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Neonatal Jaundice: Knowledge and Practices of Healthcare Providers and Trainees in Southwest Nigeria
Eta Barclay
Eta Barclay
Department of Hospital Medicine, Children’s Minnesota, Minneapolis, Minnesota;
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Ifelayo Ojo
Ifelayo Ojo
Department of Pediatrics, Hennepin Healthcare, Minneapolis, Minnesota;
Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota;
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Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota;
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Anne Hake
Anne Hake
U.S. Centers for Disease Control, Atlanta, Georgia;
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Abayomi Oyenuga
Abayomi Oyenuga
Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota;
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Katherine Satrom
Katherine Satrom
Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota;
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Troy Lund
Troy Lund
Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota;
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Mosunmoluwa Oyenuga
Mosunmoluwa Oyenuga
Department of Internal Medicine, SSM Health St. Mary’s Hospital, St. Louis, Missouri;
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Tina Slusher
Tina Slusher
Department of Pediatrics, Hennepin Healthcare, Minneapolis, Minnesota;
Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota;
Department of Pediatrics, Bowen University Teaching Hospital, Ogbomosho, Nigeria
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Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota;
Department of Pediatrics, Bowen University Teaching Hospital, Ogbomosho, Nigeria
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Daniel Gbadero
Daniel Gbadero
Department of Pediatrics, Bowen University Teaching Hospital, Ogbomosho, Nigeria
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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 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.
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Author Notes
Co-first authors: These authors contributed equally to this work.
Co-senior authors: These authors contributed equally to this work.
Authors’ addresses: Eta Barclay, Department of Hospital Medicine, Children’s Minnesota, Minneapolis, MN, E-mail: etabarclay@gmail.com. Ifelayo Ojo, Department of Pediatrics, Hennepin Healthcare, Minneapolis, MN, and Department of Pediatrics, University of Minnesota, Minneapolis, MN, E-mail: iojo@umn.edu. Anne Hake, U.S. Centers for Disease Control, Atlanta, GA, E-mail: hake0014@umn.edu. Abayomi Oyenuga, Department of Internal Medicine, University of Minnesota, Minneapolis, MN, E-mail: oyenu008@umn.edu. Katherine Satrom and Troy Lund, Department of Pediatrics, University of Minnesota, Minneapolis, MN, E-mails: ksatrom@umn.edu and lundx072@umn.edu. Mosunmoluwa Oyenuga, Department of Internal Medicine, SSM Health St. Mary’s Hospital, St. Louis, MO, E-mail: oyenugamosun@gmail.com. Tina Slusher, Department of Pediatrics, Hennepin Healthcare, Minneapolis, MN, Department of Pediatrics, University of Minnesota, Minneapolis, MN, and Department of Pediatrics, Bowen University Teaching Hospital, Ogbomosho, Nigeria, E-mail: tslusher@umn.edu. Daniel Gbadero, Department of Pediatrics, Bowen University Teaching Hospital, Ogbomosho, Nigeria, E-mail: adestar168@gmail.com.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
World Health Organization , 2019. Newborns: Reducing Mortality. Geneva, Switzerland: WHO. Available at: https://www.who.int/news-room/fact-sheets/detail/newborns-reducing-mortality. Accessed July 20, 2020.
-
2.
Lawn JE et al.2014. Every newborn: progress, priorities, and potential beyond survival. Lancet 384: 189–205.
-
3.
Olusanya BO , Teeple S , Kassebaum NJ , 2018. The contribution of neonatal jaundice to global child mortality: findings from the GBD 2016 study. Pediatrics 141: e20171471.
-
4.
Slusher TM , Zamora TG , Appiah D , Stanke JU , Strand MA , Lee BW , Richardson SB , Keating EM , Siddappa AM , Olusanya BO , 2017. Burden of severe neonatal jaundice: a systematic review and meta-analysis. BMJ Paediatr Open 1: e000105.
-
5.
Olusanya BO , Ogunlesi TA , Slusher TM , 2014. Why is kernicterus still a major cause of death and disability in low-income and middle-income countries? Arch Dis Child 99: 1117–1121.
-
6.
Blackmon LR , Fanaroff AA , Raju TN , 2004. Research on prevention of bilirubin-induced brain injury and kernicterus: National Institute of Child Health and Human Development conference executive summary, 2003. Pediatrics 114: 229–233.
-
7.
Ogunfowora OB , Daniel OJ , 2006. Neonatal jaundice and its management: knowledge, attitude and practice of community health workers in Nigeria. BMC Public Health 6: 19.
-
8.
