Understanding mistreatment during institutional delivery in Northeast Nigeria: a mixed-method study

Umar, Nasir; Wickremasinghe, Deepthi; Hill, Zelee; Usman, Umar Adamu; Marchant, Tanya

doi:10.1186/s12978-019-0837-z

Cited by 10 publications

(23 citation statements)

References 55 publications

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“…Our findings are consistent with studies from Ethiopia, Ghana, Kenya, Nigeria and the Philippines which have reported a strong association between improvements in structural quality and the availability of commodities with a substantial increase in health facility utilisation 53 54. Interestingly, the utility associated with drug and supply constraints was negative but did not reach statistical significance, perhaps a reflection of women in Gombe having coping strategies for persistent shortages of drugs and supply by sourcing these outside of the health system, rather than an indication of not caring about drugs and supply constraints 15…”

Section: Discussionmentioning

confidence: 99%

“…These negative experiences during facility-based birth have been found to undermine women’s trust in the health system, and negatively impacted their subsequent decision to deliver in the health facility 56–58. In an earlier study in Gombe State, only 3% of women reported mistreatment related to physical abuse, and less than 1% reported mistreatment related to sexual abuse during labour and delivery 15. Nonetheless, we found that absence of physical abuse and absence of sexual abuse influenced women’s hypothetical choice for place of delivery.…”

Section: Discussionmentioning

confidence: 99%

“…In-depth interviews and focus groups, alongside the literature review findings, informed our selection of six attributes and a total of 18 attribute levels relevant to the context (three attributes of four levels each and three attributes of two levels), these are highlighted in table 1. Further, the qualitative study provided us with locally appropriate expressions and language translation, enhancing respondents ease of comprehension 31…”

Section: Methodsmentioning

confidence: 99%

“…For example, in Nigeria, where a high burden of maternal mortality persists, and where the coverage of facility delivery remains relatively low, women have reported mistreatment due to improper examination and lack of supportive care,3 13 neglect or abandonment, lack of confidentiality, physical abuse, verbal abuse and mistreatment related to health system constraints 11 14. In a recent study in Gombe State, where we conducted this study, about two-thirds of women interviewed reported experiencing at least one form of mistreatment during their facility-based childbirth 15. Half of all women (50%) reported mistreatment related to health system conditions and constraints; for example, staff shortages, supply constraints, unconducive birth environment and perceptions of unreasonable requests by health workers.…”

Section: Introductionmentioning

confidence: 96%

“…Similarly, almost half (46%) of all women reported mistreatment related to poor rapport between themselves and the healthcare provider; for example, denial of birth companion and not being allowed to eat, drink or move around during labour and childbirth. Reports of mistreatment related to sexual abuse, stigma and discrimination were uncommon 15…”

Section: Introductionmentioning

confidence: 99%

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Toward improving respectful maternity care: a discrete choice experiment with rural women in northeast Nigeria

et al. 2020

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IntroductionThere is a limited understanding of the importance of respectful maternity care on utilisation of maternal and newborn health services. This study aimed to determine how specific hypothetical facility birth experience of care attributes influenced rural Nigerian women’s stated preferences for hypothetical place of delivery.MethodsAttributes were identified through a comprehensive review of the literature. These attributes and their respective levels were further investigated in a qualitative study. We then developed and implemented a cross-sectional discrete choice experiment with a random sample of 426 women who had facility-based childbirth to elicit their stated preferences for facility birth experience of care attributes. Women were asked to choose between two hypothetical health facilities or home birth for future delivery. Choice data were analysed using multinomial logit and mixed multinomial logit models.ResultsComplete data for the discrete choice experiment were available for 425 of 426 women. The majority belonged to Fulani ethnic group (60%) and were married (95%). Almost half (45%) had no formal education. Parameter estimates were all of expected signs suggesting internal validity. The most important influence on choice of place of delivery was good health system condition, followed by absence of sexual abuse, then absence of physical and verbal abuse. Poor facility culture, including an unclean birth environment with no privacy and unclear user fee, was associated with the most disutility and had the most negative impact on preferences for facility-based childbirth.ConclusionThe likelihood of poor facility birth experiences had a significant impact on stated preferences for place of delivery among rural women in northeast Nigeria. The study findings further underline the important relationship between facility birth experience and utilisation. Achieving universal health coverage would require efforts toward addressing poor facility birth experiences and promoting respectful maternity care, to ensure women want to access the services available.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Toward improving respectful maternity care: a discrete choice experiment with rural women in northeast Nigeria

