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Effect of Community Health Worker Home Visits on Childhood Illness Management among Mothers in Rural Nigeria

Abstract

Childhood illnesses such as malaria, diarrhoeal diseases, acute respiratory infections, fever, and other common conditions remain important public health concerns in Nigeria, particularly among children living in rural communities where access to healthcare services may be limited. Early recognition of illness, appropriate home care, timely healthcare-seeking, and prompt referral are important for reducing complications and preventing avoidable childhood morbidity and mortality. However, mothers and other caregivers in rural communities may face challenges including long distances to health facilities, transportation difficulties, financial constraints, limited health information, delayed recognition of danger signs, and inadequate access to skilled healthcare providers. Community health worker home visits provide an opportunity to bring basic health education, illness assessment, treatment support, referral advice, and follow-up services directly to households. Regular home visits may improve mothers' knowledge and confidence in recognizing and managing common childhood illnesses and encourage timely utilization of appropriate healthcare services. Against this background, this study investigates the effect of community health worker home visits on childhood illness management among mothers in rural Nigeria. The study will be anchored on the Social Ecological Model, Health Belief Model, and Social Cognitive Theory. The Social Ecological Model emphasizes the influence of individual, household, community, healthcare-system, and environmental factors on childhood illness management. The Health Belief Model explains how mothers' perceptions of childhood illness severity, susceptibility, perceived benefits of appropriate management, perceived barriers, and cues to action may influence their healthcare-seeking and caregiving behaviours. Social Cognitive Theory emphasizes knowledge, observational learning, self-efficacy, social support, and reinforcement as factors that influence mothers' ability to adopt appropriate childhood illness management practices. Collectively, these theoretical perspectives provide a suitable framework for explaining how community health worker home visits may influence childhood illness management among mothers in rural Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise mothers or primary caregivers of children under five years of age residing in selected rural communities in Nigeria, together with community health workers providing household-based services. A multistage sampling technique will be used to select states, local government areas, rural communities, households, mothers, and community health workers. Community health worker home visits will be assessed using indicators such as frequency of home visits, duration of visits, household coverage, health education, assessment of sick children, counselling on home care, identification of danger signs, treatment support where within the worker's scope, referral advice, follow-up of previously ill children, monitoring of treatment adherence, maternal education, documentation of visits, and availability of community health worker supplies and guidelines. Childhood illness management will be assessed using indicators such as mothers' knowledge of common childhood illnesses, recognition of danger signs, appropriate home management, correct use of prescribed medicines, appropriate fluid and feeding practices during illness, malaria prevention and treatment-seeking practices, timely healthcare-seeking, compliance with referral advice, follow-up attendance, and avoidance of inappropriate treatment practices. Data will be collected using structured questionnaires, community health worker home-visit records, child health records, referral registers, household surveys, and relevant primary healthcare records. Descriptive statistics will be used to summarize mothers' demographic characteristics, children's characteristics, frequency of home visits, common childhood illnesses, and illness-management practices. 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 community health worker home visits on childhood illness management. Where a quasi-experimental design is adopted, childhood illness-management outcomes among mothers receiving structured home visits may be compared with outcomes among mothers receiving routine community health services. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that community health worker home visits have a significant positive effect on childhood illness management among mothers in rural Nigeria. Mothers who receive regular and structured home visits are expected to demonstrate better knowledge of common childhood illnesses, improved recognition of danger signs, more appropriate home-care practices, and greater likelihood of seeking timely professional healthcare when necessary. Direct counselling and demonstrations during home visits may improve mothers' confidence in caring for sick children and help them distinguish conditions that can be safely managed at home from those requiring prompt medical attention. Follow-up visits may also improve adherence to treatment and referral recommendations and facilitate early identification of children whose conditions are worsening. However, inadequate numbers of community health workers, large geographical coverage areas, poor transportation, insufficient medicines and supplies, weak referral systems, inadequate supervision, and irregular home visits may reduce programme effectiveness. The study therefore expects accessible, regular, well-supervised, and adequately supported community health worker home visits to contribute significantly to improved childhood illness management among mothers in rural Nigeria. The study is expected to contribute to the literature on community health worker home visits, childhood illness management, maternal caregiving practices, community-based healthcare, child health, healthcare-seeking behaviour, rural healthcare, primary healthcare, 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 worker programmes, maternal and child health programme managers, development partners, community leaders, and policymakers regarding strategies for strengthening community-based child healthcare. The study will also provide evidence-based recommendations for expanding household-based community health worker services, strengthening home-visit schedules, improving community health worker training and supervision, ensuring availability of essential supplies and guidelines, strengthening referral and follow-up systems, improving maternal health education, and integrating childhood illness management into broader community-based primary healthcare programmes across rural Nigeria.

Keywords: Community health worker home visits, childhood illness management, mothers, rural healthcare, children under five, community-based healthcare, healthcare-seeking behaviour, maternal caregiving, primary healthcare, Nigeria, public health.