Eneh, AU

Ugwu, RO

English

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187INTRODUCTIONNeonatal Jaundice (NNJ) is a common disorderworldwide affecting 30-70% of newborn infants.In Nigeria it is common and often associated withserious complications . Even moderate neonatalhyperbilirubinaemia may lead to some neurologicaldamage. However, severe cases lead to brain damage(Kernicterus) . It is a leading cause of neonatalmortality among Nigerian children. Variousstudies in Nigeria show that the main aetiologicalfactors in Neonatal Jaundice include Glucose-6-Phosphatase Dehydrogenase( G6PD) deficiency,infection, prematurity, ABO blood groupincompatibility exposure to icterogenic drugs egcotrimoxazole , pyrimethoprine/sulphamethoxazoleand chemicals eg insecticides Significant1-45-124,13,1415,165,6,7,177,18Correspondence: DrAU EnehE-Mail:austaeneh@yahoo.comexposure to naphthalene, insecticides, mentholathedbalms and powders and traditional herbs have beenfound to be important risk factors in G6PD deficientbabies .The main treatment of Neonatal Jaundiceis phototherapy and Exchange Blood Transfusion(EBT). Delay and improper treatment is oftenassociated with high morbidity and mortality. Inorder to prevent the onset of bilirubinencephalopathy, it is important that effective therapyis commenced early. Our personal observation inUniversity of Port Harcourt Teaching Hospital(UPTH) on Neonatal jaundice suggests that there is adelay in seeking treatment as a result of usingineffective remedies before coming to hospital.Whether this is as a result of lack of awareness orinadequate knowledge is not known. The presentstudy was therefore undertaken to assess the19,207,9,11Nigerian Journal of Clinical PracticeJune 2009 Vol 12(2):187-191PERCEPTION OF NEONATAL JAUNDICE AMONG WOMEN ATTENDINGCHILDREN OUT PATIENT AND IMMUNIZATION CLINICS OF THE UPTHPORTHARCOURTAU Eneh, RO UgwuABSTRACTBackground:Objective:Method:ResultsConclusionKey Words:Department of Paediatrics and Child Health, University of Port Harcourt Teaching Hospital, PortHarcourt(Accepted 13 May 2008)Neonatal Jaundice (NNJ) is a common disorder worldwide. Early identification and propermanagement is needed to prevent the serious neurological complications associated with it.To determine the knowledge of the women attending Children Outpatient (CHOP) andImmunization clinics on the causes, treatment and complications of neonatal jaundice.Women who brought their children/wards to the immunization/ children out patient clinics at theUniversity of Port HarcourtTeaching Hospital Port Harcourt were interviewed using structured questionaire.: There were 255 mothers who participated in the study. Of these 30 (11.8%) have never heard ofneonatal jaundice while 225(88.2%) have heard and only those who have heard were further analyzed. The agerange was from 16 to 47yrs (mean age 27.1 ±3.3 years). Median parity was 2. One hundred and twenty two(54.2%) women had tertiary education. One hundred and seventy four (77.3%) correctly defined neonataljaundice, and in 114 (44.7%) source of information was from health talk in the clinic. Seventy five (33.3%), and50 (22.2%) erroneously believed that eating too much groundnut in pregnancy and mosquito bite respectivelywere the main causes while 55 (24.4%) correctly answered that it is due to mismatch of mother and baby'sblood. Only a few knew that use of dusting powder on baby's cord , prematurity, and storing baby's clothes incamphor were risk factors for NNJ. One hundred and fourteen (50.7%) and 60 (26.7%), wrongly believed thatexposure to sunlight and use of glucose drinks respectively were the main forms of treatment and 50 (22.2%)knew brain damage as a possible complication: There is still misconception on the causes and risk factors and treatment of neonatal jaundiceamong our women. Also only a few women are reached by the health talk in the clinics. There is thereforeurgent need for massive health enlightenment campaign.Neonatal jaundice, mother's knowledge and perception.188Nigerian Journal of Clinical Practice June 2009, Vol.12(2) Neonatal Jaundice Eneh & Ugwu>knowledge of the women attending CHOP andImmunization clinics on the causes, treatment andcomplications of neonatal jaundice.The study was carried out at the immunization andchildren out patient clinics of the University of PortHarcourt Teaching Hospital (UPTH) in the SouthSouthern part of Nigeria from 1 October to 30November 2006.The subjects comprised womenwho brought their children/wards to these clinics.The study was undertaken using structuredquestionnaire developed by the authors. Theinstrument was