Health facility preparedness for provision of maternal health services to women with disability in Wakiso District, Uganda

Abstract

Introduction: In Uganda, the prevalence of people with disabilities is 16.5% of the total population with women accounting for more than half of the number. Women with disability continue to encounter barriers in accessing maternal health services. Lack of knowledge combined with prejudice against people with disabilities leads to negative attitudes among health care providers. The aim of this study was to establish the infrastructural preparedness of health facilities for the provision of maternal health services to women with disabilities, including attitudes of health workers towards women with disability receiving maternal health services in Wakiso district, Uganda. Methods: This was a cross-sectional study conducted among 41 public and PNFP health facilities in Wakiso district. A facility observational checklist was used to assess the health facilities’ infrastructural preparedness to provide maternal health services to women with disability. In a cross-sectional survey, 182 health workers in health facilities in Wakiso district were recruited and a self-administered questionnaire was used to assess their attitude towards women with disability and factors associated with positive attitude. Positive attitude was measured as having a score of ≥50%, while a facility was considered to have adequate infrastructural preparedness to provide maternal health services to women with disability if it had a composite score of ≥50%. Results: The infrastructural preparedness for provision of maternal health services to women with disabilities among all the 41 health facilities studied was generally inadequate with an average score 32.6%, (min=11%, max=48.7%). The proportion of health workers with a positive attitude towards women with disability was low at 27.0% (95% CI; 21.0-34.0) with the mean attitude score of 44.4% (min= 20%, max= 72.9%). Type of health facility, level of health facility respondent was working in, age of respondent, cadre/profession and working experience were associated with positive attitude towards persons with disability. Health workers working in private not for profit facilities were about 4 times more likely to have a positive attitude towards persons with disability compared to those working in public facilities at 95% CI: 1.3-10.7, p-value 0.017 and this was statistically significant. Health workers working at health center IVs were 6 times more likely to have a positive attitude towards persons with disability compared to those working in hospitals at 95% CI: 1.5-22.7, p-value 0.01 and this was statistically significant. Health workers aged 25-29 years and those aged 30-34 years were more likely to have a positive attitude towards persons with disability compared to their older colleagues aged 35 years and above at adjusted odds ratios 10.707 and 10.283, 95% CIs: 1.3-87.8, p-value 0.027 and 1.7-60.8, p-value 0.01 respectively and this was statistically significant. Clinicians were 6 times more likely to have a positive attitude towards persons with disability compared to other cadres at 95% CI (1.3-29.8) and this was statistically significant with a p-value of 0.021. Health workers with 10 years or more working experience were 17 times more likely to have positive attitude compared those with lesser working experience at 95% CI: 2.3-120.4, p-value of 0.005 and this was statistically significant. Conclusions and recommendations: The study showed that all public and PNFP facilities surveyed lacked the desired infrastructural capacity to manage WWD, coupled with negative attitude among health workers towards WWD. Working in PNFP facilities, health Centre IVs, being a clinician, or a longer working experience of 10 years and above were significantly associated with a positive attitude towards persons with disability. We recommend that health facilities ensure in-service training of health workers on sign language interpretation, in-service training of health workers on management of PWDs, presence of frontline health worker in charge of PWDs and PWDs representation on health unit management committees.