Perceptions, practices, and traditional beliefs related to neonatal jaundice among Egyptian mothers: A cross-sectional descriptive study

Delivery of a post-natal neonatal jaundice education intervention improves knowledge among mothers at Jinja Regional Referral Hospital in Uganda

BACKGROUND

Neonatal jaundice (NNJ) is a major contributor to childhood morbidity and mortality. As many infants are discharged by 24 hours of age, mothers are key in detecting severe forms of jaundice. Mothers with limited knowledge of NNJ have a hard time identifying these infants who could go on to have the worst outcomes. This study aimed to determine the effect of a jaundice education package delivered to mothers prior to hospital discharge on maternal knowledge after discharge.

METHODS

This was a before and after interventional study involving an education package delivered through a video message and informational voucher. At 10-14 days after discharge, participants were followed up via telephone to assess their post-intervention knowledge. A paired t-test was used to determine the effectiveness of the intervention on knowledge improvement. Linear regression was used to determine predictors of baseline knowledge and of change in knowledge score.

RESULTS

Of the 250 mothers recruited, 188 were fit for analysis. The mean knowledge score was 10.02 before and 14.61 after the intervention, a significant difference (p<0.001). Factors determining higher baseline knowledge included attendance of 4 or more antenatal visits (p < 0.001), having heard about NNJ previously (p < 0.001), having experienced an antepartum illness (p = 0.019) and higher maternal age (p = 0.015). Participants with poor baseline knowledge (β = 7.523) and moderate baseline knowledge (β = 3.114) had much more to gain from the intervention relative to those with high baseline knowledge (p < 0.001).

CONCLUSION

Maternal knowledge of jaundice can be increased using a simple educational intervention, especially in settings where the burden of detection often falls on the mother. Further study is needed to determine the impact of this intervention on care seeking and infant outcomes.

Intergenerational exploration of traditional practices affecting child health: A phenomenological study

BACKGROUND

All over the world, various traditional practices affect child health. The aim of our research was to explore the changes in traditional practices that affect child health between generations and to investigate the life experiences of generations in depth.

METHODS

Using a phenomenological design, this study was conducted with semi-structured interviews with families of both generations (mothers and daughters). The study was written based on the COREQ checklist.

FINDINGS

Four themes (traditional practices and intergenerational differences, beliefs/emotions related to traditional practices, influence factors in traditional practices, traditional methods in child care) and fourteen sub-themes (change in practices between generations, intergenerational transmission of traditional practices, beliefs in perceived benefits, skepticism and disbelief attitude, emotional reactions and perceiving as unnecessary, mother/mother in-law, traditional knowledge from mothers and grandmothers, family elders, the role of the internet and social media, spiritual practices, use of herbal products, alternative applications to medicines, relaxing applications, health consequences of traditional practices) were generated from the data.

DISCUSSION

According to the findings, some harmless traditional practices are still relevant across generations, while harmful practices are mostly abandoned by new generations. The level of education and access to information has led the new generation to question traditional practices and show more interest in scientific knowledge-based methods.

APPLICATION TO PRACTICE

This research can contribute to advances in child health by helping us understand beliefs, feelings, and influencing factors related to traditional practices. Maternal education and community awareness-raising campaigns can be used to reduce harmful traditional practices.

Neonatal Jaundice: Its Determinants Among Neonates Admitted to Neonatal Intensive Care Units of Tigray Region General Hospitals, Northern Ethiopia

Background. Despite the significant public health impact of neonatal jaundice on neonatal survival, local epidemiologic data are scarce. Methods. A multi-centered, unmatched case-control study was conducted among 180 consecutively admitted neonates (60 cases and 120 controls). The independent determinants of newborn jaundice were determined using a multivariable binary logistic regression model, and a P-value of <0.05 was used to indicate statistical significance. Results. Maternal medical complications during the index pregnancy (AOR = 2.45; 95% CI 1.01-5.97), rural residence (AOR = 3.1; 95% CI 1.02-9.42), being a low birthweight neonate (AOR = 3.42; 95% CI 1.12-10.41), neonatal B blood group (AOR = 10.19; 95% CI 2.89-35.9), neonatal O blood group (AOR = 2.99; 95% CI 1.04-8.59), and a longer duration of hospital stay (AOR = 9.83; 95% CI 3.11-31.02) were the independent determinants of neonatal jaundice. Conclusions. Early assessment of high-risk neonates might reduce the long-term neurodevelopmental consequences.

