COLLEGE DOMASI INSTITUTE OF MANAGEMENT

AND TECHNOLOHY
STUDENT NAME TAMANDANI POFERA
PROGRAM PUBLIC HEALTH
COURSE RESEARCH METHOD I
CODE BM34
EXAM NUMBER PH-DIMT/251394
DUE DATE

ASSESSING THE PERCEPTION OF PREGNANT WOMEN ON THE ANTERNATAL CARE

SERVICES RECEIVED AT NTANJA HEALTH CENTER, MACHINGA, MALAWI

BY

TAMANDANI POFERA

A
 THESIS

SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE

AWARD OF

THE ADVANCED DIPLOMA IN PUBLIC HEALTH

JUNE, 2025

DEDICATION
This research is dedicated to my beloved parents Mr. and Mrs. Pofera and
guardians for their unwavering support, love, and encouragement throughout my
academic journey. I also dedicate this work to all pregnant women who continue
to seek better healthcare services despite the many challenges they face
ORIGIN
This research project titled “Perception of Pregnant Women on the Antenatal
Care Services Received at Ntaja Health Center, Machinga, Malawi” was
conducted by Tammie in partial fulfillment of the requirements for the award of
advanced Diploma in Public Health at Domasi institute of Management and
Technology. The study was carried out under the guidance of a qualified
supervisor and adhered to ethical standards.
ACKNOWLEDGEMENT
First and foremost, I thank the Almighty God for the strength, wisdom, and
guidance throughout the course of this study. My sincere gratitude goes to my
supervisor for the valuable advice, mentorship, and constructive feedback that
helped shape this research. I also extend appreciation to the management of
Lake Malawi Anglican University for providing the platform for this academic work.
Special thanks to the staff and patients of Ntaja Health Center for their
participation and support. Lastly, I thank my family and friends without forgetting
Sarah Kaunda, Takondwa Pofera, George Kapanda and Bernadetter Kanyinji, for
their endless encouragement and support during the entire research period.
DECLARATION
I, Tamandani Pofera declare that this research project titled “Perception of
Pregnant Women on the Antenatal Care Services Received at Ntaja Health
Center, Machinga, Malawi” is my original work and has not been presented to
any institution for the award of a degree or any other academic qualification. All
sources of information have been duly acknowledged. This research was carried
out under the supervision and guidance of my academic supervisor.

Signature: ____________________
Date: ____________________

LIST OF FIGURES
Figure 1: A Map of Machinga showing parts of Ntaja Health Center Features-
http//: Ntaja-health-center-Machinga ....................................................................... 22
LIST OF TABLES
Table 1: Age of respondents ......................................................................................... 24
Table 2: Gender of Respondent ................................................................................... 24
Table 3: Education Level of the Respondents ............................................................ 25
Table 4: Employment Status of the Respondent ........................................................ 25
Table 5: Perception of the Respondents ..................................................................... 25
Table 6: Satisfaction with Waiting Time for ANC Services ......................................... 25
Table 7: Perception of Availability of ANC Supplies .................................................. 26
Table 8: Distance from Home to Health Centre as a Challenge ............................ 26
Table 9:Cost of Transportation to the Health Facility ................................................. 26
Table 10: Long Waiting Hours at the Facility ............................................................... 26
Table of Contents
DEDICATION ....................................................................................................................... 2
ORIGIN ................................................................................................................................ 3
ACKNOWLEDGEMENT ...................................................................................................... 4
DECLARATION .................................................................................................................... 5
ABSTRACT ........................................................................................................................... 9
CHAPTER ONE: INTRODUCTION OF THE STUDY ............................................................ 10
1.0 Chapter Introduction ............................................................................................... 10
1.2 Background of the Study ......................................................................................... 11
1.3 Problem Statement................................................................................................... 12
1.3 Objectives of the Study ........................................................................................... 14
1.3.1 Main Objective ................................................................................................... 14
1.3.2 Specific Objectives ............................................................................................ 14
1.4 Research Questions .................................................................................................. 14
1.5 Significance of the Study ......................................................................................... 15
1.6 Scope of the Study ................................................................................................... 15
1.7 Limitations of the Study ............................................................................................ 15
1.8 Chapter Summary .................................................................................................... 15
2.1 Chapter Introduction ............................................................................................... 16
2.2.1 Understanding and Expectations of Antenatal Care Services ...................... 16
2.2.2 Level of Satisfaction among Pregnant Women Regarding the Quality,
Accessibility, and Interpersonal Aspects of Antenatal Care Services. ................... 17
2.2.3 Barriers and Enablers Influencing Utilization of Antenatal Care (ANC)
Services ............................................................................................................................. 18
2.3 Conceptual Framework........................................................................................... 19
2.3.1 Theoretical Basis ................................................................................................. 20
2.4 Chapter Summary .................................................................................................... 20
CHAPTER THREE: RESEARCH METHODOLOGY ............................................................. 20
3.0 Introduction ............................................................................................................... 21
3.1 Research Approach ................................................................................................. 21
3.2 Research Design ....................................................................................................... 21
3.3 Study Area ................................................................................................................. 21
3.5 Sampling Design ....................................................................................................... 22
3.5.1 Study Population ................................................................................................ 22
3.5.2 Sampling Technique .......................................................................................... 23
3.5.3 Sample Size.......................................................................................................... 23
3.6 Data Collection Method/Instrument ..................................................................... 23
3.7 Data Analysis Technique ......................................................................................... 23
3.8 Validity and Reliability .............................................................................................. 23
3.9 Ethical Considerations .............................................................................................. 23
3.10 Chapter Summary .................................................................................................. 24
CHAPTER 4: RESULTS ANF FINDINGS OF THE STUDY ..................................................... 24
4.1 INTRODUCTION .......................................................................................................... 24
4.1 Demographic and Socio-Economic Status .......................................................... 24
4.2 The perception of pregnant women towards the quality of antenatal care
services ............................................................................................................................. 25
4.4 Challenges pregnant women face when accessing antenatal care services
........................................................................................................................................... 26
4.5 Chapter Conclusion ................................................................................................. 27
CHAPTER 5: DISCUSSION OF FINDINGS ......................................................................... 27
5.0 Introduction ............................................................................................................... 27
5.1 Demographic and Social Economic Status ......................................................... 27
5.2 Discussion of Findings Based on Objective 1 ........................................................ 28
5.3 Challenges pregnant women face in accessing antenatal care services. ... 28
5.4 The perception of pregnant women on the quality of antenatal care services
offered. ............................................................................................................................. 29
5.5 Chapter Conclusion ................................................................................................. 29
CHAPTER 6: SUMMARY, CONCLUSION, AND RECOMMENDATIONS ........................ 29
6.0 Introduction ............................................................................................................... 29
6.1 Summary of the Study .............................................................................................. 30
6.4 Suggestions for Further Research ........................................................................... 30
6.2 Conclusion ................................................................................................................. 30
6.3 Recommendations ................................................................................................... 30
7.0 APPENDINCIES ........................................................................................................... 31
7.1 RESEARCH TIMEFRAME .......................................................................................... 31
7.2 Research Budget ................................................................................................... 31
8.0 QUESTIONNAIRE ......................................................................................................... 32
8.2 References ................................................................................................................. 37

