | 51.6 |
| Lack of awareness on existence of the antenatal care services | 656 | 49.9 |
| Accessibility to the clinic | 650 | 49.4 |
| Lack of privacy | 649 | 49.3 |
| Lack of time to attend antenatal care | 646 | 49.1 |
| Language barrier | 630 | 46.9 |
| Cleanliness of the clinic environment | 616 | 46.9 |
| Shyness | 612 | 46.5 |
| Lack of information on antenatal care | 606 | 46.1 |
| Lack of confidentiality | 597 | 45.3 |
| Lack of husband's/partners consent | 571 | 43.4 |
Table 5 presents the challenges faced by pregnant women with satisfaction of antenatal care services in Lagos. The results revealed that these challenges are: long hours of waiting (67.9%) at the clinic, followed by financial issues (57.2), followed by distance to the health centre (55.6%), followed by high cost of the services (55.1%), followed by level of education (51.6%). Although, lack of awareness on existence of antenatal care services (49.9%), accessibility to the clinic (49.4%), lack of privacy (49.3%) and lack of time to attend antenatal care clinic (49.1%) were moderate constraints for the respondents.
| Model | Unstandardised coefficients | Standardised coefficients | t | Sig. | ||
|---|---|---|---|---|---|---|
| B | Sth error | Beta | ||||
| (Constant) | 31.332 | 1.980 | 15.828 | 0.000 | ||
| 1 | Utilisation of antenatal care services | 0.614 | 0.023 | 0.586 | 26.179 | 0.000 |
Dependent variable: satisfaction with antenatal care services
| Model | Sum of squares | Df | Mean square | F | Sig. | |
|---|---|---|---|---|---|---|
| Regression | 83 434.391 | 1 | 83 434.391 | 685.322 | 0.000b | |
| 1 | Residual | 159 851.021 | 1 313 | 121.745 | ||
| Total | 243 285.412 | 1 314 |
R = 0.586 R square = 0.343 Adjusted R square = 0.342
Discussion
The findings of this study showed that most of the respondents (85.6%) were in their reproductive years. This finding may be due to the type of respondents used for the study, which is not abnormal in this type of study. About two-thirds of respondents (61.5%) were Yorubas; this can be due to the fact that the study area belongs to the Yoruba ethnic group. The vast majority (90%) of respondents (pregnant women) was married; hence, this reflected the much respected value of the institution of marriage in Lagos. Majority of the respondents were Christians (72.1%) while (97.7%) of the respondents had post-secondary school education, this finding had a positive effect on the utilisation of antenatal services. The implication of this is that the more educated the respondents are, the more they utilised the services because they know the implications and benefits of attending antenatal clinic during pregnancy. Some (51.2%) of the respondents were middle income individual that is $40 000 NGN –$170 000 NGN per month and employed (75.6%).
Findings shows that utilisation of antenatal care services of pregnant women in Lagos was high. This may be due to a high level of education among the respondents. Also, the findings of this study may also be influenced by the setting of the study. Emelumade et al (2014) disagreed with the findings of this and found in their study that most pregnant women do not utilise antenatal care services in Sahara Africa because they do not receive adequate attention from the healthcare providers. They further reported that healthcare providers are overwhelmed by number of pregnant women seeking antenatal care and this contributed to low utilisation of antenatal care services.
‘Most pregnant women do not utilise antenatal care services in Sahara Africa because they do not receive adequate attention from the healthcare providers’
Also, Dairo and Owoyokun (2010) conducted a study in Ibadan which the findings revealed that pregnant women's level of utilisation of antenatal care is low; this is in disagreement with the finding of this present study. Citong (2017) agreed with the findings of this present study, with the researcher reporting that the level of antenatal care utilisation among pregnant women in Kenya was slightly more than half (52%), just above average. The study by Albertina et al (2015) in Indonesia revealed that pregnant women utilised antenatal care services and the number declined gradually as the pregnancy advances towards childbirth. This implies that the level of antenatal care services utilisation decreases as the pregnancy advances which is not in accordance with the findings of this present study. Sina (2016) also reported in a study conducted at Ekiti State that the pregnant women's utilisation of antenatal care services was high and favourable; this was in conformity with the findings of this present study.