Management challenges in the treatment of severe hyperbilirubinemia in low- and middle-income countries: Encouraging advancements, remaining gaps, and future opportunities

Neonatal jaundice (NJ) is common in newborn infants. Severe NJ (SNJ) has potentially negative neurological sequelae that are largely preventable in high resource settings if timely diagnosis and treatment are provided. Advancements in NJ care in low- and middle-income countries (LMIC) have been made over recent years, especially with respect to an emphasis on parental education about the disease and technological advancements for improved diagnosis and treatment. Challenges remain, however, due to lack of routine screening for SNJ risk factors, fragmented medical infrastructure, and lack of culturally appropriate and regionally specific treatment guidelines. This article highlights both encouraging advancements in NJ care as well as remaining gaps. Opportunities are identified for future work in eliminating the gaps in NJ care and preventing death and disability related to SNJ around the globe.

Maternal knowledge, attitudes and practices related to neonatal jaundice and associated factors in Shenzhen, China: a facility-based cross-sectional study

OBJECTIVE

This study aimed to assess knowledge, attitudes and practices related to neonatal jaundice among mothers in Shenzhen, China, and analyse associated factors.

DESIGN

A cross-sectional study.

SETTING

This study was conducted in Shenzhen Hospital, Southern Medical University, a university-affiliated, tertiary level A, public hospital in China. On average, 4000 mothers are discharged from this hospital after childbirth each year, most of whom can access a mobile phone and the internet.

PARTICIPANTS

Participants were 403 mothers discharged from the study hospital within 48-72 hours after vaginal delivery or 96-120 hours after caesarean delivery between April and June 2021. Participants were recruited using convenience sampling.

PRIMARY OUTCOME

Mothers' knowledge, attitudes and practices related to neonatal jaundice, modelled using binary logistic regression.

SECONDARY OUTCOMES

Factors associated with mothers' knowledge, attitudes and practices related to neonatal jaundice.

RESULTS

The questionnaire was reliable (Cronbach's alpha=0.802) and valid (scale-level content validity index=0.958). The valid response rate was 96.4%. Only 46.4% of participating mothers had good knowledge about neonatal jaundice and 41.7% indicated they would seek information about neonatal jaundice. A binary logistic regression analysis showed good knowledge about jaundice was associated with a high education level (ie, master's degree or above; OR=5.977, 95% CI: 1.994 to 17.916, p=0.001), prior education on neonatal jaundice (OR=3.617, 95% CI: 1.637 to 7.993, p=0.001) and male babies (OR=1.714, 95% CI: 1.122 to 2.617, p=0.013). A positive attitude toward jaundice was associated with being cared for by a 'yuesao' (maternity matron specialised in caring for mothers and newborns) (OR=1.969, 95% CI: 1.264 to 3.066, p=0.003) and good knowledge about jaundice (OR=1.804, 95% CI: 1.194 to 2.726, p=0.005). Finally, good practices related to neonatal jaundice were associated with prior education on neonatal jaundice (OR=2.260, 95% CI: 1.105 to 4.625, p=0.026) and good knowledge about jaundice (OR=3.112, 95% CI: 2.040 to 4.749, p<0.001).

CONCLUSION

Many mothers have poor knowledge about jaundice, especially regarding causes, danger signs and breast milk jaundice. Maternal information-seeking behaviour about neonatal jaundice needs to be improved. Medical staff should incorporate information about the causes/danger signs of jaundice and breast milk jaundice in maternal health education. It is also necessary to strengthen health education for mothers, especially those with low education and no yuesao, and provide reliable websites where mothers can obtain information about neonatal jaundice.

Neonatal jaundice in Ghanaian children: Assessing maternal knowledge, attitude, and perceptions

Background

Neonatal jaundice (NNJ) is a major cause of preventable childhood mortality and long-term impairment especially in countries with significant prevalence of the inherited condition, glucose-6-phosphate dehydrogenase (G6PD) defect. In Ghana, routine screening of pregnant women for G6PD defect is standard care. Prevention of poor health outcomes from NNJ is contingent on population health literacy and early diagnosis. As part of a project to evaluate a screening tool for NNJ, we assessed the knowledge, attitude, and perceptions of Ghanaian mothers on NNJ at baseline.

