Background
Most of the current disease burden in youths are related to health-compromising behaviours and psycho-social problems including mental disorders, alcohol and substance misuse, sexually transmitted diseases, and unwanted pregnancies. However, many of them die prematurely, while others suffer from diseases partly because of the poor quality of health services. We therefore assessed the quality of youth-friendly health services (YFHS) and associated factors at Bayero University Medical Center, Kano State, Nigeria.

Methods
We conducted a cross-sectional study among 242 university students and health facility service providers using mixed methods. We administered a structured client exit questionnaire to collect quantitative data, while key informant interviews (KIIs) and standard checklists were used to obtain qualitative data. The quality of YFHS was measured using the Donabedian framework (structure, process, and output component). Detailed content analysis was done to generate themes and codes for the KIIs. We calculated frequencies, means and proportions. Using multivariable logistic regression, we estimated adjusted odds ratios (aOR) and 95% confidence intervals (CI) to identify predictors of good quality YFHS.

Results
The mean age of the study participants was 21.5±2.3 years. The quality of youth-friendly services for structural, process and output dimensions were 87.5%, 66.7% and 77.7% respectively. The process dimension was below the 75% cut-off point. The overall quality of youth-friendly services was 77.3%. Independent predictors of youth-friendly service satisfaction were female gender (AOR: 2.12, CI: 1.11-4.06) and waiting time <30 minutes before consultation (AOR: 6.45, CI: 1.91-21.78). KIIs revealed that unmarried students were denied access to contraceptive services.

Conclusion
The overall quality of youth-friendly health services was good. The process quality dimension was compromised due to the provider’s poor compliance with the national YFHS guidelines. Therefore, health care providers should comply with the national guidelines and reduce waiting time for youths when accessing the services.