Iskander I , Gamaleldin R , Kabbani M , 2012. Root causes for late presentation of severe neonatal hyperbilirubinaemia in Egypt. East Mediterr Health J 18: 882–887.
-
9.
American Academy of Pediatrics Subcommittee on Hyperbilirubinemia , 2004. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 114: 297–316.
-
10.
Stevenson DK , Maisels MJ , Watchko J , 2012. Care of the Jaundiced Neonate. New York, NY: McGraw-Hill Medical.
-
11.
Maisels MJ , McDonagh AF , 2008. Phototherapy for neonatal jaundice. N Engl J Med 358: 920–928.
-
12.
Hansen TWR , Maisels MJ , Ebbesen F , Vreman HJ , Stevenson DK , Wong RJ , Bhutani VK , 2020. Sixty years of phototherapy for neonatal jaundice - from serendipitous observation to standardized treatment and rescue for millions. J Perinatol 40: 180–193.
-
13.
Usman F , Diala UM , Shapiro SM , Le Pichon JB , Slusher TM , 2017. Acute bilirubin encephalopathy and its progression to kernicterus: current perspective. Res Rep Neonatol 8: 33–44.
-
14.
Le Pichon JB , Riordan SM , Watchko J , Shapiro SM , 2017. The neurological sequelae of neonatal hyperbilirubinemia: definitions, diagnosis and treatment of the kernicterus spectrum disorders (KSDs). Curr Pediatr Rev 13: 199–209.
-
15.
Olusanya BO , Ogunlesi TA , Kumar P , Boo NY , Iskander IF , de Almeida MF , Vaucher YE , Slusher TM , 2015. Management of late-preterm and term infants with hyperbilirubinaemia in resource-constrained settings. BMC Pediatr 15: 39.
-
16.
Olusanya BO , Kaplan M , Hansen TWR , 2018. Neonatal hyperbilirubinaemia: a global perspective. Lancet Child Adolesc Health 2: 610–620.
-
17.
Greco C et al.2016. Neonatal jaundice in low-and middle-income countries: lessons and future directions from the 2015 Don Ostrow Trieste yellow retreat. Neonatology 110: 172–180.
-
18.
Slusher TM , Vaucher YE , 2020. Management of neonatal jaundice in low- and middle-income countries. Paediatr Int Child Health 40: 7–10.
-
19.
Ogunlesi TA , Abdul AR , 2015. Maternal knowledge and care-seeking behaviors for newborn jaundice in Sagamu, southwest Nigeria. Niger J Clin Pract 18: 33–40.
-
20.
Wennberg RP et al.2020. Maternal instruction about jaundice and the incidence of acute bilirubin encephalopathy in Nigeria. J Pediatr 221: 47–54.
-
21.
Iliyasu Z , Abubakar IS , Gajida AU , 2010. Magnitude and leading causes of in-hospital mortality at Aminu Kano Teaching Hospital, Kano, northern Nigeria: a 4-year prospective analysis. Niger J Med 19: 400–406.
-
22.
Smitherman H , Stark AR , Bhutani VK , 2006. Early recognition of neonatal hyperbilirubinemia and its emergent management. Semin Fetal Neonatal Med 11: 214–224.
-
23.
Kaplan M , Bromiker R , Hammerman C , 2011. Severe neonatal hyperbilirubinemia and kernicterus: are these still problems in the third millennium? Neonatology 100: 354–362.
-
24.
Amegan-Aho KH , Segbefia CI , Glover NDO , Ansa GA , Afaa TJ , 2019. Neonatal jaundice: awareness, perception and preventive practices in expectant mothers. Ghana Med J 53: 267–272.
-
25.
Ten Cate O , 2017. Competency-based postgraduate medical education: past, present and future. GMS J Med Educ 34: Doc69.
-
26.
Marinopoulos SS et al.2007. Effectiveness of continuing medical education. Evid Rep Technol Assess 149: 1–69.
-
27.
Gill CJ et al.2011. Effect of training traditional birth attendants on neonatal mortality (Lufwanyama Neonatal Survival Project): randomised controlled study. BMJ 342: d346.
-
28.
Satishchandra DM , Naik VA , Wantamutte AS , Mallapur MD , 2009. Impact of training of traditional birth attendants on the newborn care. Indian J Pediatr 76: 33–36.
-
29.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG, 2009. Research electronic data capture (REDCap) - a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42: 377–381.
-
30.
