|Year : 2020 | Volume
| Issue : 3 | Page : 184-190
Knowledge and attitude on neonatal jaundice among women of reproductive age group in rural community in northern Nigeria
Chinedu John-Camillus Igboanusi1, Awawu Grace Nmadu2, Istifanus Anekoson Joshua2, Mary Ojonema Onoja-Alexander3, Benjamin Olatubosun4
1 Department of Public Health, Headquarters 2 Division Medical Services & Hospital, Nigerian Army, Adekunle Fajuyi Cantonment, Ibadan, Nigeria
2 Department of Community Medicine, College of Medicine, Kaduna State University, Kaduna, Nigeria
3 Department of Community Medicine, College of Medical Sciences, Kogi State University, Anyigba, Nigeria
4 Department of Surgery, Federal Medical Centre, Bida, Niger State, Nigeria
|Date of Submission||24-Jul-2018|
|Date of Decision||04-Nov-2018|
|Date of Acceptance||05-Feb-2019|
|Date of Web Publication||7-Oct-2020|
Dr. Chinedu John-Camillus Igboanusi
Department of Public Health, Headquarters 2 Division Medical Services & Hospital, Nigerian Army, Adekunle Fajuyi Cantonment, Ibadan
Background: Neonatal jaundice (NNJ) is a common cause of hospitalization in the 1st week of life and a significant cause of neonatal morbidity and mortality worldwide. Objectives: The aim of this study was to assess the knowledge and attitude related to NNJ among women of reproductive age group in Basawa community, Zaria, Nigeria. Materials and Methods: The cross-sectional descriptive study was carried out in January 2017 among mothers aged 15–49 years. One hundred and seventy-two structured, pretested, interviewer-administered questionnaires were used to collect data. Data were analyzed using SPSS software version 21. Results were presented in tables and charts. Results: The mean age of respondents was 34 ± 6.98 years; 158 (92%) of them were aware of NNJ and predominant sources of information from relatives (35%) and hospital (33.1%). Ninety-one percent had poor knowledge of NNJ. Only 76 (46%) and 36 (21%) respondents, respectively, identified infection and breast milk as causes of NNJ. Complications of NNJ mentioned included serious illness (56.4%) and disability (21.5%). Majority of respondents (106, 62%) had poor attitude to NNJ. About 132 (77%) believed that NNJ had an effect on neonates and was curable while only 66 (38%) believed that health education during antenatal care was a preventive measure for NNJ. A statistically significant association was found between income and level of knowledge of respondents about NNJ (P = 0.043). Conclusion: This study highlighted inadequate knowledge, poor attitude, and misconceptions about NNJ. It underscores the importance of health education programs and campaigns in addressing the gaps in knowledge.
Keywords: Attitude, knowledge, neonatal jaundice, women of reproductive age group
|How to cite this article:|
Igboanusi CJ, Nmadu AG, Joshua IA, Onoja-Alexander MO, Olatubosun B. Knowledge and attitude on neonatal jaundice among women of reproductive age group in rural community in northern Nigeria. Sahel Med J 2020;23:184-90
|How to cite this URL:|
Igboanusi CJ, Nmadu AG, Joshua IA, Onoja-Alexander MO, Olatubosun B. Knowledge and attitude on neonatal jaundice among women of reproductive age group in rural community in northern Nigeria. Sahel Med J [serial online] 2020 [cited 2021 Sep 17];23:184-90. Available from: https://www.smjonline.org/text.asp?2020/23/3/184/297454
| Introduction|| |
Neonatal jaundice (NNJ) is a common condition found in neonatal units worldwide but more so in the developing world such as Nigeria. It is a significant cause of neonatal morbidity and mortality worldwide and is estimated to be present in 60% of term and 80% of preterm babies. Global estimates suggest that every year, roughly 1.1 million babies would develop severe hyperbilirubinemia and the vast majority reside in Sub-Saharan Africa and South Asia. Jaundice is the most common morbidity in the 1st week of life and is the most common cause of readmission after discharge from birth hospitalization. NNJ can lead to complications such as cerebral palsy, bilirubin encephalopathy, and even death. Literature has shown that early interventions including phototherapy and appropriate exchange blood transfusion are modalities used to successfully prevent kernicterus and reduce the morbidity and mortality associated with this condition.