ABSTRACT
This study aimed to assess the perception of pregnant women on the antenatal
care services received at Ntaja Health Center, Machinga, Malawi. The specific
objectives were to examine the quality of antenatal services provided, explore
the accessibility of ANC services, assess the level of satisfaction among pregnant
women, and identify challenges faced in accessing antenatal care. A descriptive
cross-sectional study design was used, with data collected using questionnaires,
focus group discussions, and observations. Stratified sampling was employed to
select participants, and data were analyzed using SPSS and Microsoft Excel. The
findings revealed varied perceptions regarding the quality and accessibility of
ANC services, with some women expressing satisfaction while others cited
challenges such as long waiting times, inadequate resources, and poor
communication from healthcare providers. The study concludes by
recommending improvements in service delivery, infrastructure, and
communication strategies to enhance maternal health outcomes.
CHAPTER ONE: INTRODUCTION OF THE STUDY
1.0 Chapter Introduction
Antenatal care (ANC) is widely recognized as a key pillar in the reduction of
maternal and neonatal mortality globally. According to the World Health
Organization (WHO, 2016), ANC presents a strategic opportunity to deliver
interventions that can significantly improve maternal and fetal health outcomes,
such as early detection and management of pregnancy-related complications,
promotion of healthy behaviors, and immunization. Globally, millions of women
still face barriers to accessing timely and quality ANC services, contributing to over
295,000 maternal deaths reported annually, particularly in low- and middle-
income countries (WHO, 2022). In Sub-Saharan Africa, where over 66% of these
deaths occur, poor access, underutilization of services, and health system
inefficiencies remain major challenges (UNFPA, 2020). In response to these
persistent issues, initiatives such as the Sustainable Development Goals (SDG 3.1)
aim to reduce the global maternal mortality ratio to less than 70 per 100,000 live
births by 2030 (United Nations, 2015).
Malawi has made notable strides in promoting maternal health through policies
such as the Malawi Health Sector Strategic Plan II (2017–2022), which prioritizes
improving maternal, newborn, and child health services. Despite these
commitments, maternal mortality in Malawi remains high at 349 deaths per
100,000 live births (NSO & ICF, 2023). The Ministry of Health continues to implement
free maternal healthcare services in public facilities, yet utilization and satisfaction
remain uneven, particularly in rural and underserved areas. Studies conducted in
Malawi have indicated that factors such as poor health worker attitudes, lack of
privacy, long waiting times, and inadequate health education negatively
influence women's experiences during ANC visits (Chimatiro et al., 2018;
Chikaphupha et al., 2021).
Ntaja Health Center, Machinga District represents a rural health facility serving a
predominantly agrarian population. The center provides basic ANC services
under the Essential Health Package, yet there are concerns raised by community
stakeholders and anecdotal reports suggesting that pregnant women may have
mixed feelings about the quality and responsiveness of the care they receive.
Understanding these perceptions is crucial for tailoring interventions to meet the
specific needs of women in rural Machinga. This research, therefore, seeks to
investigate the perception of pregnant women regarding the ANC services
provided at Ntaja Health Center, highlighting the strengths, challenges, and
areas for improvement.