Methods

Using a cross-sectional design, mothers attending antenatal and postnatal clinics at 3 selected health facilities in 2 geographical regions of Ghana were interviewed. Data on mothers’ understanding, perceptions, beliefs, and actions towards NNJ were evaluated. Chi-square test was used to determine the association between selected maternal characteristics and knowledge, attitude, and perception to NNJ.

Results

Of the 504 mothers interviewed, 428(85.4%) had heard about NNJ, 346 (68.7%) said the earliest signs are seen in the eyes, 384(76.2%) knew NNJ may be harmful and 467(92.7%) recommended seeking healthcare for the jaundiced newborn. None of the women knew about G6PD or their G6PD status following antenatal screening. Most did not know the signs/symptoms of severe NNJ. Of the 15 mothers who had had a jaundiced neonate, cost was the most perceived (8 out of 15) barrier to accessing health care. There were significant associations (p-value ≤ 0.05) between maternal age, educational level, and knowledge of NNJ.

Conclusion

Despite the high level of awareness of NNJ, gaps still exit in the knowledge, attitudes and perceptions of mothers concerning NNJ. Improving education of women about the causes, symptoms/signs, and the role of G6PD in severe NNJ is recommended. Addressing barriers to accessing healthcare for the jaundiced infant may enhance timely management of NNJ and reduce the associated complications and mortality.

Assessment of Egyptian Mothers’ Knowledge and Domestic Management Practices of Fever in Preschool Children in Zagazig City, Sharkia Governorate

(1) Background: Childhood fever is a frequent reason for health care visits. Parents are worried about fever and its complications and show variation between their knowledge about managing fever and real practice, which are affected by many factors and beliefs. This study aimed to assess knowledge of Egyptian mothers about fever of preschool children and its domestic management and the relation between them and to identify sociodemographic factors affecting mothers’ knowledge and practice. (2) Methods: a cross-sectional study was conducted at the pediatric outpatient clinic at Zagazig University Hospitals among 297 mothers with preschool children. A structured questionnaire consisting of three parts assessed the sociodemographic characteristics, mothers’ knowledge about childhood fever, and its management practices. (3) Results: 37.7% of mothers had good knowledge about childhood fever, and 23.9% showed good management practices. Young mothers, less number of children, high education, sufficient income, and good knowledge were the significant predictors of domestic management practices towards childhood fever. (4) Conclusions: The Egyptian mothers showed insufficient levels of knowledge and domestic management practices towards preschool childhood fever. Health education interventions should be targeted to mothers to improve their knowledge and practice.

Knowledge, attitudes and practices regarding neonatal jaundice among caregivers in a tertiary health facility in Ghana

BACKGROUND

Neonatal jaundice is a major reason babies are frequently re-admitted after hospital discharge following delivery. One means of improving neonatal care and reducing potential mortality associated with neonatal jaundice in resource-limited settings is to create awareness among caregivers. Caregivers who tend to have higher knowledge and awareness, also have positive attitudes, and are not guided by outmoded socio-cultural beliefs and practices are more likely to seek early care and treatment for neonatal jaundice.

OBJECTIVE

This study investigated caregivers' knowledge, attitude and practices regarding neonatal jaundice in a tertiary health facility in the Volta region of Ghana.

METHODS

This was a descriptive cross-sectional study that employed a quantitative approach for data collection. A total of 202 caregivers from the Ho Teaching Hospital in the Volta region of Ghana were sampled using a systematic random sampling strategy where quantitative data was collected using a questionnaire and analyzed with STATA version 14.0. Ordered logistic regression was used to determine the factors that were associated with caregivers' knowledge regarding neonatal jaundice and attitude after controlling for relevant covariates.

RESULTS

Less than half of the caregivers demonstrated good knowledge (45.5%) and attitude (47.5%) but 58.9% had good practices regarding neonatal jaundice. Caregivers who had prior awareness and education on neonatal jaundice were three times more likely to have good knowledge about jaundice than those without previous education [AOR = 3.02, (95%CI: 1.59-5.74), p = 0.001]. A caregiver employed in the public sector was two times more likely to have a good attitude about jaundice than those employed in the private sector [AOR = 2.08, (95%CI: 1.03-4.21), p = 0.042].