NNJ is prevalent in Nigeria and continues to be associated with substantial case fatality rates and long-term morbidity. A previous study conducted in Nigeria reported that about 62.2% of admissions into neonatal units were primarily due to NNJ, 37.8% of whom developed NNJ on admission, and 30% of these patients developed kernicterus. The Nigerian Society of Neonatal Medicine estimated that significant hyperbilirubinemia accounts for 1 out of every 5 neonatal admissions and for at least 5% of all neonatal mortalities in Nigeria.
Previous studies have demonstrated poor knowledge and attitude of mothers about NNJ as important risk factors for the development of the condition., It is of utmost importance that mothers have a clear understanding of how to recognize NNJ and how to respond appropriately and also have a good attitude toward NNJ. This is because early recognition and prompt treatment decrease the likelihood of development of the potentially permanent complications of NNJ. Studies have also highlighted the importance of mothers' knowledge and attitude toward NNJ to the prevention of complications of NNJ. A study conducted in Iran highlighted the importance of educating mothers, families, and care centers on the causes and complications of jaundice and mentioned not recognizing symptoms as one of the biggest issues and a well-known reason for complications. In Nigeria, studies conducted in Benin, Port Harcourt, and Sagamu have reported poor knowledge of the causes and danger signs of NNJ. These studies also brought to fore the need for educational awareness programs to increase awareness about the issue. Taking into consideration, the common occurrence of NNJ in Nigeria and the high mortality due to late presentation for treatment, it is important to determine the knowledge and attitude of mothers as the regarding NNJ primary caregivers to children. Therefore, the aim of this study was to assess the knowledge and attitude of mothers in Basawa community, Zaria, about NNJ. It is expected that the study will generate evidence-based information for decision-making to mount interventions that would improve maternal knowledge health outcomes with regard to NNJ in the community.
| Materials and Methods|| |
The cross-sectional descriptive study was carried out in Basawa community, Zaria, Northwestern Nigeria, in January 2017. Basawa is a ward in Sabon Gari local government area (LGA) of Zaria, Kaduna State. Basawa has a primary health-care center, and Ahmadu Bello University Teaching Hospital is located <5 km from Basawa and serves as a referral center for the health centers in and around Basawa.
The study population consisted of women of reproductive age group (15–49 years) in Basawa, Sabon Gari LGA of Kaduna State. The sample size (n) for the study population was calculated using Fisher's formula; n = z2pq/d2,  using 88% prevalence of NNJ as reported in a previous study, and finite correction formula in a population <10,000; nf = n/1 + n/N . A sample size of 156 was obtained. A response rate of 90% was anticipated, thus the sample size was adjusted to 172.
A multistage sampling technique was used to select the sample for the study as follows:
- Stage 1: From the two LGAs in Zaria, Sabon Gari LGA was selected using simple random sampling technique (balloting)
- Stage 2: Out of the 11 wards in Sabon Gari LGA, one ward (Basawa) was selected using simple random sampling technique (balloting)
- Stage 3: The houses in the ward were numbered, and the houses with odd numbers were selected for the study. In each selected house, a woman of reproductive age that had given birth to a child in the last 2 years was selected by simple random sampling (by ballot method).
A structured, pretested, interviewer-administered questionnaire was used for data collection. The questionnaire covered the demographic variables of the women. It also had questions that assessed their knowledge and attitude toward NNJ.
Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software version 21 (SPSS Inc., Chicago, IL, USA). For the purpose of this study, “serious illness” was defined as a condition that carries a high risk of mortality, negatively impacts quality of life and daily function, and/or is burdensome in symptoms, treatments, or caregiver stress. “Disability” was defined as any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a child. Income was stratified into five classes based on the global standard Pew Research Center analysis from the World Bank PovcalNet database with poor people earning $2 or less daily (<21,600 naira monthly), low income $2.01–10 (>21,600–108,000 naira monthly), upper-middle income $10.01–20 (>108,000–216,000 naira monthly), high-middle income >$20–50 (>216,000–540,000 naira monthly), and high-income earning >$50 daily (>540,000 naira monthly) ($1 is equivalent to 360 naira).
The knowledge was scored using a scale of 100 and <50% was graded as poor, 50%–74% as fair, and ≥75% as good. The attitude was scored using a scale of 35 and scores <12 were graded as poor, 13–24 as fair, and 25–35 as good. For continuous variables, means and standard deviations were determined. Data were presented in frequency and proportions. Fisher's exact test was applied for evaluating associations of categorical variables. Statistical significance was taken as P ≤ 0.05.
Institutional ethical clearance was obtained from the Ethical Committee of Ahmadu Bello University, Zaria, Nigeria, on November 21, 2016. Permission to carry out the study in the community was obtained from the community head. Participation in the study was voluntary and confidentiality was ensured, and informed consent was also obtained from the participants before the data were collected.
| Results|| |
A total of 172 questionnaires were administered to the respondents using mobile data collection method (Epiinfo™ version 126.96.36.199 CDC Atlanta, Georgia). The response rate was 100%. Majority of the respondents (44.8%) were between the age groups of 25 and 34 years. The mean age of the respondents was 34 ± 7 years. About 152 (88.4%) were married and 3 (1.8%) were single mothers. Seventy-nine (46.5%) were Muslims and 93 (54.1%) were Christians. Most of the respondents (63, 36.6%) were Hausa by tribe and had tertiary education (43%). Among the respondents, 66 (38.3%) were civil servants and 51 (29.7%) were homemakers [Table 1]. Majority of the respondents (84, 48.8%) were poor earning <$2 a day, while only 12 (7%) of them belonged to the middle-income class [Table 2]. None of the respondents in the study belonged to the high-income class.
The major sources of information on NNJ mentioned by respondents included relatives (35%) and the hospital (33.1%). Other sources of information reported included friends (34%) and the media (8%). Seventy-six (46%) and 36 (21%) respondents, respectively, identified infection and breast milk as major causes of NNJ. About 72 (42%) respondents knew that early treatment of infections can help prevent NNJ. Complications of NNJ mentioned included serious illness (56.4%) and disability (21.5%). Most of the respondents (120, 69.8%) recognized yellowness of the eye as a danger sign and only 50 (29.1%) recognized high fever as a danger sign. The majority of respondents (91, 53%) mentioned the hospital as a modality for treatment [Table 3]. Majority of the respondents (85, 49%) did not know the risk factors for NNJ. Prematurity and low birth weights were recognized as risk factors by 51 (30%) and 36 (21%) of respondents respectively. Based on the classification of knowledge scores, majority of the respondents (157, 91.3%) had poor level of knowledge of NNJ, while 14 (8.1%) and 1 (0.6%) had good and fair levels of knowledge of NNJ, respectively.
|Table 3: Respondents knowledge of the causes, preventive measures, complications, danger signs, and modalities of neonatal jaundice (n=172)|
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Majority of the respondent (132, 76.7%) felt that NNJ had an effect on the newborn and was curable, while 11 (6.4%) felt that NNJ was not a problem. About 66 (38%) respondents believed that health education prevents NNJ, while 37 (21.5%) agreed to blood group test being a preventive measure for NNJ. The major reason for not believing in antenatal care as a means of preventing NNJ was based on the experience of NNJ (29.1%) [Table 4]. Based on the classification of attitude scores, majority of the respondents (106, 61.6%) had poor attitude toward the prevention of NNJ while 65 (37.8%) and 1 (0.6%) had fair and good attitudes, respectively.