1.2 Background of the Study

Antenatal care (ANC) is a critical component of maternal health services, aiming
to ensure the well-being of both mother and unborn child through timely
interventions, health promotion, and education during pregnancy. Globally, ANC
has been acknowledged by health authorities and researchers as a fundamental
tool in reducing maternal and neonatal morbidity and mortality (WHO, 2016). The
World Health Organization recommends a minimum of eight ANC visits to improve
pregnancy outcomes, yet in many low- and middle-income countries,
attendance and quality of ANC remain suboptimal (WHO, 2022). Barriers such as
geographic inaccessibility, poor quality of care, lack of skilled providers, and
sociocultural beliefs continue to limit women’s access to comprehensive
antenatal services, particularly in rural areas of Sub-Saharan Africa (Say et al.,
2014). In Malawi, the government has made considerable efforts to improve
maternal health outcomes by offering free ANC services in public health facilities.
The Malawi National Reproductive Health Policy and the Health Sector Strategic
Plan II have placed emphasis on increasing coverage and improving the quality
of maternal care (MoH, 2017). However, despite these policies, the utilization of
ANC services remains inconsistent, and maternal mortality remains a public health
concern, with the Malawi Demographic and Health Survey (2022) reporting that
only 51% of women attend the recommended four or more ANC visits, and many
start ANC late in their pregnancies (NSO & ICF, 2023). This suggests that the
availability of services alone is not sufficient—women’s perceptions and
experiences of care significantly influence their decisions to utilize ANC services.
At the community level, Ntaja Health Center, Machinga District serves a
population that is predominantly rural, with limited access to higher-level health
facilities. Although the center offers ANC services under the Essential Health
Package, informal reports from community leaders and health surveillance
assistants indicate varying levels of satisfaction among pregnant women. Some
report positive experiences, such as supportive healthcare workers and timely
services, while others cite challenges including overcrowding, long wait times,
and limited counseling on danger signs during pregnancy. These varying
perceptions can affect not only individual health-seeking behavior but also
influence community trust in healthcare systems. Understanding pregnant
women's perceptions at Ntaja Health Center is essential for informing targeted
quality improvement initiatives, fostering positive client-provider relationships, and
ultimately enhancing maternal health outcomes in rural Malawi.

1.3 Problem Statement

Antenatal care (ANC) is crucial in safeguarding maternal and neonatal health,
yet its coverage and quality remain inconsistent across many low-income
countries, particularly in Sub-Saharan Africa. The World Health Organization (2022)
estimates that globally, approximately 810 women die every day from
preventable causes related to pregnancy and childbirth, and the majority of
these deaths occur in low-resource settings. In Malawi, maternal health continues
to face serious challenges. The latest Malawi Demographic and Health Survey
(NSO & ICF, 2023) reports that while 91% of women receive at least one ANC visit,
only 51% complete the recommended four or more visits, and merely 42% begin
care during the first trimester. These statistics signal a substantial gap in optimal
maternal care. Further, disparities in service utilization and quality are more
pronounced in rural areas such as Machinga District, where access to healthcare
facilities is limited, and pregnant women often experience logistical, financial,
and systemic barriers. Anecdotal accounts from rural communities suggest that
some women avoid ANC services due to poor treatment by staff, long wait times,
or lack of trust in service quality. The Government of Malawi has introduced
several policy measures to address maternal health, including the National
Reproductive Health Policy, the Health Sector Strategic Plan II (2017–2022), and
integration of ANC into the Essential Health Package. These strategies aim to
promote early ANC initiation, increase service coverage, and enhance the
quality of care. Free maternal services have been made available in all public
health facilities, and task-shifting has been encouraged to ensure that even
remote areas like Ntaja have skilled personnel available. Moreover, various non-
governmental organizations (NGOs) and development partners have supported
maternal health through the provision of infrastructure, health worker training, and
maternal education campaigns. While these efforts have led to improvements in
access and awareness, recent studies suggest that the quality of care and
patient experience have not improved at the same pace. Issues such as
inadequate counseling, poor provider attitudes, and lack of essential supplies
continue to be reported in studies conducted across different parts of Malawi
(Chikaphupha et al., 2021; Chimatiro et al., 2018). Despite national efforts to scale
up maternal health services, very few studies have explored how pregnant
women perceive the antenatal care they receive, particularly at the level of
individual rural facilities like Ntaja Health Center. While statistics show progress in
service coverage, they often mask qualitative aspects of care such as respect,
dignity, communication, and satisfaction—all of which influence service utilization.
In a rural context where health-seeking behavior is heavily influenced by word-of-
mouth and community perceptions, understanding women’s experiences and
viewpoints is essential. This study, therefore, seeks to fill this critical knowledge gap
by exploring the perceptions of pregnant women attending ANC at Ntaja Health
Center. The findings will not only inform facility-level improvements but may also
contribute to broader policy revisions aimed at enhancing quality and
responsiveness in maternal health services across Malawi.

1.3 Objectives of the Study

1.3.1 Main Objective
To assess the perception of pregnant women regarding the antenatal care
services received at Ntaja Health Center, Machinga District, Malawi.

1.3.2 Specific Objectives

1. To explore pregnant women’s understanding and expectations of
antenatal care services at Ntaja Health Center.
2. To assess the level of satisfaction among pregnant women regarding the
quality, accessibility, and interpersonal aspects of antenatal care services
provided.
3. To identify perceived barriers and enablers influencing pregnant women’s
utilization and experiences of antenatal care services at the facility.

