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Effect of Postnatal Home Visits on Early Detection of Maternal Postpartum Complications in Nigeria

Abstract

Maternal postpartum complications remain an important public health concern in Nigeria and contribute significantly to maternal morbidity and mortality during the period following childbirth. Women may experience complications such as postpartum haemorrhage, puerperal infections, hypertensive disorders, thromboembolic conditions, anaemia, and mental health problems during the postpartum period. Some complications may develop after discharge from healthcare facilities and may remain undetected because of limited access to postnatal services, inadequate follow-up, geographical barriers, financial constraints, low awareness of postpartum danger signs, and delays in seeking appropriate healthcare. Postnatal home visits provide an opportunity for healthcare workers to monitor mothers in their homes, identify warning signs early, provide health education, assess recovery, support breastfeeding and newborn care, and facilitate timely referral when complications are identified. However, inadequate staffing, limited transportation, weak referral systems, insufficient training, and inconsistent implementation of postnatal home-visit programmes may affect their effectiveness in Nigeria. Against this background, this study investigates the effect of postnatal home visits on early detection of maternal 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 postnatal home visits, perceived barriers, and cues to action may influence participation in postnatal follow-up. The Social Ecological Model emphasizes the influence of individual, household, community, healthcare, socioeconomic, and cultural factors on postpartum care utilization and maternal health outcomes. The Health Systems Framework emphasizes service delivery, health workforce, health information, transportation, referral systems, financing, governance, and accessibility as essential components of effective postnatal healthcare. Collectively, these theoretical perspectives provide a suitable framework for explaining how postnatal home visits may influence early detection of maternal postpartum complications in Nigeria. The study will adopt a quantitative analytical cohort or quasi-experimental research design. The study population will comprise women who have recently delivered and are enrolled in selected healthcare facilities or community-based postnatal programmes across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, healthcare facilities, postnatal programmes, and eligible postpartum women. Postnatal home visits will be assessed using indicators such as whether a home visit was received, timing of the first visit, number and frequency of visits, duration of visits, healthcare worker conducting the visit, maternal assessment performed, blood pressure monitoring, assessment of bleeding and infection, counselling on postpartum danger signs, breastfeeding support, and referral arrangements. Early detection of maternal postpartum complications will be assessed using indicators such as identification of abnormal bleeding, elevated blood pressure, fever or signs of infection, severe headache, visual disturbances, wound complications, severe anaemia, thromboembolic symptoms, and other clinically relevant postpartum danger signs; timing of detection; referral; and subsequent clinical management. Data will be collected using structured questionnaires, postnatal home-visit records, maternal health records, referral registers, hospital records, and community health programme documents. Descriptive statistics will be used to summarize maternal characteristics, home-visit coverage, timing and frequency of visits, identified 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 postnatal home visits on early detection of maternal postpartum complications. Where a quasi-experimental design is adopted, early complication detection among women receiving structured postnatal home visits may be compared with detection among women receiving routine postnatal care without structured home visits. Relevant maternal, socioeconomic, healthcare-access, and delivery-related factors will be 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 postnatal home visits have a significant positive effect on the early detection of maternal postpartum complications in Nigeria. Women who receive timely and regular postnatal home visits are expected to have a higher likelihood of having postpartum complications identified at an earlier stage than women who do not receive home-based follow-up. Home visits 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. They may also improve mothers' knowledge of postpartum warning signs and encourage timely healthcare-seeking behaviour. However, inadequate staffing, limited transportation, geographical challenges, weak referral mechanisms, insufficient training, poor documentation, and low household acceptance may reduce the effectiveness of home-visit programmes. The study therefore expects accessible, timely, adequately staffed, and well-coordinated postnatal home visits to contribute significantly to improving early detection and management of maternal postpartum complications in Nigeria. The study is expected to contribute to the literature on postnatal home visits, postpartum complications, maternal health, postnatal care, 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, 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 postnatal home-visit programmes, improving healthcare worker training and supervision, strengthening community-based maternal monitoring, ensuring timely referral of women with complications, improving transportation and communication systems, increasing maternal awareness of postpartum danger signs, and integrating postnatal home visits into broader maternal and newborn health programmes across Nigeria.

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