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Influence of Community-Based Pregnancy Risk Screening on High-Risk Pregnancy Detection among Women of Reproductive Age in Nigeria

Abstract

High-risk pregnancy is an important maternal health concern in Nigeria and may arise from pre-existing medical conditions, pregnancy-related complications, previous adverse pregnancy outcomes, advanced maternal age, adolescent pregnancy, multiple gestation, nutritional deficiencies, and other maternal or fetal factors. When pregnancy risks are not identified early, women may experience preventable complications that can adversely affect maternal and fetal health. However, high-risk pregnancies may remain undetected because of limited access to antenatal care, financial constraints, geographical barriers, inadequate awareness, delayed healthcare-seeking, and insufficient access to routine maternal risk assessment. Community-based pregnancy risk screening provides an opportunity to identify women with potential pregnancy-related risks through community outreach programmes, primary healthcare centres, maternal health campaigns, community health workers, and other accessible platforms. Early detection can facilitate timely antenatal registration, clinical evaluation, specialist referral, closer monitoring, appropriate treatment, birth preparedness, and other evidence-based maternal health interventions. Against this background, this study investigates the influence of community-based pregnancy risk screening on high-risk pregnancy detection among women of reproductive age in Nigeria. The study will be anchored on the Health Belief Model, Social Ecological Model, and Three Delays Model. The Health Belief Model explains how women's perceptions of susceptibility to pregnancy complications, perceived severity, perceived benefits of risk screening, perceived barriers, and cues to action may influence participation in community-based pregnancy risk screening and subsequent healthcare-seeking behaviour. The Social Ecological Model emphasizes the influence of individual, family, community, socioeconomic, cultural, environmental, and healthcare-system factors on maternal health and access to pregnancy-related services. The Three Delays Model explains how delays in deciding to seek care, reaching appropriate healthcare facilities, and receiving adequate care may influence the identification and management of pregnancy risks. Collectively, these theoretical perspectives provide a suitable framework for explaining how community-based pregnancy risk screening may influence high-risk pregnancy detection among women in Nigeria. The study will adopt a quantitative cross-sectional analytical or quasi-experimental research design. The study population will comprise women of reproductive age, particularly pregnant women and women with confirmed pregnancies, residing in selected communities across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, households, primary healthcare centres, maternal health outreach sites, and eligible participants. Community-based pregnancy risk screening will be measured using indicators such as availability of screening services, screening coverage, frequency of community screening activities, assessment of maternal age, obstetric history, previous pregnancy complications, blood pressure, blood glucose where appropriate, anaemia risk, nutritional status, infection risk, existing medical conditions, medication history, pregnancy symptoms, fetal or pregnancy-related concerns, multiple pregnancy risk, availability of trained maternal health personnel, health education, and referral arrangements. High-risk pregnancy detection will be assessed using indicators such as identification of women with hypertension or hypertensive risk, anaemia, diabetes or abnormal glucose status, previous adverse obstetric history, multiple pregnancy, high-risk maternal age, significant pre-existing medical conditions, pregnancy-related warning signs, women requiring further clinical assessment, newly identified high-risk pregnancies, referrals for specialized antenatal care, and documented high-risk pregnancy classifications where appropriately established. Data will be collected using structured questionnaires, maternal health assessment forms, antenatal records, community health registers, validated screening tools where applicable, and referral documentation. Descriptive statistics will be used to summarize participants' demographic and reproductive characteristics, screening coverage, identified risk factors, and patterns of high-risk pregnancy detection. Inferential statistical techniques, including chi-square tests, correlation analysis, and logistic or multiple regression analysis, will be used to determine the influence of community-based pregnancy risk screening on high-risk pregnancy detection. Where appropriate, high-risk pregnancy detection rates before and after implementation of community-based pregnancy risk screening activities 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 community-based pregnancy risk screening has a significant positive influence on high-risk pregnancy detection among women in Nigeria. Women reached through systematic community-based screening are expected to have a higher likelihood of previously unrecognized pregnancy risks being identified than women without access to such screening. Routine assessment may facilitate early identification of hypertension, anaemia, abnormal glucose status, previous obstetric complications, multiple pregnancy, pre-existing medical conditions, nutritional risks, and other factors associated with high-risk pregnancy. Early detection may facilitate timely antenatal registration, closer maternal and fetal monitoring, appropriate treatment, health education, birth preparedness, specialist referral, and timely management of complications. Bringing pregnancy risk assessment closer to communities may reduce geographical, financial, transportation, and informational barriers and may encourage women who have not yet accessed formal antenatal services to seek appropriate care. Community health education may also improve awareness of pregnancy danger signs and the importance of early antenatal care. Conversely, inadequate screening coverage, shortage of trained maternal health personnel, financial constraints, limited diagnostic equipment, cultural barriers, delayed healthcare-seeking, and weak referral and follow-up systems may reduce the effectiveness of community-based pregnancy risk screening. The study therefore expects accessible, systematic, and appropriately implemented community-based pregnancy risk screening to contribute significantly to improved detection and early management of high-risk pregnancies in Nigeria. The study is expected to contribute to the literature on community-based pregnancy risk screening, high-risk pregnancy detection, maternal health, antenatal care, reproductive health, community health services, preventive maternal healthcare, obstetric risk assessment, 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, primary healthcare centres, maternal and child health programmes, midwives, nurses, community health workers, obstetricians, development partners, women's organizations, and policymakers regarding strategies for improving early identification of maternal risks. The study will also provide evidence-based recommendations for expanding community-based pregnancy risk screening, strengthening maternal health services at the primary healthcare level, improving availability of trained maternal health personnel and diagnostic equipment, strengthening referral and follow-up systems, promoting early antenatal care, increasing community awareness of pregnancy danger signs, and integrating pregnancy risk screening into appropriate community-based maternal and reproductive health programmes across Nigeria.

Keywords: Community-based pregnancy risk screening, high-risk pregnancy detection, women of reproductive age, maternal health, antenatal care, obstetric risk assessment, pregnancy complications, reproductive health, maternal healthcare, community health services, Nigeria, public health.