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Effect of Community Health Worker Home Visits on Childhood Healthcare Practices among Mothers in Rural Nigeria

Abstract

Childhood illnesses remain an important public health concern in Nigeria, particularly in rural communities where mothers and caregivers may experience limited access to timely and appropriate healthcare services. Inadequate knowledge of childhood danger signs, delayed healthcare-seeking, poor adherence to recommended immunization schedules, inappropriate home management of common childhood illnesses, and limited use of preventive healthcare services may contribute to avoidable childhood morbidity and mortality. Community health worker (CHW) home visits provide an opportunity to bring essential health information and basic preventive and supportive services closer to households. Through home visits, community health workers may educate mothers on child nutrition, immunization, hygiene, malaria prevention, breastfeeding, danger-sign recognition, appropriate home care, and timely healthcare-seeking. However, inadequate CHW training, irregular home visits, limited supervision, transportation challenges, shortages of educational materials, and weak referral systems may affect the effectiveness of community-based services in rural Nigeria. Against this background, this study investigates the effect of community health worker home visits on childhood healthcare practices among mothers in rural 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 children's susceptibility to illness, perceived severity of childhood diseases, perceived benefits of recommended healthcare practices, perceived barriers, and cues to action may influence childhood healthcare behaviours. The Social Ecological Model emphasizes the influence of mothers, families, communities, socioeconomic conditions, cultural practices, and healthcare systems on childhood healthcare practices. The Health Systems Framework emphasizes service delivery, health workforce, health information, essential health commodities, financing, governance, and accessibility as important components of effective community-based healthcare. Collectively, these theoretical perspectives provide a suitable framework for explaining how CHW home visits may influence childhood healthcare practices among mothers in rural Nigeria. The study will adopt a quantitative analytical cross-sectional or quasi-experimental research design. The study population will comprise mothers or primary caregivers of children under five years residing in selected rural communities in Nigeria. A multistage sampling technique will be used to select states, local government areas, rural communities, households, and eligible mothers. CHW home visits will be assessed using indicators such as receipt of home visits, frequency and duration of visits, timing of visits, CHW contact, topics discussed, health education provided, assessment of child health, immunization reminders, nutrition counselling, hygiene education, malaria prevention education, recognition of childhood danger signs, and referral support. Childhood healthcare practices will be assessed using indicators such as adherence to recommended immunization schedules, appropriate breastfeeding and complementary feeding practices, use of insecticide-treated nets, hygiene and sanitation practices, appropriate home management of common childhood illnesses, timely healthcare-seeking, recognition of danger signs, use of preventive healthcare services, and adherence to healthcare recommendations. Data will be collected using structured questionnaires, CHW home-visit records, child health cards, immunization registers, primary healthcare records, and relevant community health programme documents. Descriptive statistics will be used to summarize maternal and child characteristics, exposure to CHW home visits, and childhood healthcare 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 CHW home visits on childhood healthcare practices. Where a quasi-experimental design is adopted, childhood healthcare practice scores before and after exposure to structured CHW home visits may be compared, while relevant maternal, household, socioeconomic, and community 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 community health worker home visits have a significant positive effect on childhood healthcare practices among mothers in rural Nigeria. Mothers who receive regular and comprehensive CHW home visits are expected to demonstrate better adherence to recommended preventive and curative childhood healthcare practices than mothers with limited or no exposure to home-based community health services. Home visits may improve mothers' knowledge of childhood danger signs, encourage timely healthcare-seeking, promote immunization uptake, strengthen appropriate nutrition and breastfeeding practices, improve malaria prevention, and encourage better hygiene and sanitation practices. However, the effectiveness of home visits may be influenced by CHW workload, frequency of visits, quality of training, availability of healthcare commodities, household socioeconomic conditions, cultural beliefs, geographical barriers, and access to functional referral services. The study therefore expects regular, adequately supported, and well-coordinated CHW home visits to contribute significantly to improved childhood healthcare practices among mothers in rural Nigeria. The study is expected to contribute to the literature on community health worker home visits, childhood healthcare practices, child health, community-based healthcare, primary healthcare, maternal and child health, health education, healthcare-seeking behaviour, 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 programmes, development partners, and policymakers regarding strategies for strengthening community-based child healthcare. The study will also provide evidence-based recommendations for expanding CHW home-visit programmes, improving CHW training and supervision, strengthening household health education, improving immunization and child-health follow-up, ensuring availability of essential health commodities, strengthening referral systems, and integrating home-based child healthcare into broader primary healthcare and maternal, newborn, and child health programmes across rural Nigeria.

Keywords: Community health workers, home visits, childhood healthcare practices, mothers, children under five, child health, community-based healthcare, primary healthcare, healthcare-seeking behaviour, rural Nigeria, public health.