1.4 Research Questions

1. What are pregnant women’s understandings and expectations of
antenatal care services at Ntaja Health Center?
2. How satisfied are pregnant women with the quality, accessibility, and
interpersonal aspects of antenatal care services provided at the facility?
3. What are the perceived barriers and enablers influencing the utilization and
experiences of antenatal care services by pregnant women at Ntaja
Health Center?
1.5 Significance of the Study
This study is significant because it provides insights into how pregnant women
perceive antenatal care services at a rural health facility, which is often
overlooked in broader healthcare evaluations. By focusing on Ntaja Health
Center, the research highlights the lived experiences, satisfaction levels, and
challenges faced by expectant mothers in accessing maternal care. The findings
will be valuable to healthcare providers, district health management teams, and
policymakers in identifying areas for improvement, enhancing service delivery,
and promoting respectful, patient-centered care. Ultimately, this can contribute
to better maternal health outcomes and increased utilization of antenatal
services in similar rural settings.

1.6 Scope of the Study

This study is limited to assessing the perceptions of pregnant women attending
antenatal care services at Ntaja Health Center, Machinga District. It focuses on
their experiences, satisfaction, and challenges related to the services offered,
without examining clinical outcomes or including other health facilities in the
district.

1.7 Limitations of the Study

The study may face limitations such as a small sample size, which could affect the
generalizability of the findings. Additionally, responses may be influenced by
social desirability bias, where participants may not fully express negative views.
Time constraints and language barriers may also affect data collection and
interpretation.

1.8 Chapter Summary

This chapter introduced the study by outlining the importance of antenatal care
at global, national, and local levels. It highlighted the current challenges in
maternal health, presented the research problem, stated the objectives and
questions guiding the study, and explained its significance, scope, and limitations.
CHAPTER 2 LITERATURE REVIEW

2.1 Chapter Introduction

This chapter presents a critical review of existing literature related to antenatal
care (ANC) services, focusing on the key variables outlined in the study. It explores
the understanding and expectations of pregnant women regarding ANC,
satisfaction levels with services received, and barriers/enablers influencing
utilization. The chapter also discusses the theoretical and conceptual frameworks
that underpin the study, thus providing a foundation for the methodology and
interpretation of results.

2.2.1 Understanding and Expectations of Antenatal Care Services

Pregnant women’s understanding of antenatal care plays a critical role in
influencing their decision to seek and utilize maternal health services. According
to Bloom et al. (2001), knowledge of the importance of ANC is strongly associated
with timely and consistent attendance. In many low-resource settings, including
Malawi, ANC is often perceived as a means to obtain tangible benefits such as
iron supplements, rather than a holistic health-promoting activity (Chimatiro et al.,
2018).
Research in Sub-Saharan Africa has shown that women with higher levels of
education or prior exposure to health promotion messages are more likely to
understand ANC as a preventive and promotive service rather than curative
(Titaley et al., 2010; Afulani, 2015). Expectant mothers commonly anticipate
services such as physical examinations, laboratory tests, and counseling on
danger signs, nutrition, and birth preparedness. However, in many rural areas,
women report limited expectations due to a lack of information or previous
negative experiences (Moyer & Mustafa, 2013).
In Malawi, the Ministry of Health (MoH, 2017) has emphasized community
sensitization campaigns to promote awareness of ANC benefits. Yet, studies show
gaps in understanding persist, particularly in rural communities where
misconceptions, low literacy levels, and inadequate male involvement
undermine service uptake (NSO & ICF, 2023). Moreover, expectations can vary
significantly across socio-economic and demographic factors, suggesting a need
for targeted and culturally appropriate health education.
Understanding and expectation influence not only whether women attend ANC
but also how they evaluate the quality of services received. When expectations
align with actual service delivery, satisfaction and trust in the healthcare system
are reinforced (Kruk et al., 2009). Therefore, evaluating these perceptions provides
critical insights into service utilization patterns and health outcomes.

2.2.2 Level of Satisfaction among Pregnant Women Regarding the Quality,

Accessibility, and Interpersonal Aspects of Antenatal Care Services.
Satisfaction with antenatal care services is a key determinant of continued use,
compliance, and trust in the healthcare system. Pregnant women’s level of
satisfaction is shaped by multiple factors, including quality of care, accessibility,
and provider-patient interactions (Donabedian, 1988). The World Health
Organization (WHO, 2016) defines quality maternal care as care that is safe,
effective, timely, efficient, equitable, and people-centered. When these
dimensions are met, women are more likely to feel respected, empowered, and
willing to attend subsequent visits.
In the Malawian context, evidence from studies such as Chimatiro et al. (2018)
and Chikoko et al. (2020) indicates that while some women express satisfaction
with the availability of services, concerns remain about long waiting times, lack of
privacy, inadequate communication, and occasional verbal abuse from health
workers. Accessibility challenges—especially in rural settings like Machinga—
include distance to facilities, transportation issues, and poor infrastructure, all of
which influence how services are perceived and experienced (NSO & ICF, 2023).
Interpersonal relationships between pregnant women and healthcare providers
are central to satisfaction. Women value respectful, friendly, and empathetic
interactions (Afulani et al., 2019). Negative attitudes, dismissiveness, or judgmental
behavior from health workers lead to fear, resentment, and disengagement from
ANC services. On the other hand, when providers are supportive, listen actively,
and provide adequate explanations, clients are more likely to report high
satisfaction levels (Kruk et al., 2014).
Another important aspect is the availability of essential resources and
infrastructure, including drugs, clean water, and basic equipment. Their absence
not only undermines service delivery but also contributes to dissatisfaction and
mistrust (Gabrysch & Campbell, 2009). Additionally, gender dynamics, cultural
beliefs, and household decision-making power affect how women evaluate
services. In patriarchal communities, some women may be unable to express
dissatisfaction openly due to social norms or fear of being blamed (Moyer &
Mustafa, 2013)

