BACKGROUND Improving quality of care including the clinical aspects and the experience of care has been advocated for improved coverage and better childbirth outcomes. OBJECTIVE This study aimed to explore the quality of care relating to the prevalence and manifestations of mistreatment during institutional birth in Gombe State, northeast Nigeria, an area of low institutional delivery coverage. METHODS The frequency of dimensions of mistreatment experienced by women delivering in 10 health facilities of Gombe State were quantitatively captured during exit interviews with 342 women in July-August 2017. Manifestations of mistreatment were qualitatively explored through in-depth interviews and focus groups with 63 women living in communities with high and low coverage of institutional deliveries. RESULTS The quantitative data showed that at least one dimension of mistreatment was reported by 66% (95% confidence interval (CI) 45-82%) of women exiting a health facility after delivery. Mistreatment related to health system conditions and constraints were reported in 50% (95% CI 31-70%) of deliveries. In the qualitative data women expressed frustration at being urged to deliver at the health facility only to be physically or verbally mistreated, blamed for poor birth outcomes, discriminated against because of their background, left to deliver without assistance or with inadequate support, travelling long distances to the facility only to find staff unavailable, or being charged unjustified amount of money for delivery. CONCLUSIONS Mistreatment during institutional delivery in Gombe State is highly prevalent and predominantly relates to mistreatment arising from both health system constraints as well as health worker behaviours, limiting efforts to increase coverage of institutional delivery. To address mistreatment during institutional births, strategies that emphasise a broader health systems approach, tackle multiple causes, integrate a detailed understanding of the local context and have buy-in from grassroots-level stakeholders are recommended.

中文翻译：

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了解尼日利亚东北部机构分娩期间的虐待：一项混合方法研究。


背景技术已经提倡提高护理质量，包括临床方面和护理体验，以提高覆盖范围和更好的分娩结果。目的 本研究旨在探讨尼日利亚东北部贡贝州机构分娩覆盖率较低的地区与机构分娩期间虐待发生率和表现相关的护理质量。方法 2017 年 7 月至 8 月，在对 342 名妇女进行离职面谈时，对贡贝州 10 个卫生机构的妇女遭受虐待的频率进行了定量分析。通过对 63 名妇女进行深入访谈和焦点小组，定性地探讨了虐待的表现形式生活在机构分娩覆盖率高或低的社区。结果 定量数据显示，66%（95% 置信区间 (CI) 45-82%）的产后离开医疗机构的妇女报告至少在某一方面遭受过虐待。 50%（95% CI 31-70%）的分娩中报告了与卫生系统条件和限制有关的虐待。在定性数据中，妇女对被敦促在医疗机构分娩却遭到身体或言语上的虐待、因出生结果不佳而受到指责、因其背景而受到歧视、在没有帮助或支持不足的情况下分娩、长途跋涉等表示沮丧。到了设施后却发现工作人员不在，或者被收取了不合理的送货费用。 结论 贡贝州机构分娩期间的虐待现象非常普遍，主要与卫生系统限制和卫生工作者行为引起的虐待有关，限制了提高机构分娩覆盖率的努力。为了解决机构分娩期间的虐待问题，建议采取强调更广泛的卫生系统方法、解决多种原因、结合对当地情况的详细了解并获得基层利益相关者支持的策略。