There was a statistically significant association between income and knowledge scores of respondents about NNJ [Table 5]. There were no statistically significant relationships found between age (P = 0.448), marital status (P = 1.000), religion (P = 0.408), level of education (P = 0.196), occupation of respondents (P = 0.654), and level of knowledge of respondents about NNJ. There was also no statistically significant association between respondents' respondents with a history of a previous child with NNJ and their level of knowledge of NNJ (P = 0.461).
|Table 5: Relationship between sociodemographic characteristics of respondents and knowledge of neonatal jaundice|
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| Discussion|| |
NNJ is a significant health problem due to its high prevalence in both low- and middle-income countries, and it can progress to life-threatening forms with high mortality and lifelong comorbidity. It is largely preventable if severe hyperbilirubinemia is identified early and treated promptly with effective measures such as phototherapy or exchange transfusion in severe cases. Adequate maternal knowledge, early perception and care-seeking behavior are fundamental components of effective management of NNJ. A high level of awareness of NNJ was shown in this study which was similar with reports from similar studies conducted in Aba in Nigeria and Malaysia where 96% and 95% of the respondents were, respectively, aware of NNJ., This was, however, different from the findings of a study conducted in Gwoza, Borno State, Nigeria, where only a small percentage (26.5%) of respondents were aware of NNJ. The differences in the level of awareness about NNJ in different states in the country highlight the need for nationwide enlightenment campaigns to eliminate these differences. The predominant source of information in the current study was from the hospital, which was similar to what was reported in other similar studies conducted in Nigeria and Thailand., It is interesting to note that only a few percentage of respondents reported the media as a source of information about NNJ. Broadcasting of health messages on radio and television has been associated with successful implementation of programs directed at increasing awareness about NNJ and should be a means that should be exploited in passing accurate and educative health messages.
The overall level of knowledge among the respondents in this study was low, with only 1% of respondents having a high knowledge score. The respondents had inadequate knowledge of the causes of NNJ. This was comparable to the findings of Nigerian studies conducted in Benin, Port Harcourt, and Sagamu. Similar findings were also observed from a study conducted in Motahari Hospital, Iran, where a small percentage of mothers knew blood group incompatibility (30%), breast milk (20%), and infections (37%) as causes of NNJ. There were also some misconceptions about the causes of jaundice by respondents in this current study, and women erroneously believed that excess groundnut oil intake in pregnancy caused NNJ. This was in agreement to the findings from previous studies conducted in Nigeria,, and also a study in Iran where respondents had different misconceptions about food and NNJ, such as yellow-colored foods such as snacks or drinks being causes of jaundice. These misconceptions about NNJ highlight the importance of conducting health education and promotion programs to enhance women's knowledge on the causes of NNJ and correct erroneous misconceptions about NNJ.
A significant proportion of respondents in the present study had wrong perceptions about the prevention of NNJ. This compares with the findings of a multicenter study conducted in Nigeria, which also reported erroneous beliefs about the prevention of NNJ. A significant number of respondents in the multicenter study believed that no conscious practice (21%), not drinking cold water (11.5%), and not eating groundnuts (11.1%) could prevent NNJ. Research from Iran showed that majority of mothers (75.2%) thought that they had to follow a special diet or take medicinal herbs to prevent jaundice. A corresponding study in Lucknow Hospital, India, showed that many mothers (53.6%) thought that consuming special foods could prevent NNJ and also believed that the use of medicines (18.7%) could prevent NNJ. The misconceived preventive beliefs about NNJ may also be due to poor knowledge and prevalent myths. This further highlights the need for mounting educational and awareness increasing interventions about NNJ.
Although preventive measures appear to play a minor role in the management of NNJ, proven preventive health measures provided at well-baby nurseries and at delivery rooms have been effective in reducing infant mortality and morbidity. It is indispensable in the prevention of rhesus incompatibility in sensitized women. This can be used to encourage and educate women about the danger and prevention of rhesus incompatibility. Practices such as ensuring babies are well fed (breastfed) and hydrated, carefully monitoring of babies for danger signs, and educating mothers to seek help promptly have been proven to be useful preventing the of progression.