2.2.3 Barriers and Enablers Influencing Utilization of Antenatal Care (ANC)

Services
The utilization of antenatal care (ANC) services is vital for ensuring maternal and
fetal health. However, several barriers and enablers influence pregnant women’s
ability and willingness to access and continue using these services. Understanding
these factors helps stakeholders to design targeted interventions that improve
maternal health outcomes, especially in rural and resource-constrained settings
like Ntaja Health Center, Machinga.
One of the most documented barriers is distance to health facilities, especially in
rural areas where healthcare centers are sparsely distributed. Pregnant women
often have to walk long distances, sometimes over 5 kilometers, which becomes
increasingly difficult in advanced stages of pregnancy or during the rainy season
(NSO & ICF, 2023). Transport challenges such as lack of ambulances or affordable
public transport also contribute to missed appointments (Gabrysch & Campbell,
2009).
Another major barrier is cost-related constraints, even when services are declared
free. Hidden costs such as paying for transport, buying medication when there is
a stock-out, or acquiring recommended dietary supplements can deter women
from accessing care (Chikoko et al., 2020). Moreover, long waiting times, poor
service quality, and unfriendly attitudes of healthcare workers further discourage
women from attending ANC visits (Afulani et al., 2019).
Sociocultural factors also play a crucial role. In some communities, low levels of
education among women and lack of awareness about the importance of ANC
services lead to low utilization (Moyer & Mustafa, 2013). Gender dynamics and
male dominance in household decisions can also restrict women's autonomy,
making it difficult for them to seek care without permission or accompaniment
from their partners (Simkhada et al., 2008).
Conversely, a number of enabling factors have been identified. Health education
and community sensitization programs that highlight the benefits of ANC have
been found to improve attendance and knowledge levels. Programs such as the
Malawi Community Health Strategy (2017-2022) encourage outreach services
and the use of Health Surveillance Assistants (HSAs) to follow up on pregnant
women at the community level (MOH, 2017).
Supportive partners and family members also enable better ANC attendance.
Women who receive emotional, financial, or physical support are more likely to
attend appointments consistently (Chimatiro et al., 2018). Additionally, positive
past experiences with healthcare services, such as respectful treatment, short
waiting times, and availability of medical supplies, build trust and increase the
likelihood of return visits (Kruk et al., 2014).
Government policies and international programs like Results-Based Financing (RBF)
and Safe Motherhood Initiatives have also acted as structural enablers by
improving service quality, increasing staff motivation, and ensuring essential
supplies are available (WHO, 2016).

2.3 Conceptual Framework

A conceptual framework provides a systematic structure to understand and
analyze the perceptions of pregnant women on antenatal care (ANC) services
at Ntaja Health Center. This framework outlines the key variables and their
relationships, drawing from existing literature, health behavior theories, and the
socio-ecological model.

2.3.1 Theoretical Basis

This study is guided by the Health Belief Model (HBM), which posits that health
behavior is influenced by individual beliefs about health conditions and the
perceived benefits or barriers to taking action. The HBM suggests that the
likelihood of a pregnant woman attending ANC services is determined by:
Perceived susceptibility (belief about the risk of pregnancy complications),
Perceived severity (belief about the seriousness of the complications), Perceived
benefits (belief that ANC can prevent or reduce the severity), Perceived barriers
(beliefs about obstacles to accessing ANC, such as distance, cost, or poor
treatment), Cues to action (external factors that prompt ANC attendance, e.g.,
health education) and Self-efficacy (confidence in one’s ability to attend ANC)