Findings of this study also reveal that the level of satisfaction with antenatal care services among pregnant women in Lagos was high. This means that respondents had high satisfaction with the antenatal care services rendered to them, with most of the satisfaction arising from services provided to them at the general hospitals in Lagos. The study by Rahman et al (2016) is in consonance with the findings of this study. They reported that women had high levels of satisfaction with the antenatal care services received in Malaysia. Other studies such as those by Jallow et al (2012) and Tetui et al (2012) also reported that women were significantly satisfied with maternal health services received during antenatal attendance. Also, the present study is in contrary with Galle et al (2015) who found that the expectations and satisfaction with antenatal care services of pregnant women was high and also evaluated that the information received during antenatal care scheduled and the organisational aspects of antenatal care as less satisfactory which is in contrast with the findings of this study. On the contrary, the findings negates Rahman et al (2016) as they reported that pregnant women were satisfied with the antenatal care services in Malaysia.
Findings also show that pregnant women in Lagos had challenges that affected their satisfaction with antenatal care services. This study further revealed long waiting hours in the clinic, income/financial constraints, high cost of service received in the antenatal care, distance to health centres, level of education, lack of awareness on existence of the antenatal care services, accessibility to the clinic, lack of privacy, language barrier, lack of time to attend antenatal clinics, lack of information on antenatal services, cleanliness of the clinic's environment, shyness, lack of confidentiality, and lack of husband's/partners consent as the major challenges faced by pregnant women in Lagos with satisfaction with antenatal care services. The studies by Jallow et al (2012) and Tetui et al (2012) reported that a good physical environment and efficient management were significant in pregnant women's satisfaction with assessment of the health facility and maternal care services. These findings were in accordance with the findings of this present study.
Also, health providers' unfriendliness, negative attitude and impatience were a major challenge to satisfaction of antenatal care services among pregnant women in Nigeria and Zambia (Butawa et al, 2010; Dzomeku, 2011). Jallow et al (2012) reported in their study, conducted in Bangladesh, that inadequacy of privacy during antenatal care services, lack of confidentiality during check-ups and delivery are major challenge to satisfaction of antenatal care services. The studies by Abd-Rabou et al (2006) and Aniebue and Aniebu (2011) revealed that provision of support, effective communication, health provider's commitment, availability of time overcoming the language barrier and convenience of access are challenges of satisfaction with antenatal care in developing countries faced by pregnant women (respondents), supporting the findings of this present study. Furthermore, studies by Bazant and Koenig (2009), Cham et al (2009) and Oladapo et al (2016), carried out in Kenya, Zambia and Nigeria respectively, reported that the cost of care, affordable drugs, availability of finance, free medicines, educational level and husband support were challenges to satisfaction of antenatal care among pregnant women. All of these findings are in accordance with the findings of this present study.
A regression analysis was used to determine the influence of utilisation on satisfaction with antenatal care services. The result reveals that utilisation of antenatal care services significantly influenced pregnant women's satisfaction with antenatal care services in Lagos (F(1, 1313)=685.322, p<0.05). This finding corroborates with the finding of Albertina et al (2015) on their study, carried out in Balikpapan, that the support from family, friends and social group significantly influence the utilisation of antenatal care services, meaning that social support greatly affects the pregnant mother to utilise antenatal care services regularly. They further stated that the more support obtained, the higher the utilisation of antenatal care services.
Conclusion
The study concludes that utilisation was a significant determinant of satisfaction with antenatal care services. Also, long waiting hours in the clinic, income/financial constraints, high cost of services and distance to health centres are the major challenges faced by pregnant women in Lagos. Efforts should be made by Lagos healthcare management to reduce waiting hours, cost of services and perhaps more health centres in line with the WHO's prescription of one in five minutes walking distance to ensure ready accessibility.