pilot tested on 10 mothers and wasrevised to remove ambiguity and ensure clarity ofthe questions. The main survey was conducted bytwo trained house officers in the department ofPaediatrics under supervision of the authors. Thequestions sought information from the respondentson their ages, educational status, knowledge ofjaundice, source of information, causes and riskfactors of jaundice, treatment and probablecomplications. Informed consent was obtained fromthe respondents. Adequate guidance on how toanswer the question was given to the subject, withcare being taken so as not to influence theresponse.The data was analyzed using SPSS version11.Data was summarized as descriptivestatistics namely mean, median, Standard Deviation(SD) and percentage.Ethical approval was obtained from the EthicalCommittee of the University of Port HarcourtTeaching Hospital, Port Harcourt.There were 255 mothers who participated in thestudy. Of these 30 (11.8%) said they have neverheard of neonatal jaundice while 225(88.2%) haveheard and only those who have heard were furtheranalyzed. The age range was from 16 to 47yrs (meanage 27.1 ±3.3 years). Table 1 revealed that themajority 37.8% were in the age range 26 30 years.Median parity was 2. Most of the women 122(54.2%) had tertiary education, while 64 (28.4%)and 39 (17.3%) had secondary and primaryeducations respectively. One hundred and seventyfour (77.3%) respondents correctly defined neonataljaundice as yellowish discolouration of the eye andskin, 20 (8.9%) answered that it was “baby passingtoo much urine”, 12 (5.3%) replied that it was whenthe baby was “off colour”, 6 (2.7%) respectivelyanswered that it was when baby is pale and bluishdiscolouration while the remaining 7 (3. %) hadvarious answers such as eye discharge , convulsionsetc. The sources of information for 114 (50.7%)respondents was from health talk in the clinic, 70 (31.1%) from friends, neighbours and relatives,21(9.3%) read it from books while mass media andSUBJECTSAND METHODSRESULTSst thChi-square test was used forcomparison of proportions and where figures weresmall the Fisher's exact probability test was applied.The level of statistical significance was set at = 0.05.pother sources ( eg pharmacist, church ) was in 10(4.4%) respectively. Table 2 lists the causes and riskfactors of neonatal jaundice as given by therespondents. Seventy five (33.3%) respondents saidthat eating too much groundnut in pregnancy was amajor cause of NNJ, 55 (24.4%) correctly answeredthat it is when the mother's blood does not matchbaby's blood while 50 (22.2%) think that mosquitobite was the cause. Only a few knew that use ofdusting powder on baby's cord , prematurity, andstoring baby's clothes in camphor were causes/ riskfactors of NNJ 18 (8%), 16 (7.1) and 10 (4.4%)respectively. The 'don't know' responses numbered 30(13.3%). On the treatment of NNJ, the responsesincluded exposure to sunlight by 114 (50.7%), givingof glucose drinks by 60 (26.7%), use of oralantibiotics by 51(22.7%) and use of special lightsource in the hospital by 42 (18.7%) Table 3. Only 6(2.7%) respondents knew that blood transfusion is aform of treatment and the source of information forthese 6 was health talk, while up to 22 (9.8%) saidnothing should be done and source of information forall 22 was friends/ neighbours/relatives. On thequestion on whether they considered NNJ a seriousproblem that need prompt doctors attention, 144(64%) answered in the affirmative while 81 (36%)answered no. Only 50 (22.2%) of the respondentsrecognized brain damage as a possible danger whilethe majority 175 (77.8%) did not. Table 4 shows thenumber of respondents in the various age groups whohad correct perception of the definition, causes,treatment and complications of NNJ. Although therespondents were similar in their perception ondefinition and causes, there was low perception on thetreatment and complications in all the age groups.There was no statistical significant difference amongthe various age groups. Table 5 shows the level ofeducation of those with correct perception of variousaspects of NNJ. There were statistical significantdifferences between those with primary educationand those with tertiary education on the correctperception of definition =17.39, p=0.00003 withYates correction), treatment =6.68, p=0.009 withYates correction), and complications =14.76,p=0.00012 with Yates correction), but no significantdifference between those with secondary andtertiary education.Table 1:16-20 7(3.1)21-25 28 (12.4)26-30 85 (37.8)31-35 77 (34.2)35 28 (12.4)(x(x(x222Age Distribution of RespondentsAge in years No of respondents (%)Total 225 (100)>189among them. A minimum of secondary educationpositively influenced their perception. Thisawareness however, is not associated with adequateknowledge of certain aspects of the condition such astreatment and complication.Although 50.7% of thewomen were reached by the health talk in the clinicsthis did not have much impact on their knowledge ofcauses, treatment and complications. In this studymass media was an insignificant source ofinformation, this is similar to a study by Ogunfoworaand co-workers in Shagamu Also in this study31.1% had their source of information fromfriends/neighbours/relations, this is also comparableto findings by Ogunfowora and co-workers . Thereare still misconceptions on the causes and treatmentof neonatal jaundice among our women. A lot ofwomen think that eating too much ground nut andmosquito bite in pregnancy cause jaundice. Thesemisconceptions may have also stemmed from thefact that the sources of information in 31.1% of therespondents were from either friends, neighbours orrelatives who may have also gotten wronginformation themselves. Although several studies inNigeria show that exposure to some householdicterogenic substances are risk factors, in this studyonly a few women knew this. Since these householdchemicals are important in the pathogenesis ofneonatal jaundice in our environment and theseicterogenic agents are commonly used in storage ofthe babies' clothes, dressing of the babies cords andas mosquito repellant, health education aimed ateliminating the exposure of neonates to such agentsis highly needed. In this study a large number of thewomen believe that exposure to sunlight is the maintreatment. This usually diverts attention and lead todelay in seeking medical attention. There isinsufficient evidence to support exposure to sunlightfor the treatment of jaundice. The persistence of thispractice 40 years after publication of a report on asingle case series raises questions about the influenceof evidence on the beliefs of professional healthcareworkers . The use of sunlight as treatment appears tohave resulted from anecdotal reports of itseffectiveness rather than from rigorous medicalevidence. If the effectiveness of sunlight exposurefor jaundice is unknown, so too is the incidence ofpotential risks to the neonate for example, sunburn orphotosensitivity. The effectiveness of “sunshinephototherapy cot” in the treatment of NNJ has beenreported by Olowe for use in Primary Health Care(PHC) facilities although it was recommended formild jaundice. Also exposure to sunlight has beensaid to be effective if it is intense and prolonged, butsuch intense and prolonged exposure in ourenvironment may cause hyperpyrexia and sunburn.Glucose water drink as a treatment for NNJ was212122232425Table 2:Table 3:Table 4:Table 5:Neonatal jaundice is a worldwide and potentiallylethal condition; therefore, mothers involved in thecare of the newborn must possess adequateknowledge on the causes/risk factors, treatment andseverity of the illness. In the present study 77.3% ofthe respondents knew what neonatal jaundice is. Thismay probably be as a result of high literacy rateCauses/Risk Factors for Jaundice AsGiven By the Respondents.Treatment Options Given By theRespondents.Number of Respondents in the VariousAge Groups with Correct Perception of theDefinition, Causes, Treatment and Complicationsof NNJ.Number of Respondents within VariousEducational Backgrounds with CorrectPerception of the Definition, Causes, Treatmentand Complications of NNJ.DISCUSSIONNigerian Journal of Clinical Practice June 2009, Vol.12(2) Neonatal Jaundice Eneh & Ugwu190highly rated in this study. This has no physiologicalbasis; such a therapy not only diverts attention frombreast milk but creates a false confidence in themother thus delaying seeking appropriate medicalattention. Thus the high rating of exposure tosunlight and use of glucose drinks is unfounded andtantamount to dangerous delays or mismanagement.There was lack of knowledge on the possible dangersof Neonatal jaundice. Although 64% consideredNNJ a serious problem that needs doctor's attention,only 22.2% knew that brain damage was a possibledanger. The inadequacy of knowledge of this dangermay have caused the trivialization of the illness assome of the respondents said nothing should be done,and child should be taking to church, or use eye dropor herbal medication.It is concluded that a lot of mothers do not haveadequate knowledge on the causes / risk factors,treatment and complications of NNJ. A lot ofinformation has been obtained on NNJ in Nigeria.The information