Community-related factors militating against effective management of neonatal jaundice in resource-limited settings

Abstract

Neonatal jaundice is a leading cause of neonatal admission and deaths in most parts of the low and middle income countries (LMICs). The burden of this condition is less significant in the developed world where the health system is efficient in the  prevention, early detection and prompt treatment of neonatal hyperbilirubinaemia. In the less developed parts of the world with high rates of out-of-hospital delivery,many affected babies often reach the health facility only when complications of  hyperbilirubinaemia have already set in. Such children go on to develop various neurologic deficits and serious handicapping conditions that adversely affect quality of life. Therefore, there is a gap in care that needs to be addressed in order to reduce the burden of neonatal hyperbilirubinaemia and its complications in the resource-constrained parts of the world. The gap is created by failure of early detection of jaundice in the newborn, poor perception of the potential seriousness of the condition and delay in seeking appropriate care. This review addresses the various factors contributing to this gap, including inadequate knowledge of mothers and healthcare providers at both the primary health care and general practice levels, as well as weak health system at the peripheral levels of health care. It also aims to highlight some of the measures which may be adopted to improve the knowledge and capability of significant participants in newborn care such as female education, mass media campaigns,  development of national guidelines for the management of neonatal jaundice, and the new concepts of knowledge translation and task analysis with the overall objective of strengthening the health system to appropriately manage newborn infants with hyperbilirubinaemia in developing countries of the world.

Key words: Acute Bilirubin Encephalopathy, Care-seeking behaviour, Jaundice, Low and Middle Income Countries, Maternal Knowledge, Newborn care.