2.4 Chapter Summary

This chapter discussed the importance of antenatal care (ANC), existing literature
on ANC services, and the factors influencing pregnant women’s perceptions and
utilization of ANC. It covered relevant theoretical and conceptual frameworks
and identified the research gap. It concluded by highlighting the need for more
localized studies, particularly in rural settings like Ntaja Health Center
CHAPTER THREE: RESEARCH METHODOLOGY
3.0 Introduction
This chapter presents the methodology used in the study. It outlines the research
design and approach, study site, population, sampling techniques, sample size,
data collection methods, data analysis tools, ethical considerations, and the
limitations and delimitations of the study.
3.1 Research Approach
This study used a quantitative research approach. The aim was to collect
numerical data that can be analyzed statistically. This approach was selected
because it allows for objective measurement of variables and helps to make
generalizations from the findings. It also made it easier to use tools such as
questionnaires, which provide structured responses that can be compared.
3.2 Research Design
The study used a descriptive cross-sectional design. This design helped in
collecting data at a single point in time to describe the current situation of
antenatal care services as perceived by pregnant women. It was suitable
because it is cost-effective, simple to manage, and can provide a clear snapshot
of the population’s views during the study period.
3.3 Study Area
The study was conducted at Ntaja Health Centre in Machinga District, Malawi.
Machinga is located in the Central Region of Malawi and borders Zambia to the
west. The district lies between latitudes 13°55' and 14°15' South and longitudes
32°30' and 33°00' east. Ntaja Health Centre is one of the health facilities serving
rural communities in the district. The area is mostly populated by smallholder
farmers and has limited access to advanced health services.
According to the 2018 Malawi Population and Housing Census, Machinga District
had a population of about 602,305 people, with a large number of women of
reproductive age. The health center provides essential maternal services,
including antenatal care, and is easily accessible to the surrounding population.
Figure 1: A Map of Machinga showing parts of Ntaja Health Center Features-
http//: Ntaja-health-center-Machinga
3.5 Sampling Design
Sampling design refers to the method used to select individuals or groups from a
population to participate in a study. It helps ensure that the sample is
representative of the entire population, allowing for accurate generalization of
results (Kothari, 2004). This study used a stratified sampling technique to divide the
population into groups based on characteristics such as age, education level,
and parity to ensure all sub-groups were fairly represented.
3.5.1 Study Population
The study population comprised all pregnant women who attended antenatal
care services at Ntaja Health Centre in Machinga District during the data
collection period. This group was chosen because they directly experienced the
services under investigation and could provide relevant and reliable information
about their perceptions.
3.5.2 Sampling Technique
This study used stratified random sampling. The population was divided into
different groups or strata such as age, education level, and number of
pregnancies. From each stratum, participants were randomly selected to ensure
fair representation. This technique improves the accuracy and reliability of the
results (Creswell, 2014).
3.5.3 Sample Size
The sample size was determined using the Taro Yamane formula (Yamane, 1967):
n = N/1+N (e²)
Where:
n = sample size
N = total population
e = margin of error (0.05)
Assuming the population of pregnant women attending antenatal care at Ntaja
Health Centre is 200:
n = 200 / 1 + 200 (0.05)² = 200/ 1+ 0.5 = 200/1.5 = 133
Therefore, the study used a sample size of 133 participants.
3.6 Data Collection Method/Instrument
Data were collected using structured questionnaires, focus group discussions, and
direct observation. The questionnaire had both closed-ended questions and
Likert-scale items. Focus groups were used to explore shared experiences and
perceptions, while observations helped capture non-verbal communication and
behaviors.
3.7 Data Analysis Technique
Data were coded and analyzed using SPSS and Microsoft Excel. Descriptive
statistics such as frequencies and percentages were used to summarize the data.
Charts and tables were generated to present the findings clearly. Thematic
analysis was applied to qualitative data from focus groups.
3.8 Validity and Reliability
The tools were tested for content validity by consulting academic supervisors and
experts in public health. Reliability was ensured through a pilot study at a nearby
health facility with similar characteristics. Necessary adjustments were made
before the actual data collection.
3.9 Ethical Considerations
The study followed all ethical guidelines as provided by Domasi Institute of
Management and Technology. An official approval letter was obtained from the
research committee before data collection began. Informed consent was sought
from all participants after clearly explaining the purpose of the study, their right to
participate voluntarily, and the right to withdraw at any point without
consequences. Participants were assured of confidentiality and anonymity, and
no names were recorded. Data collected was used strictly for academic
purposes, and access was limited to the research team only.

3.10 Chapter Summary

This chapter presented the research approach, design, study area, sampling
methods, data collection instruments, analysis techniques, validity, reliability, and
ethical considerations.

CHAPTER 4: RESULTS ANF FINDINGS OF THE STUDY

4.1 INTRODUCTION
This chapter presents analysis of the results of the data that was collected in a
study conducted at Ntanja Health Center, Machinga District.
4.1 Demographic and Socio-Economic Status
Table 1: Age of respondents
Age Group Frequency (n) Percentage (%)
18 – 25 20 25
26- 35 30 37.5
36 – 45 18 22
46 and above 12 15
Source: Author5
The researcher found that most respondents were between 26 and 35 years old
(37. 5%), representing the active reproductive and economically productive age
group.

Table 2: Gender of Respondent

Gender Frequency(n) Percentage (%)
Male 35 43.8
Female 45 56.2
Source: Author
The researcher found that females slightly dominated the sample (56.2%), which
may reflect the demographic reality of health service users in the study area.
Table 4.3: Level of Education
Table 3: Education Level of the Respondents
Education Level Frequency Percentage (%)
No formal School 5 6.2
Primary 20 25
Secondary 35 43.8
Tertiary 20 25

Source: Author
The researcher found that the majority of respondents had attained secondary
education (43.8%), indicating a relatively informed population.
Table 4: Employment Status of the Respondent
Employment Status Frequency(n) Percentage (%)
Employed 30 37.5
Unemployed 25 31.3
Self-Employed 25 31.3
Source: Author
The researcher found that half of the respondents were unemployed (37.5%),
which could influence access and attitudes toward antenatal services.
4.2 The perception of pregnant women towards the quality of antenatal care
services
Table 5: Perception of the Respondents
Response Frequency(n) Percentage(%)
Agree 60 75
Neutral 10 12.5
Disagree 10 12.5
Source: Author
The researcher found that 75% of respondents agreed that health workers treated
them with respect and care, while 25% either disagreed or were neutral.
Table 6: Satisfaction with Waiting Time for ANC Services
Response Frequency(n) Percentage (%)
Satisfied 30 37
Neutral 20 25
Not- Satisfied 30 37

Source: Author
The researcher found that 37.5% of the respondents were satisfied with the waiting
time, while an equal percentage expressed dissatisfaction, indicating mixed
perceptions.
Table 7: Perception of Availability of ANC Supplies
Response Frequency(n) Percentage (%)
Always Available 20 25
Sometimes Available 40 50
Rerely Available 20 25

Source: Author
The researcher found that only 25% of respondents felt that ANC supplies were
always available, while 75% experienced inconsistent availability.
4.4 Challenges pregnant women face when accessing antenatal care services

Table 8: Distance from Home to Health Centre as a Challenge

Response Frequency(n) Percentage (%)
Yes 50 62.3
No 30 37.5

Source: Author
The researcher found that 62.5% of the respondents reported that the distance
from their homes to Ntanja Health Centre was a major challenge when accessing
antenatal care services

Table 9:Cost of Transportation to the Health Facility

Response Frequency (n) Percentage (%)
Expensive 45 56.3
Affordable 20 25
No -Transport Cost 15 18.5

Source: Author
The researcher found that over half (56.25%) of the respondents considered the
cost of transportation to be expensive, which posed a challenge in accessing
antenatal services.

