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Published on: November 20, 2015
Antenatal jaundice instruction and acute bilirubin encephalopathy in Nigeria
Richard P Wennberg1, Zainab O Imam2, David D Shwe3
1Emeritus, Department of Pediatrics, University of California, Davis, Davis, CA, USA. rpw3450@gmail.com.
Insights
Maternal education on jaundice, including antenatal instruction with postnatal reinforcement, significantly reduces the incidence of acute bilirubin encephalopathy (ABE) and related deaths in Nigeria. This approach empowers mothers for timely care-seeking, improving neonatal outcomes.
Area of Science:
- Neonatal Health
- Public Health
- Pediatrics
Background:
- Acute Bilirubin Encephalopathy (ABE) is a prevalent condition in Nigeria.
- Limited parental recognition of jaundice and delayed healthcare-seeking contribute to ABE incidence.
Purpose of the Study:
- To compare the effectiveness of different maternal jaundice education strategies on ABE incidence.
- To assess the impact of antenatal and postnatal instruction versus no instruction on ABE prevention.
Main Methods:
- A comparative study involving 647 neonatal admissions for jaundice.
- Stratification of risk factors and comparison of ABE incidence across three groups: antenatal/postnatal instruction, postnatal instruction only, and no instruction.
Main Results:
- The group receiving both antenatal and postnatal instruction had the lowest ABE incidence (1.2%), compared to postnatal only (16.8%) and no instruction (23.1% to 90.9%).
- ABE was associated with out-of-hospital delivery and limited antenatal care, risks mitigated by maternal instruction.
- Instruction increased detection of jaundice at lower bilirubin levels, facilitating earlier intervention.
Conclusions:
- Interactive antenatal jaundice instruction with postnatal reinforcement is highly effective in reducing ABE incidence.
- Empowering mothers through education is crucial for neonatal jaundice management in low-resource settings.
- Integrating jaundice education into antenatal care can significantly decrease bilirubin-induced brain injury.
Background:
Acute Bilirubin Encephalopathy (ABE) is common in Nigeria. Parents' inability to recognize jaundice and delays in seeking care are significant barriers to its prevention.
Methods:
We compared associations of (1) interactive antenatal maternal jaundice instruction with postnatal reinforcement, (2) standard postnatal instruction, and (3) no maternal instruction with the incidence of ABE among 647 jaundice admissions stratified for risk factors identified in initial descriptive analysis.
Results:
Eighty-three (83/647;12.8%) admissions developed ABE including eleven jaundice-related deaths. ABE was present at admission in 20/22 (90.9%) if mothers received no jaundice instruction and no antenatal care, 42/182 (23.1%) if received antenatal care but no instruction, 16/95 (16.8%) if received postnatal instruction only, and 4/337 (1.2%) if mothers received both antenatal and postnatal instruction (p < .001). ABE was highly associated with out-of-hospital delivery, number of antenatal clinic visits, and birth attendant, but these risks were mitigated by antenatal/postnatal instruction. Admission rates with bilirubin levels below treatment guidelines (12 mg/dL) were higher following instruction (30.7%) than with no instruction (14.4%). Limiting subjects to those meeting admission criteria increased ABE rates in all groups without altering conclusions.
Conclusion:
Interactive antenatal instruction with postnatal reinforcement resulted in timely care seeking and a lower incidence of ABE.
Impact:
Empowering mothers to participate in neonatal jaundice management is critical in low-income countries where jaundice monitoring and follow up are unreliable. Instructing mothers about jaundice in antenatal clinics with postnatal reinforcement is more effective than standard postpartum instruction in facilitating jaundice detection, timely care seeking, and lowering the incidence of acute bilirubin encephalopathy (ABE). Antenatal training also mitigates risks for ABE associated with out-of-hospital deliveries, limited antenatal care, and unskilled birth attendants.
Impact:
Adding structured jaundice instruction in antenatal clinics could greatly reduce bilirubin induced brain injury in countries where ABE is common.
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