Knowledge, traditional beliefs and management practices of neonatal jaundice among antenatal women

INTRODUCTION

In the first two weeks of life, neonatal jaundice is one of the most common reasons for readmission in neonates.^[1,2] It is characterized by yellowing of the skin, sclera, and mucous membrane due to excessive breakdown of red blood cells and immature liver function.^[2,3] Neonatal jaundice may be physiological, resolving naturally within 2 or 3 weeks, or pathological, resulting from underlying conditions such as sepsis, haemolytic, and metabolic disorders, which require urgent treatment.^[2,4] Early detection and timely treatment are imperative to avoid complications such as bilirubin encephalopathy, kernicterus, or death.^[5]

Globally, neonatal jaundice is one of the causes of infant morbidity and mortality, affecting up to 60% of term and 80% of preterm infants during the first days of life.^[5-7] Its prevalence ranges from 3.2-4.4. per 10,000 live births in Europe and America, rising to 251.3 and 667.8 in Southeast Asia and African countries, respectively. In Sub-Saharan Africa and South Asia, it affects 73 per 100,000 live births, with Nigeria reporting a higher incidence of 10-36%.^[8,9]

The medical management of neonatal jaundice varies with severity. Mild cases typically require only adequate breastfeeding, while severe cases may necessitate phototherapy or exchange blood transfusion.^[10] However,^[11] argue that prevention is more effective and safer than these conventional treatments, which may be harmful to neonates.

In low and middle-income countries, mothers who deliver at term without complications are often discharged early, sometimes before signs of neonatal jaundice appear.^[1] As a result, many are already at home caring for their newborns when symptoms develop, making maternal awareness/education and early recognition of jaundice critical.^[7]

While studies suggest that many mothers are aware of neonatal jaundice,^[1,7,12] misconceptions persist. Beliefs such as jaundice being caused by yellow fever, malaria in pregnancy, yellow clothing, or consuming palm oil remain common.^[1,13] Maternal knowledge has been linked to factors like antenatal care, attendance, and previous experience with the condition.^[5,13] Sadly, some mothers also indulge in the traditional treatments, ranging from giving glucose water to applying paw-paw extract, use of concoctions, not drinking cold water during pregnancy, or cutting of the baby’s eyelids, some of which may be harmful.^[14]

Khedmat et al.,^[15] in an Iranian study, noted that the traditional treatments commonly used by mothers include the plant extract, pomegranate paste, and other herbal compounds. These alternatives were preferred due to their perceived affordability and fewer side effects. Similarly, in Nigeria,^[14] found that many antenatal women favoured traditional methods over hospital care, contributing to the persistent practice across generations. However,^[16] cautioned that reliance on traditional remedies may delay proper medical interventions, potentially worsening health outcomes.

Given the high mortality rates linked with neonatal jaundice in Nigeria and widespread traditional beliefs, this study aims to assess the knowledge, beliefs, and practices related to neonatal jaundice among antenatal women at Poly General Hospital, Asata, Enugu State. These insights can inform tailored interventions geared towards improving early detection, effective management, and infant health outcomes.

MATERIAL AND METHODS

RESULTS

Table 1 presents the demographic characteristics of the antenatal women. Their age ranged from 17-42 years, with a mean and standard deviation of 28.52 ± 5.85 and a modal age group of ≤25 years (35.2%). They were predominantly Christian (95.3%) and married (90.7%). More than half of the respondents (58.1%) had a tertiary education, and the average family income was 50-100 thousand (49.6%). A greater percentage of the respondents had a parity of 1 (25%).

From Table 2, most of the women (66.1%) knew jaundice in a newborn baby to be a yellowish discoloration of the skin and eyes of a baby. However, the majority (62.7%) believed malaria and typhoid cause jaundice in newborn babies. Many believed that phototherapy is the treatment for jaundice in newborn babies (52.5%). Brain damage was the major complication of jaundice in newborn babies (39.4%). Overall, only a few (6.4%) of the women had adequate knowledge of neonatal jaundice.

Table 3 shows the traditional beliefs related to neonatal jaundice. The main belief reported by the respondents was that jaundice in newborn babies can cause serious consequences if managed traditionally (2.97±0.65).

Table 4, the major practices in the management of neonatal jaundice among the women were exposing newborns to sunlight (79.2%) and the use of glucose water to treat jaundice in a newborn baby (67.8%).

A cross-tabulation of the respondents’ highest academic attainment and knowledge of neonatal jaundice was done [Table 5]; it was observed that there was a significant association between academic attainment and knowledge of neonatal jaundice of the women (p = 0.031). Only those with a degree certificate had a higher percentage of good knowledge (17.2%).

The knowledge of neonatal jaundice and traditional practices in its management was compared. It revealed that there is no significant association between knowledge and practice (p = 0.156). Both the good and poor knowledge were almost the same for their traditional beliefs [good (1.68±0.17); poor (1.73±0.16)] [Table 6].

