Provision and experience of quality antenatal care services in public primary health care facilities in Nigeria: a mixed methods study using the WHO Quality of Care framework

Abstract Background Quality antenatal care (ANC) is essential for improved maternal and newborn health outcomes. Yet, providing quality ANC services remains challenging in Nigeria, with suboptimal ANC coverage and the highest global maternal deaths. Using the WHO quality of care framework, we assessed the provision and experience of quality ANC services in public primary healthcare (PHC) facilities in Nigeria and the associated determinants. Methods This convergent mixed-methods study was conducted in Anambra, Jigawa, and Kebbi states. We used a semi-structured questionnaire to conduct exit interviews with 1200 randomly sampled pregnant women accessing ANC services across 150 public PHC facilities in these states. Using semi-structured interview guides, we conducted 15 key informant interviews, 21 in-depth interviews, and 18 focus group discussions with purposively selected ANC healthcare workers (HCWs) and community members across the states. Quantitative data were analysed using descriptive statistics and logistic regression at p