Ogbo FA , Trinh FF , Ahmed KY , Senanayake P , Rwabilimbo AG , Uwaibi NE , Agho KE , Global Maternal Child Health Research Collaboration , 2020. Prevalence, trends, and drivers of the utilization of unskilled birth attendants during democratic governance in Nigeria from 1999 to 2018. Int J Environ Res Public Health 17: 372.
-
31.
Orimadegun AE , Akinbami FO , Tongo OO , Okereke JO , 2008. Comparison of neonates born outside and inside hospitals in a children emergency unit, southwest of Nigeria. Pediatr Emerg Care 24: 354–358.
-
32.
Adebami OJ , 2015. Assessment of knowledge on causes and care of neonatal jaundice at the Nigerian primary and secondary health institutions. Int J Res Med Sci 3: 2605–2612.
-
33.
Okperi BO , 2013. Neonatal jaundice and birth asphyxia as major causes of cerebral palsy in Nigeria: are doctors’ wrong beliefs and practices part of the problem? Int J Med Biomed Res 2: 226–230.
-
34.
Orimadegun AE , Ojebiyi AO , 2017. Primary health workers’ knowledge and practices relating to neonatal jaundice in Ibadan, Nigeria. Afr J Prim Health Care Fam Med 9: e1–e7.
-
35.
Stop Kernicterus International , 2021. Understanding Jaundice in Newborns. Bothell, WA: Bilimetrix USA LLC. Available at: https://skibilimetrixusa.azurewebsites.net/. Accessed December 9, 2021.
-
36.
Kaplan M , Hammerman C , 1998. Severe neonatal hyperbilirubinemia. A potential complication of glucose-6-phosphate dehydrogenase deficiency. Clin Perinatol 25: 575–559.
-
37.
Bhutani VK , Johnson L , Sivieri EM , 1999. Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns. Pediatrics 103: 6–14.
-
38.
Ullah S , Rahman K , Hedayati M , 2016. Hyperbilirubinemia in neonates: types, causes, clinical examinations, preventive measures and treatments: a narrative review article. Iran J Public Health 45: 558–568.
-
39.
Okeke TC , Ocheni S , Nwagha UI , Ibegbulam OG , 2012. The prevalence of Rhesus negativity among pregnant women in Enugu, Southeast Nigeria. Niger J Clin Pract 15: 400–402.
-
40.
Adeyemi AS , Bellow-Ajao HT , 2016. Prevalence of Rhesus D-negative blood type and the challenges of Rhesus D immunoprophylaxis among obstetric population in Ogbomosho, southwestern Nigeria. Ann Trop Med Public Health 9: 12–15.
-
41.
Omotade OO , Adeyemo AA , Kayode CM , Falade SI , Ikpeme S , 1999. Gene frequencies of ABO and RH (D) blood group alleles in a healthy infant population in Ibadan, Nigeria. West Afr J Med 18: 294–297.
-
42.
Bhutani VK et al.2013. Neonatal hyperbilirubinemia and Rhesus disease of the newborn: incidence and impairment estimates for 2010 at regional and global levels. Pediatr Res 74: 86–100.
-
43.
Lee J , Poitras BT , 2019. Prevalence of glucose-6-phosphate dehydrogenase deficiency, U.S. Armed Forces, May 2004–September 2018. MSMR 26: 14–17.
-
44.
Nkhoma ET , Poole C , Vannappagari V , Hall SA , Beutler E , 2009. The global prevalence of glucose-6-phosphate dehydrogenase deficiency: a systematic review and meta-analysis. Blood Cells Mol Dis 42: 267–278.
-
45.
Cappellini MD , Fiorelli G , 2008. Glucose-6-phosphate dehydrogenase deficiency. Lancet 371: 64–74.
-
46.
Luzzatto L , Ally M , Notaro R , 2020. Glucose-6-phosphate dehydrogenase deficiency. Blood 136: 1225–1240.
-
47.
Owa JA , 1989. Relationship between exposure to icterogenic agents, glucose-6-phosphate dehydrogenase deficiency and neonatal jaundice in Nigeria. Acta Paediatr 78: 848–852.
-
48.
HealthTap , 2020. Is Eucalyptus Safe for G6pd Baby? sunnyvale, CA: HealthTap. Available at: https://www.healthtap.com/questions/1486351-is-eucalyptus-safe-for-g6pd-baby/. Accessed July 18, 2020.
-
49.
Arogbokun O , Shevic M , Slusher T , Farouk Z , Elfstrum A , Weber J , Cusick S , Lun T , 2020. Traditional African remedies induce hemolysis in a glucose-6-phosphate dehydrogenase deficient zebrafish model. Sci Rep 10: 19172.
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