Upon comparing knowledge levels and traditional beliefs, the study revealed no significant association between the two among the women (p = 0.955). Interestingly, both those with good knowledge and those with poor knowledge of neonatal jaundice displayed similar traditional beliefs [good (2.67±0.57); poor (2.66±0.42)] [Table 7].

DISCUSSION

In this study, although the majority of the respondents were able to identify some signs of neonatal jaundice, the overall knowledge was poor. Signs such as problems with feeding, difficulty waking up from sleep, and pulling of the neck or body backward were reported only by a few. Also, in terms of treatment, only slightly above average stated phototherapy as the treatment for neonatal jaundice, while others were not aware of the treatment options. Additionally, most of the respondents lacked knowledge of the complications of neonatal jaundice, and only a few reported brain damage as a major complication. This could be due to the respondents having attended an antenatal class before, where neonatal jaundice may have been discussed.

These findings are consistent with the findings of,^[1,16,17] where most of the expectant mothers have poor knowledge of the clinical manifestations of neonatal jaundice, its treatment, and complications. This poor knowledge might be attributed to their primiparity since a larger number of other respondents were primiparous, thus having no previous antenatal services or childbirth. This is also in line with the report of Huang et al.^[3] In contrast, a study conducted in Abia state, Nigeria, showed that the respondents had an excellent knowledge of neonatal jaundice.^[18] This might be due to differences in the parity of expectant mothers, location, and/or educational attainment of the participants.

Concerning beliefs, a higher percentage of participants believed that jaundice in newborn babies can cause serious consequences if managed traditionally. Unfortunately, a minority of them still affirm beliefs like the use of paw-paw leaf extract, avoidance of cold water during pregnancy, drinking of herbal concoctions by mother and baby, the use of vitamin K and A, use of coconut water, use of egg white, use of Blackstone, use of mustard seed, use of scent leaves and use of lemon, with exposure of newborn to sunlight as their major belief. Though not significant,^[18] this suggests that some myths were found among the respondents, and therefore, the need to improve the knowledge of neonatal jaundice among mothers is important. Some studies support this finding, where it was reported that most expectant mothers prefer medical management of neonatal jaundice to traditional management.^[19] Alhassan et al.^[14] reported a contrasting finding to this study. He indicated that most expectant mothers do not see neonatal jaundice as a condition that requires medical treatment, as they do not perceive it to be dangerous or have any consequences.

Sadly, though these mothers agree that traditional treatment of neonatal jaundice can cause consequences, the majority of them still indulge in the exposure of newborns to sunlight and the use of glucose water as the major practice of treating neonatal jaundice. Some agreed to practices such as the use of herbs, cutting the eyelids with a razor, and putting the child in a dark room, while very few of them affirmed leaving the child at home to recover on his own. These practices indulged by these women here support other studies where glucose water and exposure to sunlight were major practices in treating neonatal jaundice.^[14,16,20]

The study’s hypotheses underscored a significant relationship between participants’ level of education and their understanding of neonatal jaundice. This suggests that educated mothers may have better absorbed antenatal information, leading to a more comprehensive awareness of the condition. However, the analysis did not reveal any influence of knowledge on traditional practices or beliefs.

Overall, the findings of this study indicate a concerning inadequate knowledge and misconceptions among expectant mothers regarding neonatal jaundice. Only a minority of the respondents were able to identify key signs of neonatal jaundice. Moreover, there was a lack of awareness regarding the appropriate treatment, with only a slight mention of phototherapy as a treatment option. Additionally, the study uncovers myths and traditional beliefs prevalent among expectant mothers. This could potentially lead to delays in seeking appropriate medical care and exacerbate the condition.

Therefore, this study highlights the urgent need for targeted education and awareness programs aimed at expectant mothers to improve their understanding of neonatal jaundice, its management, and the potential risks associated with traditional beliefs. By addressing these gaps, healthcare professionals can better support early detection and appropriate treatment of neonatal jaundice, ultimately reducing the incidence of complications and improving neonatal outcomes.

CONCLUSION

The research findings underscore a notable deficiency in adequate understanding of neonatal jaundice among expectant mothers receiving care at Poly General Hospital, Asata, Enugu State. Notably, educational attainment emerged as a significant factor linked to this knowledge gap. Interestingly, although participants recognized the potentially serious consequences of traditional neonatal jaundice management, their actions often contradicted these beliefs, with many still relying on traditional practices.

In response to these findings, proactive interventions are warranted. Healthcare professionals, particularly nurses, could take the lead in organizing health education campaigns, television broadcasts, radio discussions, and various health promotion activities. These initiatives present valuable opportunities to rectify misconceptions surrounding neonatal jaundice and disseminate accurate information, ultimately fostering heightened awareness and promoting improved maternal healthcare practices.