et al. 2020

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To call or not to call: exploring the validity of telephone interviews to derive maternal self-reports of experiences with facility childbirth care in northern Nigeria

et al. 2022

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BackgroundTo institutionalise respectful maternity care, frequent data on the experience of childbirth care is needed by health facility staff and managers. Telephone interviews have been proposed as a low-cost alternative to derive timely and actionable maternal self-reports of experience of care. However, evidence on the validity of telephone interviews for this purpose is limited.MethodsEight indicators of positive maternity care experience and 18 indicators of negative maternity care experience were investigated. We compared the responses from exit interviews with women about their childbirth care experience (reference standard) to follow-up telephone interviews with the same women 14 months after childbirth. We calculated individual-level validity metrics including, agreement, sensitivity, specificity, area under the receiver operating characteristic curve (AUC). We compared the characteristics of women included in the telephone follow-up interviews to those from the exit interviews.ResultsDemographic characteristics were similar between the original exit interview group (n=388) and those subsequently reached for telephone interview (n=294). Seven of the eight positive maternity care experience indicators had reported prevalence higher than 50% at both exit and telephone interviews. For these indicators, agreement between the exit and the telephone interviews ranged between 50% and 92%; seven positive indicators met the criteria for validation analysis, but all had an AUC below 0.6. Reported prevalence for 15 of the 18 negative maternity care experience indicators was lower than 5% at exit and telephone interviews. For these 15 indicators, agreement between exit and telephone interview was high at over 80%. Just three negative indicators met the criteria for validation analysis, and all had an AUC below 0.6.ConclusionsThe telephone interviews conducted 14 months after childbirth did not yield results that were consistent with exit interviews conducted at the time of facility discharge. Women’s reports of experience of childbirth care may be influenced by the location of reporting or changes in the recall of experiences of care over time.

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Understanding rural women's preferences for telephone call engagement with primary health care providers in Nigeria: a discrete choice experiment

Umar,

Hill,

Schellenberg

et al. 2023

BMJ Glob Health

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BackgroundThe COVID-19 pandemic has accelerated the use of mobile phones to provide primary health care services and maintain continuity of care. This study aims to understand rural women’s preferences for telephone call engagement with primary health care providers in Nigeria.MethodsA discrete choice experiment was conducted alongside an action research project that empowered primary health care workers to develop and implement a telephone call intervention to assess and enhance experiences with facility childbirth care. Between January and March 2022, 30 providers from 10 primary health care facilities implemented the choice experiment among rural women who had institutional childbirth to elicit service user preferences for telephone call engagement. The women were asked to express their preferred scenario for telephone call engagement with their primary health care providers. Generalised linear mixed models were used to estimate women’s preferences.ResultsData for 460 women were available for the discrete choice experiment. The study showed that rural women have preferences for telephone call engagement with primary health care providers. Specifically, women preferred engaging with female to male callers (β=1.665 (95% CI 1.41, 1.93), SE=0.13, p<0.001), preferred call duration under 15 min (β=1.287 (95% CI 0.61, 1.96), SE=0.34, p<0.001) and preferred being notified before the telephone engagement (warm calling) (β=1.828 (95% CI 1.10, 2.56), SE=0.37, p<0.001). Phone credit incentive was also a statistically significant predictor of women’s preferences for engagement. However, neither the availability of scheduling options, the period of the day or the day of the week predicts women’s preferences.ConclusionsThe study highlights the importance of understanding rural women’s preferences for telephone call engagement with healthcare providers in low-income and middle-income countries. These findings can inform the development of mobile phone-based interventions and improve acceptability and broader adoption.

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Understanding mistreatment during institutional delivery in Northeast Nigeria: a mixed-method study

Cited by 10 publications

References 55 publications

Toward improving respectful maternity care: a discrete choice experiment with rural women in northeast Nigeria

Toward improving respectful maternity care: a discrete choice experiment with rural women in northeast Nigeria

To call or not to call: exploring the validity of telephone interviews to derive maternal self-reports of experiences with facility childbirth care in northern Nigeria

Understanding rural women's preferences for telephone call engagement with primary health care providers in Nigeria: a discrete choice experiment

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