Table 10: Long Waiting Hours at the Facility

Response Frequency(n) Percentage (%)
Yes 60 75
No 20 25
Source: Author
The researcher found that 75% of the participants indicated they experienced
long waiting hours at the health facility, highlighting it as a common challenge in
seeking antenatal care.
4.5 Chapter Conclusion
This chapter has presented and analyzed the findings of the study based on the
questionnaire responses. The results have been categorized into demographic
and socio-economic characteristics and the three specific objectives of the study.
Tables and explanations were used to display the responses, and trends have
been identified and described based on the data collected.

CHAPTER 5: DISCUSSION OF FINDINGS

5.0 Introduction
This chapter discusses the findings presented in Chapter 4. The findings are
interpreted, compared with previous studies, and linked to the research
objectives. This section provides insights into what the results mean in relation to
the perception of pregnant women on antenatal care services at Ntanja Health
Centre.
5.1 Demographic and Social Economic Status
The findings from the study revealed that the majority of respondents were aged
between 26 and 35 years. This aligns with a study conducted by Banda (2020),
which also found that most antenatal care service users in rural Malawi are within
this age group due to their reproductive capacity and active engagement in
family planning and maternal health.
In terms of gender, women dominated the sample, which is expected in a study
focusing on pregnant women’s perceptions. This supports previous findings by
Chirwa (2019), who noted that gender-specific studies in maternal health typically
involve female respondents, as they are the direct recipients of antenatal care.
Educational status showed that most respondents had attained secondary
education. This suggests a relatively literate group capable of understanding
basic health messages, which may positively influence their perception of
antenatal care. These results correspond with a study by Kalua et al. (2018), who
emphasized the role of education in improving health-seeking behavior among
pregnant women.
Employment status showed that 50% of the respondents were unemployed. This
could be due to the rural setting of the study where formal employment
opportunities are limited. Unemployment may affect the ability to access quality
care and transport, as supported by Lungu and Muula (2021), who found that
economic status is a strong determinant of maternal health service utilization in
Malawi.
5.2 Discussion of Findings Based on Objective 1
To assess the knowledge level of pregnant women towards antenatal care
services at Ntanja Health Centre.
The study revealed that most respondents had knowledge of the importance of
early ANC attendance, with many indicating they knew it helps detect
complications early. This finding is consistent with a study by Moyo et al. (2020),
who found that knowledge about ANC was generally high among women in
southern Malawi due to sensitization by health surveillance assistants.
However, a small number of respondents indicated that they were not aware of
some specific ANC components such as tetanus vaccination or HIV testing. This
indicates knowledge gaps which could be addressed by improving
communication during clinic visits. A study by Nyasulu and Chimwaza (2017)
revealed similar gaps in the understanding of ANC components among rural
women.
The study also found that women believed in the benefits of regular ANC visits,
reflecting a positive attitude. According to WHO (2020), knowledge and attitudes
towards ANC are crucial in determining attendance and service utilization.
5.3 Challenges pregnant women face in accessing antenatal care services.
The findings showed that long distance to health facilities, poor roads, and lack
of transport were the most cited challenges. This matches findings by Ngwira et
al. (2019), who observed that geographic and infrastructural barriers significantly
affect access to maternal services in rural Malawi.
Financial constraints were also mentioned, even though the services are provided
for free. This includes money for transport, food, or paying someone to
accompany them. Such hidden costs have also been highlighted by Msiska et al.
(2018) as factors that deter rural women from accessing healthcare services
regularly.
Another challenge identified was the negative attitude of some health workers.
Some respondents mentioned being shouted at or ignored. This discourages
women from seeking early or regular care, as similarly found in a study by Mponda
and Zgambo (2021), which called for more patient-centered care approaches in
rural health centers.
5.4 The perception of pregnant women on the quality of antenatal care services
offered.
Most respondents perceived the services at Ntanja Health Centre as good,
particularly in terms of availability of services like blood pressure checks and
provision of health talks. This is in line with the findings of Phiri and Nyondo-
Mipando (2020), who noted that rural women often appreciate the available
ANC services even when they are limited in scope.
However, there were concerns about the long waiting time and shortage of staff,
which created frustrations among women. These issues affect the perception of
quality and have also been discussed in literature by Zimba and Kumwenda
(2017), who found that overworked and understaffed facilities compromise
maternal health service delivery.
The attitude of health workers was reported as mixed. While some respondents
found them caring, others felt they were harsh or dismissive. This variation in
provider behavior plays a critical role in shaping overall satisfaction, as noted by
WHO (2019), which emphasizes respectful maternity care.
5.5 Chapter Conclusion
This chapter discussed the key findings of the study. It was observed that
demographic and socio-economic factors influenced antenatal care
perceptions. The knowledge of ANC services was fairly high, but several
challenges hinder access and affect perception of service quality. The next
chapter presents the summary, conclusions, and recommendations.