CONCLUSION

Less than two thirds of the caregivers demonstrated good practice with limited knowledge and poor attitude. Efforts to promote well informed and improved caregivers' attitude will advance positive maternal health-seeking behavior and reduce disabilities and death through early detection and intervention of infants with neonatal jaundice. Public awareness and education about neonatal jaundice especially among caregivers in the private sector should also be intensified.

Effect of humanized care in the treatment of neonatal jaundice and its effect on oxygen saturation

OBJECTIVE

This study aimed to investigate the effect of humanized care in the treatment of neonatal jaundice and its effect on oxygen saturation.

METHODS

A total of 202 infants with neonatal jaundice admitted to our hospital from January 2018 to June 2020 were divided into group A (n=102) and group B (n=100) according to their parents' choice. Group A received humanized care and group B received routine nursing. The clinical efficacy, serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TBIL) levels and arterial blood oxyhemoglobin saturation (SaO₂), cerebral oxygen saturation (rSO₂), mean arterial pressure (MAP) levels were determined between the two groups.

RESULTS

Compared with group B, group A had significantly shorter time of fetal stool turning yellow, time of jaundice regression and duration of blue light irradiation (P < 0.05), lower serum AST, ALT and TBIL levels (P < 0.05), higher levels of SaO₂, rSO₂ and MAP (P < 0.05), higher average sleep time per day and mean daily milk consumption (P < 0.05). The incidence of adverse events in group A was significantly lower than that in group B (P < 0.05). Parental satisfaction with care in group A was significantly higher than that in group B (P < 0.05).

CONCLUSION

Humanized care can significantly improve the prognosis and recovery speed and is conducive for SaO₂ to return to normal level, and can reduce the adverse reactions with high parental satisfaction.

Knowledge on neonatal jaundice and its associated factors among mothers in northern Ethiopia: a facility-based cross-sectional study

OBJECTIVE

This study aimed to assess mother's knowledge on neonatal jaundice (NNJ) and its associated factors in northern Ethiopia.

DESIGN

Facility-based cross-sectional study.

SETTING

Referral hospitals in Amhara region, Ethiopia.

PARTICIPANTS

The study was done among 380 mothers selected using a systematic random sampling technique at referral hospitals in the Amhara region, northern Ethiopia, from 1 March 2019 to 30 July 2019.

PRIMARY OUTCOME

Mother's knowledge on NNJ, modelled using binary logistic regression.

SECONDARY OUTCOME

Factors associated with mother's knowledge about NNJ RESULTS: This study revealed that the overall mother's knowledge on NNJ was 39.2%. Having favourable attitude (AOR=2.05, 95% CI: 1.25 to 3.34), having a history of NNJ in previous children (AOR=7.51, 95% CI: 3.12 to 18.05), having a history of NNJ in the current child (AOR=1.97, 95% CI: 1.19 to 3.27), antenatal care (ANC) follow-up (AOR=3.85, 95% CI: 1.24 to 14.55) and resided in the urban area (AOR=2.63, 95% CI: 1.32 to 5.25) were factors significantly associated with mother's knowledge on NNJ.

CONCLUSIONS

This study showed that mothers' knowledge on NNJ was low. The attitude of mothers on NNJ, previous and current child history of NNJ, ANC follow-up and residence were variables that had a significant association with mother's knowledge on NNJ. Enhancing NNJ educational programmes targeting mothers in raising awareness on the prevention of NNJ in the population are the recommended interventions.

Knowledge, Observation and Practices Related to Neonatal Jaundice in a Rural Community in Kano, Nigeria

BACKGROUND

Neonatal jaundice (NNJ) is a common condition and when not adequately treated leads to acute bilirubin encephalopathy/kernicterus. This largely preventable condition is an important cause of death and disability in low- and middle-income countries. Education, early detection and effective management are key for prevention and require an understanding of community knowledge and practices to foster appropriate behavior to prevent severe NNJ. Therefore, the aim of this study was to identify knowledge, observation for jaundice (both active and passive) and practices related to NNJ in northern Nigeria.

METHODS

This descriptive, correlational and cross-sectional study enrolled 298 household members with an average age of 29.8 years in Kano, Nigeria. A structured questionnaire regarding knowledge of, potential sequelae and causes and local practices related to NNJ was administered and data were analyzed using descriptive and Chi-square statistics.

