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Effect of Postpartum Home-Based Care on Early Detection of Postpartum Complications in Nigeria

Abstract

Postpartum complications remain an important public health concern in Nigeria and contribute significantly to maternal morbidity and mortality during the period following childbirth. Complications such as postpartum haemorrhage, puerperal infections, hypertensive disorders, anaemia, wound complications, and other postpartum health problems may develop after mothers leave healthcare facilities and may remain undetected when access to postnatal care is limited. Early identification of postpartum complications is essential for timely treatment and referral and may prevent progression to severe illness and death. Postpartum home-based care provides an opportunity for healthcare workers to monitor mothers within their homes, assess their recovery after childbirth, identify danger signs, provide health education, support breastfeeding and maternal wellbeing, and facilitate timely referral to appropriate healthcare facilities. However, inadequate healthcare workforce, limited transportation, geographical barriers, poor referral systems, insufficient training, and inconsistent implementation of home-based postpartum services may affect their effectiveness in Nigeria. Against this background, this study investigates the effect of postpartum home-based care on early detection of postpartum complications in Nigeria. The study will be anchored on the Health Belief Model, Social Ecological Model, and Health Systems Framework. The Health Belief Model explains how mothers' perceptions of susceptibility to postpartum complications, perceived severity, perceived benefits of home-based care, perceived barriers, and cues to action may influence participation in postpartum monitoring and healthcare-seeking behaviour. The Social Ecological Model emphasizes the influence of individual, family, community, healthcare, socioeconomic, and cultural factors on postpartum health and utilization of maternal healthcare services. The Health Systems Framework emphasizes service delivery, health workforce, health information, transportation, referral systems, financing, governance, and accessibility as essential components of effective postpartum home-based care. Collectively, these theoretical perspectives provide a suitable framework for explaining how postpartum home-based care may influence early detection of postpartum complications in Nigeria. The study will adopt a quantitative analytical cohort or quasi-experimental research design. The study population will comprise mothers who have recently delivered and are enrolled in selected healthcare facilities or community-based maternal health programmes across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, healthcare facilities, postpartum programmes, and eligible mothers. Postpartum home-based care will be assessed using indicators such as receipt of home visits, timing of the first visit, frequency and number of visits, duration of visits, healthcare worker conducting the visit, assessment of maternal vital signs, monitoring of postpartum bleeding, assessment for signs of infection, blood pressure monitoring, wound assessment where applicable, breastfeeding support, counselling on postpartum danger signs, and referral arrangements. Early detection of postpartum complications will be assessed using indicators such as identification of abnormal postpartum bleeding, fever or infection, elevated blood pressure, severe headache, visual disturbances, wound complications, severe anaemia, and other clinically relevant postpartum danger signs; timing of detection; referral; and subsequent clinical management. Data will be collected using structured questionnaires, home-visit records, maternal health records, postnatal care registers, referral registers, hospital records, and community health programme documents. Descriptive statistics will be used to summarize maternal characteristics, home-based care coverage, frequency of visits, detected complications, and referral patterns. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of postpartum home-based care on early detection of postpartum complications. Where a quasi-experimental design is adopted, early complication detection among mothers receiving structured postpartum home-based care may be compared with detection among mothers receiving routine postpartum care without structured home visits, while relevant maternal, socioeconomic, delivery-related, and healthcare-access factors are appropriately controlled. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that postpartum home-based care has a significant positive effect on the early detection of postpartum complications in Nigeria. Mothers who receive timely and regular home-based postpartum care are expected to have a higher likelihood of postpartum complications being identified at an earlier stage compared with mothers who do not receive structured home-based follow-up. Home-based monitoring may facilitate routine assessment of maternal wellbeing, early identification of abnormal bleeding, hypertension, infection, anaemia, and other danger signs, and prompt referral for appropriate clinical management. It may also improve mothers' awareness of postpartum warning signs and encourage timely healthcare-seeking behaviour. However, inadequate staffing, limited transportation, geographical barriers, weak referral mechanisms, insufficient healthcare-worker training, poor documentation, and low household acceptance may reduce the effectiveness of home-based postpartum services. The study therefore expects accessible, timely, adequately staffed, and well-coordinated postpartum home-based care to contribute significantly to improving early detection and management of postpartum complications in Nigeria. The study is expected to contribute to the literature on postpartum home-based care, postpartum complications, postnatal care, maternal health, community-based maternal healthcare, early detection, maternal morbidity, maternal mortality, 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, healthcare facilities, community health programmes, obstetricians, midwives, nurses, community health workers, development partners, and policymakers regarding strategies for strengthening postpartum care. The study will also provide evidence-based recommendations for expanding postpartum home-based care programmes, improving healthcare-worker training and supervision, strengthening community-based maternal monitoring, ensuring timely referral of mothers with complications, improving transportation and communication systems, increasing maternal awareness of postpartum danger signs, and integrating home-based postpartum care into broader maternal and newborn health programmes across Nigeria.

Keywords: Postpartum home-based care, postpartum complications, early detection, postnatal care, maternal health, maternal morbidity, maternal mortality, community-based healthcare, postpartum women, Nigeria, public health.