The knowledge of complications of NNJ was also low in the current study; a small proportion (22% and 1%, respectively) knew that disability and brain damage were complications of severe NNJ. This was consistent with what was reported in a study conducted in Saravan, Iran, where 24% of respondents knew that brain damage was a complication of NNJ. The knowledge of danger signs among respondents was also low in the current study and only 29%, 4%, and 22% of respondents in this study knew high fever, convulsion, and excessive crying, respectively, which were danger signs of NNJ. This was, however, higher than what was reported a study in Aba, Nigeria, where 88% of the respondents did not know even one danger sign of NNJ. The inability of the mothers in this study to recognize danger signs quickly may be contributory to late presentations at health facilities and can also contribute to poor treatment outcomes in neonates. The poor knowledge about NNJ in the current study calls for desperate measures of intervention. The attitude score of the respondents in the current study was poor with the majority (62%) of respondents having poor attitude toward NNJ, and only 1% of respondents had a good attitude. A similar study in Egypt showed higher attitude scores than what was reported in our study with 89.8% of mothers exhibiting moderate attitude and 10% of mothers exhibiting positive attitude toward NNJ. High attitude scores were also reported in a study conducted at the University of Benin Teaching Hospital, Nigeria, where 91% of mothers had good attitude toward the management of NNJ. Higher attitude scores could be attributed to high levels of awareness and knowledge of NNJ among respondents. The differences in health-seeking attitudes toward NNJ in the various studies could also due to differences in health-seeking behavior and cultural backgrounds of respondents.
Reports from this study showed that there were no statistically significant relationships between maternal age, marital status, religion, level of education, occupation, and level of knowledge about NNJ. A study conducted in Mosan-Okunola community in Lagos similarly showed that there were also no statistically significant associations between knowledge of NNJ and maternal age or level of education. Other studies have found statistically significant associations between maternal age and level of education of mothers but that was in contrast to the findings of this study. A study in Egypt showed that maternal sociodemographic factors influenced knowledge levels related to NNJ. In the Egyptian, study working mothers were significantly more knowledgeable and attained higher attitude scores than homemakers. Our study in contrast to a previous in Nigeria did not show a significant relationship between the level of education and knowledge of NNJ. The Nigerian study showed that multiparous mothers and those with tertiary education were more likely to recognize an infant with jaundice accurately. In comparison to a study in Aba, Nigeria, our study did not show that ethnicity and religion were predictive of maternal knowledge of NNJ. The findings from our study agreed with that of a study in Ilesha that knowledge of NNJ was better among mothers in higher social class. This is not surprising because those of higher social class are more likely with more resources and opportunities to be educated/exposed compared to those in the lower social class, and previous studies have shown higher levels of education to be associated with better levels of knowledge on NNJ.,,,
In contrast to the findings in our study, a statistically significant relationship was found between the experience of NNJ and knowledge of NNJ in a study conducted in Thailand where a history of a previous child with NNJ was a strong determinant of the knowledge of NNJ. The differences in statistical relationships observed in the different studies could be due to the sociodemographic and cultural differences among the study populations.
Our study limitations were as follows: first, our study was conducted on a relatively small scale in one selected LGA and community, which might limit the generalizability of our results; and second, response bias such as giving false responses can also not be ruled out from the study.
| Conclusion|| |
This study showed that despite the high level of awareness of NNJ among the respondents, most of them had inadequate knowledge about the causes, risk factors, and methods of prevention of NNJ. The attitude to NNJ was also generally poor among the respondents. A significant association was found between monthly income of respondents and knowledge of NNJ. There is a need for health authorities to carry out awareness and educational campaigns to educate mothers about the causes, prevention, complications, and danger signs of NNJ.
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Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]