RESULTS

Participants reported: 85% NNJ to be a sign of illness; 3% understood that NNJ could cause brain damage; 94% did not actively observe for jaundice in their newborns; 56% did not know what causes NNJ; 88% would seek care if their newborn developed jaundice. Significant relationships between educational levels and what study participants would do if a newborn develops jaundice and between occupation, educational level and knowledge about causes of NNJ were noted, consistent with a difference in active jaundice observation between ethnic groups.

CONCLUSION

A public health approach to NNJ with a strong community education program is a crucial next step in the fight to eliminate severe NNJ.

Patterns of acute bilirubin encephalopathy in Nigeria: a multicenter pre-intervention study

BACKGROUND

Acute bilirubin encephalopathy (ABE) is an important cause of neonatal morbidity in Nigeria, accounting for 5-14% of neonatal deaths. Most newborns with severe ABE have irreversible damage before receiving treatment emphasizing the need for timely pre-admission monitoring and referral. There is limited evidence that educational interventions targeting mothers and health care providers will reduce delayed care.

OBJECTIVE

To provide baseline data on the incidence of ABE and associated pre-admission risk factors in five centers of Nigeria in order to evaluate the effect of subsequent educational interventions on outcome.

STUDY DESIGN

The incidence of ABE among newborns treated for hyperbilirubinemia was documented prospectively. Bivariate analysis and multivariate logistic regression were used to evaluate risk factors for acute bilirubin encephalopathy and reasons for regional differences in its occurrence.

RESULTS

Of 1040 infants, 159 treated for hyperbilirubinemia (15.3%) had mild to severe bilirubin encephalopathy (including 35 deaths), but the incidence ranged from 7 to 22% between centers. Logistic regression identified four common predictors: total serum bilirubin (odds ratio 1.007 per mg/dl rise), out-of-hospital births (OR 2.6), non-alloimmune hemolytic anemia (OR 2.8), and delayed care seeking (OR 4.3).

CONCLUSION

The high occurrence of bilirubin encephalopathy in Nigeria is due in large part to a delay in seeking care. A planned intervention strategy will target conditions leading to severe hyperbilirubinemia and delay.

Maternal detection of neonatal jaundice during birth hospitalization using a novel two-color icterometer

Background

Mothers are frequently the first to observe the onset of jaundice in their newborn infants before the decision to seek treatment. However, simple-to-use tools that could facilitate early detection of jaundice and assist mothers to seek professional care, especially after hospital discharge, are rare. This study therefore, set out to evaluate the performance of a -two-color icterometer (Bilistrip™) as a possible screening tool for detecting significant jaundice by mothers or care-givers in the first week of life.

Methods

Prior to discharge, mothers in a maternity hospital were trained to use the Bilistrip™ on the blanched skin of their baby’s nose to ascertain absence (Light Yellow) or presence (Dark Yellow) of significant jaundice. Their babies had transcutaneous bilirubin (TcB) measurements independently, along with total serum bilirubin (TSB) if indicated. The reliability of Bilistrip™ as a screening test for significant jaundice was determined at different TcB and TSB thresholds. The predictive performance of Bilistrip™ was also evaluated with multivariable logistic regression.

Results

Some 2492 mother-infant pairs were enrolled over 15 months, of which 347 (13.9%) chose Dark Yellow. The mean TcB for Dark Yellow (10mg/dL) was significantly higher (p<0.001) than for Light Yellow (6.1mg/dL). Bilistrip™ showed increasing sensitivity (47.0% - 92.6%) and negative predictive value (NPV) (91.4% - 99.9%) for selected TcB thresholds (≥10mg/dL, ≥12mg/dL, ≥15mg/dL, and ≥17mg/dL). Among neonates with TSB measurements (n = 124), Bilistrip™ was associated also with increasing sensitivity (86.8% - 100%) and NPV (62.5% - 100%). The sensitivity and NPV for detecting neonates requiring phototherapy were 95.8% respectively. Only one of the 24 neonates who required phototherapy was missed by the Bilistrip™.

Conclusions

Bilistrip™ is a potential decision-making tool for empowering mothers to detect neonates with clinically significant jaundice that may require close monitoring or treatment, and neonates not requiring treatment for jaundice in the first week of life.