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Neonatal jaundice detection in low-resource Mexican settings: possibilities and barriers for innovation with mobile
Gabriela Jiménez-Díaz1,2, Anders Aune3,4,5, Jesús Elizarrarás-Rivas6,7
1Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway. gabriela.j.diaz@ntnu.no.
Insights
A smartphone device for neonatal jaundice screening shows promise in low-income settings. Implementation requires addressing barriers like internet access and costs to improve infant care and prevent brain damage.
Area of Science:
- Neonatal health
- Medical device implementation
- Global health equity
Background:
- Neonatal jaundice is a common condition with severe consequences if undetected, particularly in low-resource settings.
- Visual assessment for neonatal jaundice lacks accuracy, leading to adverse outcomes in low- and middle-income countries.
- Picterus Jaundice Pro (Picterus JP), a smartphone-based tool, offers a more accurate screening method compared to visual assessment.
Purpose of the Study:
- To identify barriers and facilitators for implementing the Picterus JP device in Mexican public health services.
- To explore current neonatal jaundice detection processes and stakeholder perspectives in low-income Mexican settings.
Main Methods:
- Qualitative data collection through focus groups, semi-structured interviews, and observations in Oaxaca, Mexico.
- Inclusion of medical doctors, nurses, and health administrators as participants.
- Thematic analysis guided by the Consolidated Framework for Implementation Research.
Main Results:
- Four themes emerged: current neonatal care and jaundice detection, needs for improvement, implementation barriers/facilitators, and healthcare worker expectations.
- Deficiencies in current neonatal jaundice detection were identified, alongside a desire for more accurate methods.
- Picterus JP was seen as user-friendly and compatible with routines, but internet issues and costs posed adoption barriers.
Conclusions:
- Implementing Picterus JP as a supportive screening tool for neonatal jaundice is promising.
- Contextual barriers, such as infrastructure and cost, must be addressed for successful integration.
- Optimizing visual assessment remains an important strategy for improving neonatal jaundice detection.
Background:
Neonatal jaundice is a common condition that can lead to brain damage and disabilities when severe cases go undetected. Low- and middle-income countries often lack accurate methods for detecting neonatal jaundice and rely on visual assessment, resulting in a higher incidence of adverse consequences. Picterus Jaundice Pro (Picterus JP), an easy-to-use and affordable smartphone-based screening device for the condition, has demonstrated higher accuracy than visual assessment in Norwegian, Philippine and Mexican newborns. This study aimed to identify the barriers and facilitators to implementing Picterus JP in public health services in low-income settings in Mexico by exploring the current process of neonatal jaundice detection and stakeholders' perspectives in that context.
Methods:
Qualitative data collection techniques, including one focus group, 15 semi-structured interviews and four observations, were employed in urban and rural health facilities in Oaxaca, Mexico. The participants included medical doctors, nurses and health administrators. The data were analysed by thematic analysis guided by the Consolidated Framework for Implementation Research.
Results:
The analysis yielded four main themes: (I) the current state of neonatal care and NNJ detection, (II) the needs and desires for enhancing NNJ detection, (III) the barriers and facilitators to implementing Picterus JP in the health system and (IV) HCWs' expectations of Picterus JP. The findings identify deficiencies in the current neonatal jaundice detection process and the participants' desire for a more accurate method. Picterus JP was perceived as easy to use, useful and compatible with the work routine, but barriers to adoption were identified, including internet deficiencies and costs.
Conclusions:
The introduction of Picterus JP as a supporting tool to screen for neonatal jaundice is promising but contextual barriers in the setting must be addressed for successful implementation. There is also an opportunity to optimise visual assessment to improve detection of neonatal jaundice.
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