CHAPTER 6: SUMMARY, CONCLUSION, AND RECOMMENDATIONS

6.0 Introduction
This chapter summarizes the entire study, draws conclusions based on the findings,
and provides recommendations for improving antenatal care (ANC) services. It
also offers suggestions for future research related to maternal health.
6.1 Summary of the Study
The study was conducted to assess the perception of pregnant women on the
antenatal care services they receive at Ntanja Health Centre, Mchinji, Malawi. It
aimed to:
 Assess the knowledge level of pregnant women towards antenatal care
services.
 Explore challenges pregnant women face in accessing antenatal care
services.
 Determine their perceptions of the quality of antenatal care services
offered.
6.4 Suggestions for Further Research
Future research should focus on:
1. Comparing ANC service perceptions between rural and urban health
centers.
2. Exploring men’s involvement in antenatal care decisions.
6.2 Conclusion
The study concluded that pregnant women attending Ntanja Health Centre
generally possess a good level of knowledge regarding antenatal care services.
Most of the respondents understood the importance of early booking, attending
all scheduled visits, and receiving key services such as vaccinations and health
education. Despite this knowledge, access to antenatal care remains a
challenge. Women reported difficulties such as long distances to the health
facility, unreliable or expensive transport, and long waiting hours at the clinic.
These challenges significantly affect the utilization of ANC services. Furthermore,
while the majority of respondents expressed satisfaction with the services received,
some noted negative attitudes from health workers and the lack of privacy during
examinations. These concerns, although not universal, point to areas that require
attention in order to improve service delivery and client satisfaction.
6.3 Recommendations
The study recommends that health education on antenatal care should be
increased in the community. This can be done through community outreach
programs, radio messages, and health talks at clinics. By doing so, more pregnant
women will understand the importance of attending antenatal clinics early and
consistently throughout their pregnancy.
The government and partners should improve access to health services,
especially for women in remote areas. This can be achieved by constructing more
health facilities closer to communities and improving transport options. Such
measures will help reduce the delays and challenges pregnant women face
when seeking care.
7.0 APPENDINCIES
7.1 RESEARCH TIMEFRAME
ITEMS JAN FEB MARCH APRIL MAY JUNE
Research
Title
Defend

Concept
Note

Data
Collection
Analysis

Defend

Thesis
submission

7.2 Research Budget

CATEGORY ITEMS AMOUNT (MK)

1 Stationary 15 000
2 Printing & Photocopying Questionnaires 3 500
3 Transport 48 000
4 Airtime 2 000
7 Contingency 5 000
Total 73,500
8.0 QUESTIONNAIRE
PERCEPTION OF PREGNANT WOMEN ON THE ANTENATAL CARE SERVICES
RECEIVED AT NTAJA HEALTH CENTRE, MACHINGA, MALAWI
Date of interview -------------------
Questionnaire Number
Consent
My name is TammieI am conducting a study titled “Perception of Pregnant
Women on the Antenatal Care Services Received at Ntaja Health Centre,
Machinga, Malawi.” The purpose of this questionnaire is to gather information
from pregnant women about their experiences with antenatal care. Your
participation is voluntary, and your responses will be kept confidential and used
for academic purposes only.
Section 1: Demographic and Socio-Economic Status
1. How old are you?
a) Below 20
b) 20–34
c) 35 and above

2. What is your marital status?

a) Single
b) Married
c) Divorced/Widowed

3. What is your highest level of education?

a) No formal education
b) Primary
c) Secondary and above

4. What is your main source of income?

a) Farming
b) Business
c) Formal employment

5. What is your average monthly income?

a) Less than MK20, 000
b) MK20, 000–MK50, 000
c) More than MK50, 000

6. What is your religious affiliation?

a) Christian
b) Muslim
c) Other

7. How far is your home from Ntaja Health Centre?

a) Less than 5 km
b) 5–10 km
c) More than 10 km

8. How many times have you been pregnant (including the current pregnancy)?
a) First time
b) 2–3 times
c) More than 3 times
Section 2: Perception on Quality of Antenatal Care Services
1. Were you welcomed warmly during your visits?
a) Yes
b) No
c) Not sure
2. Were the health workers respectful during service delivery?
a) Agree
b) Disagree
c) Neutral

3. Do you think the services provided meet your expectations?

a) Yes
b) No
c) Somehow

4. Are the waiting times reasonable?

a) Yes
b) No
c) Not sure

5. Are the antenatal care services consistent during every visit?

a) Always
b) Sometimes
c) Never

Section 3: Factors Influencing Perception

1. Do you feel the health center is clean and hygienic?
a) Yes
b) No
c) Not sure

2. Is distance to the health center a challenge for you?

a) Yes
b) No
c) Sometimes

3. Do you receive proper information and counselling during your visits?

a) Yes
b) No
c) Not always

4. Are you comfortable discussing your health issues with the staff?
a) Agree
b) Disagree
c) Neutral

5. Does the availability of medication influence your satisfaction?

a) Yes
b) No
c) Not sure

Section 4: Level of Satisfaction with ANC Services

1. Are you satisfied with the services provided during ANC visits?
a) Yes
b) No
c) Not sure

2. Do you feel safe receiving care at this facility?

a) Yes
b) No
c) Sometimes
3. Would you recommend Ntaja Health Centre to another pregnant woman?
a) Yes
b) No
c) Maybe

4. Are the services timely and efficient?

a) Always
b) Sometimes
c) Never

5. Do you plan to complete all your ANC visits at this facility?

a) Yes
b) No
c) Not sure

THANK YOU
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