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Effect of Home-Based Newborn Care on Neonatal Care Practices among Mothers in Rural Nigeria

Abstract

Neonatal health remains an important public health concern in Nigeria, particularly in rural communities where mothers may experience limited access to skilled healthcare services, inadequate transportation, poor access to health information, and financial barriers to seeking timely newborn care. The first 28 days of life represent a critical period during which newborns are particularly vulnerable to infections, birth complications, hypothermia, feeding difficulties, and other conditions that can contribute to neonatal illness and death. Home-based newborn care provides an approach through which mothers and families receive essential information, support, and services for promoting appropriate newborn health practices within the home. Such care may include newborn hygiene, thermal care, appropriate breastfeeding, cord care, recognition of danger signs, appropriate care-seeking, and timely referral to healthcare facilities when complications occur. However, inadequate knowledge, cultural practices, misconceptions, limited follow-up, and poor access to trained community health workers may affect the adoption of appropriate neonatal care practices among mothers in rural Nigeria. Against this background, this study investigates the effect of home-based newborn care on neonatal care practices among mothers in rural Nigeria. The study will be anchored on the Health Belief Model, Social Learning Theory, and Health Systems Framework. The Health Belief Model explains how mothers' perceptions of newborn health risks, perceived severity of neonatal complications, perceived benefits of appropriate newborn care, perceived barriers, and cues to action may influence their adoption of recommended neonatal care practices. Social Learning Theory emphasizes the role of observation, instruction, interaction, reinforcement, and modelling in the development and adoption of health behaviours. The Health Systems Framework emphasizes service delivery, health workforce, health information, essential medicines and technologies, financing, and accessibility as important components of effective healthcare delivery. Collectively, these theoretical perspectives provide a suitable framework for explaining how home-based newborn care may influence neonatal care practices among mothers in rural Nigeria. The study will adopt a quantitative quasi-experimental or cross-sectional analytical research design. The study population will comprise mothers with newborn infants residing in selected rural communities in Nigeria. A multistage sampling technique will be used to select states, local government areas, rural communities, eligible mothers, and relevant community health workers. Home-based newborn care will be measured using indicators such as home visits by trained health workers, frequency of visits, newborn health education, counselling on breastfeeding, thermal care, cord care, hygiene, recognition of newborn danger signs, referral guidance, and follow-up support. Neonatal care practices will be assessed using indicators such as early initiation of breastfeeding, exclusive breastfeeding, appropriate cord care, thermal protection, newborn hygiene, appropriate bathing practices, recognition of danger signs, timely care-seeking, appropriate referral, and compliance with recommended postnatal care practices. Data will be collected using structured questionnaires, home-visit records, maternal and newborn health records, community health worker records, and relevant programme documents. Descriptive statistics will be used to summarize mothers' characteristics, exposure to home-based newborn care, and neonatal care practices. Inferential statistical techniques, including chi-square tests, correlation analysis, and logistic or multiple regression analysis, will be used to determine the effect of home-based newborn care on neonatal care practices. Where appropriate, neonatal care practices before and after exposure to home-based newborn care may be compared to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that home-based newborn care has a significant positive effect on appropriate neonatal care practices among mothers in rural Nigeria. Mothers who receive regular home-based newborn care and counselling are expected to demonstrate better practices relating to breastfeeding, thermal protection, cord care, hygiene, recognition of newborn danger signs, and timely healthcare-seeking than mothers with limited exposure to such services. Home visits by trained healthcare workers or community health workers may provide mothers with practical information and support that can improve their confidence and ability to care for newborns at home. Home-based newborn care may also facilitate early identification of newborn health problems and promote timely referral to healthcare facilities when complications arise. Conversely, inadequate home-visit coverage, limited availability of trained health workers, poor follow-up, cultural beliefs, misinformation, and limited access to healthcare facilities may reduce the effectiveness of home-based newborn care in improving neonatal care practices. The study therefore expects effective and continuous home-based newborn care to contribute significantly to improved neonatal care practices among mothers in rural Nigeria. The study is expected to contribute to the literature on home-based newborn care, neonatal health, maternal and child health, newborn care practices, community health services, rural healthcare, health education, 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 centres, community health workers, maternal and child health programme managers, development partners, and policymakers regarding strategies for improving newborn care in rural communities. The study will also provide evidence-based recommendations for expanding home-based newborn care programmes, strengthening community health worker training, increasing the frequency and coverage of home visits, improving maternal education on essential newborn care, strengthening referral systems, improving postnatal follow-up, and integrating home-based newborn care into existing primary healthcare and maternal and child health programmes across rural Nigeria.

Keywords: Home-based newborn care, neonatal care practices, mothers, newborn health, rural Nigeria, maternal and child health, community health workers, neonatal health, newborn care, postnatal care, healthcare practices, public health.