accumulated must be shared withthe community especially the mothers. We thereforerecommend that there is urgent need for healthenlightenment campaign on NNJ in the hospitals (ashealth talks and information pamphlet), mass media,women organizations and churches by paediatriciansemphasizing the possible trigger factors available inthe home, the appropriate treatment (what to do andwhat not to do with a jaundiced baby) and the effecton the brain. It should also emphasize early medicalconsultation and discourage use of self medicationand reliance on unproven treatment methods. Thiswill make them seek prompt attention in the hospitaland reduce the neurological effect and mortality fromNNJ in the society.The authors wish to thank Dr. Bathlomew Ntui andDr. Eze, house officers in the Department ofPaediatrics, for the active role they played in the datacollection.Kernicterus: still a concern.Neonatal Netw 2005; 17(2): 167-9.. Effect of clofibrate in jaundiced termnewborns. Indian J Paediatr 2005:72:123-6.. Accuracy oftranscutaneous bilirubinometer estimatesusing Bilicheck in Thai neonates. J Med AssicThai 2005; 88(2):187-90.CONCLUSIONACKNOWLEDGMENTREFERENCES1. Juretschke LJ.2. Mohammadzadeh A, Farhat AS, IranpourR3. Janjidamai W, Tansantiwong T4. Newman TB, Maisels MS5. Ransome-Kuti O6.7. Effiong CE, LaditanAAO.8. Animashaun A9. Owa JA, Dawodu AH, Familusi JBDuggan MB, Ogala W11 . Asindi AA12. Fadero FF13. Hansen TW14. Bhutani VK, Johnson LH15 . Owa JA, Oshinaike AI16. Ezechukwu CC, Ugochukwu EF, Egbuonu I,Chukwuka JO17. Azubuike JC. Kernicterus inotherwise healthy, breastfed term newborns.Pediatr 1995; 96:730-3.. Problems of Paediatricsemergencies in Nigeria. Niger Med. J. 1972;2:6 2-70.Neonatal jaundice in Ibadan.Incidence and etiologic factors in babies born inhospital. 1975; 67: 208-213.Neonatal Jaundicein Ibadan: a study of cases in the out-patientclinic. Nig J Paediatr 1976; 3: 1-8.. Aetiology of Cerebral palsy inAfrican Children. Afr J Med Sci 1997; 2: 165-171.. Kerniterusin Nigerian infants. West Afr. J. Med 1987;6:11-22.. Cerebral palsy inNigeria- A report from Zaria. Ann TropPaediatr 1982; 2: 7-11.. The pattern of neurologicaldisabilities in children seen at the University ofCa laba r Teaching Hospi ta l . Nig JPaediatr1988; 13: 127-132.. Causes of Neonatal deaths in UCHIbadan: An autopsy study. Nig J Paediatr 1985;12: 65-68.. Treatment of neonatal jaundice.Tidsskr Nor Laegeforen 2005; 125(5):594-8.. Newborn jaundiceand kernicterus health and societalperspectives. Indian J Pediatr 2003; 70(5):407-16.. Neonatal morbidityand mortality in Nigeria. Indian J Pediatr 1998;65(3):441-9.. Risk factors for neonatalmortality in a regional tertiary hospital inNigeria. Nigerian Journal of Clinical Practice2004; 7(2) : 50-2.. Neonatal jaundice in EasternNigeria. J Trop Paediatr. 1985; 31: 82-84.Effiong CE, Aimaku VE, Bienzle U, OyedejiGA, Ikpe DE.J Natl Med Assoc10.Nigerian Journal of Clinical Practice June 2009, Vol.12(2) Neonatal Jaundice Eneh & Ugwu19118. Coulter JBS, Akpabio MA, Jikeme MA,Kay T19. Familusi JB, Dawodu AH. A20. Olowe SA, Ransome-Kuti O21 Ogunfowora OB, Adefuye PO, Fetuga MB.. Neonatal Jaundice in NorthernNigeria. Nig J Paediatr 1978; 5: 12-5.survey ofneonatal jaundice in association withhousehold drugs and chemicals in Nigeria.Ann Trop Paediatri 1985; 5: 219-222.. The risk ofj a u n d i c e i n g l u c o s e - 6 - p h o s p h a t edehydrogenase deficient babies exposed tom e n t h o l . A c t a P a e d i a t r S c a n d1980;69(3):341-5.What Do Expectant Mothers Know aboutNeonatal Jaundice? International ElectronicJournal of Health Education, 2006; 9:134-140.22. Renea V Johnston, Jeremy N Anderson,Cheryl Prentice23. Harrison SL, Buettner PG, MacLennan R.924 Olowe SA.25. Chan MCK. Is sunlight an effectivetreatment for infants with jaundice? EBM INACTION MJA2003; 178: 1Why do mothers still sun their infants?1999; 35: 296-29 .. Sunshine phototherapy cot:utilization of sunlight for phototherapy. Nig JPaediatr 1985; 12; 69-. 3. The fetus and the newborn. In :Paediatrics in the Tropics. Hendrickse RG, BarrDCD and Mathews TS (eds). London,Blackwell Scientific Publications 1991: 163-6.JPaediatr Child HealthNigerian Journal of Clinical Practice June 2009, Vol.12(2) Neonatal Jaundice Eneh & Ugwu

Perception of nonatal jaundice among women attending children out patient and immunization clinics of the UPTH Port Harcourt

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Perception of nonatal jaundice among women attending children out patient and immunization clinics of the UPTH Port Harcourt

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