Neonatal Jaundice: Knowledge and Practices of Healthcare Providers and Trainees in Southwest Nigeria

Abstract

Severe neonatal jaundice (SNNJ) is a leading cause of neonatal morbidity and mortality in low- and middle-income countries (LMICs). Risk mitigation and management modalities for SNNJ have led to a marked reduction in complications in high-income countries but not in LMICs likely in part due to knowledge gaps among healthcare providers. This study, a cross-sectional study conducted in Ogbomosho, Nigeria, aimed to identify SNNJ knowledge and practices among Nigerian healthcare providers/trainees. Healthcare providers/trainees completed a structured questionnaire. Healthcare providers/trainees included are nurse midwives (33.4%), nurses (18.6%), nursing students (15.2%), traditional birth attendants (TBAs) (12.7%), physicians (10.2%), and medical students (9.9%). Most physicians were aware of the common causes of SNNJ; however, knowledge deficits in other groups were notable. Despite most providers endorsing that glucose-6-phosphate dehydrogenase deficiency can cause SNNJ (91% of physicians, 60% of nurses, 71% of midwives, 81% of medical students, 43% of nursing students, 7% of TBAs), very few providers recognized that it is common, ranging from 3% in nurses up to a high of 47% among medical students. Gaps in provider knowledge regarding preventative measures and sequela were also noted. These data identified significant knowledge gaps regarding the etiology of SNNJ among healthcare providers/trainees, which can lead to missed opportunities in effective prevention and treatment. These deficits must be addressed if we are to eliminate tragic and preventable complications from SNNJ in Nigeria and other LMICs.

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

“…Now decades later after this 1989 recommendation, routine G6PD deficiency screening programs have not been adopted in many regions, even those with a significant burden of G6PD deficiency and SNJ ( 81 ). A recent survey of healthcare providers in Nigeria, one such high risk country, illustrated gaps in knowledge of the common prevalence and need for screening of G6PD deficiency at their local hospital ( 20 ). The combination of routine screening and education of both healthcare workers and parents is needed to reduce the contribution of G6PD deficiency to SNJ globally.…”

“…Arogbokun et al reported that eucalyptus oil induced a 13.4% increase in hemolysis and methylated spirit showed a 39.7% increase in hemolysis in the zebrafish model ( 94 ). A survey of healthcare workers and trainees in Southwest Nigeria demonstrated that even these medical professionals often recommended hemolytic agents for the umbilical cord (82% recommended methylated spirit) ( 95 ). Other regional practices may delay proper care.…”

“…An emphasis on prenatal prevention must include education of the maternal providers, including obstetric physicians, traditional birth attendants, or nurse midwives. A survey of healthcare providers and trainees identified significant gaps in provider knowledge related to prevention of and possible sequela of SNJ ( 20 ). For example only 53% of healthcare providers reported seeing a case of neonatal jaundice and very few traditional birth attendants recognized risk factors for SNJ (G6PD deficiency, Rh incompatibility, preterm birth) ( 20 ).…”

“…A survey of healthcare providers and trainees identified significant gaps in provider knowledge related to prevention of and possible sequela of SNJ ( 20 ). For example only 53% of healthcare providers reported seeing a case of neonatal jaundice and very few traditional birth attendants recognized risk factors for SNJ (G6PD deficiency, Rh incompatibility, preterm birth) ( 20 ). Risk factors of SNJ that should be identified during pregnancy include a family history of SNJ, Rh negative blood type, family history of G6PD deficiency or other risk factor for hemolysis.…”

“…There have been noteworthy improvements in the care of infants with NJ over the last years and decades. Significant effort has been made in the prevention of SNJ through parental and healthcare provider education ( 19 , 20 ) and improved diagnosis with more accessible bilirubin measurement tools ( 21 – 25 ). The advent of phototherapy over sixty years ago ( 26 ) with improved quality of devices including the introduction to light emitting diode (LED) based units ( 27 , 28 ), and subsequent upscaling and distribution of this treatment has reduced the need for exchange transfusions and therefore likely improved outcomes ( 29 – 31 ).…”