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Effect of Postnatal Home Visits on Postnatal Care Attendance among Mothers in Rural Nigeria

Abstract

The postnatal period is a critical phase of maternal and newborn health during which mothers and newborns require timely assessment, health education, counselling, and follow-up care. Despite the importance of postnatal care, attendance at recommended postnatal services remains inadequate in many rural communities in Nigeria. Rural mothers may experience barriers such as long distances to healthcare facilities, transportation difficulties, financial constraints, limited awareness of postnatal care, inadequate healthcare services, and competing household responsibilities. Postnatal home visits provide an opportunity for healthcare workers or trained community health personnel to bring maternal and newborn health services directly to mothers within their homes. Such visits may include assessment of maternal and newborn health, counselling on breastfeeding and nutrition, identification of danger signs, family planning information, immunization guidance, health education, referral, and encouragement to attend facility-based postnatal services. Postnatal care attendance refers to a mother's utilization of recommended postnatal healthcare services within the appropriate period following childbirth. Against this background, this study investigates the effect of postnatal home visits on postnatal care attendance among mothers in rural Nigeria. The study will be anchored on Andersen's Behavioral Model of Health Services Use, the Health Belief Model, and the Health Systems Framework. Andersen's Behavioral Model explains healthcare utilization through predisposing, enabling, and need-related factors and provides a framework for understanding how home-based healthcare interventions may influence utilization of postnatal services. The Health Belief Model explains health-seeking behaviour through perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and cues to action. The Health Systems Framework emphasizes service delivery, health workforce, health information, and access to essential healthcare services as important components of an effective health system. Collectively, these theoretical perspectives provide a suitable framework for explaining how postnatal home visits may influence postnatal care attendance among mothers in rural Nigeria. The study will adopt a quantitative cross-sectional research design. Data will be collected from mothers who have recently given birth and reside in selected rural communities where postnatal home-visit services are available. A multistage sampling technique will be used to select states, local government areas, rural communities, primary healthcare facilities, and eligible mothers. Postnatal home visits will be assessed using indicators such as receipt of home visits, frequency of visits, timing of the first visit, availability of trained healthcare workers, maternal health assessment, newborn assessment, breastfeeding counselling, family planning counselling, health education, identification of danger signs, referral services, follow-up support, and communication regarding facility-based postnatal appointments. Postnatal care attendance will be assessed using indicators such as attendance at postnatal healthcare facilities, timing of the first postnatal visit, number of postnatal visits attended, attendance within the recommended period, and completion of recommended follow-up visits. Structured questionnaires, community health-worker records, postnatal registers, and maternal health records will be used for data collection where available. Descriptive statistics will be used to summarize participants' characteristics, postnatal home-visit coverage, and postnatal care attendance patterns. Inferential statistical techniques, including chi-square tests, correlation analysis, and multiple regression analysis, will be used to determine the effect of postnatal home visits on postnatal care attendance. Diagnostic tests will also be conducted to assess the reliability of research instruments and the robustness of the findings. The study is expected to find that postnatal home visits have a significant positive effect on postnatal care attendance among mothers in rural Nigeria. Mothers who receive timely and regular postnatal home visits are expected to be more likely to attend facility-based postnatal care than mothers who do not receive such visits. Home visits may increase mothers' awareness of the importance of postnatal care, identify maternal and newborn health problems early, provide reminders about scheduled postnatal appointments, and encourage mothers to seek facility-based care when necessary. Home-based counselling may also improve mothers' knowledge of postpartum danger signs, breastfeeding, newborn care, family planning, and appropriate healthcare-seeking practices. Conversely, inadequate coverage of home visits, insufficient community health workers, irregular visits, transportation challenges for healthcare workers, and limited resources may reduce their effectiveness. However, postnatal home visits alone may not fully determine postnatal care attendance because maternal education, household income, family support, distance to healthcare facilities, cultural practices, previous healthcare experiences, and perceived need for postnatal services may also influence attendance. The study is expected to contribute to the literature on postnatal home visits, postnatal care attendance, maternal and newborn health, community health, primary healthcare, maternal healthcare utilization, nursing, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, local government health authorities, primary healthcare facilities, community health workers, maternal and child health programme managers, development partners, and policymakers regarding strategies for improving postnatal care utilization in rural communities. The study will also provide evidence-based recommendations for expanding postnatal home-visit programmes, increasing the availability of trained community health workers, improving home-visit scheduling and follow-up, strengthening referral systems, providing adequate logistics for community health workers, improving maternal health education, and integrating home-based postnatal services with routine facility-based maternal and newborn healthcare programmes across rural Nigeria.

Keywords: Postnatal home visits, postnatal care attendance, mothers, rural Nigeria, maternal health, newborn health, community health, primary healthcare, maternal healthcare utilization, postnatal care, maternal and child health, public health.