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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 15  |  Issue : 1  |  Page : 37-41

Influence of maternal educational instruction on mothers' knowledge about neonatal jaundice


1 Department of Paediatrics, Faculty of Clinical Sciences, College of Health Sciences, Ahmadu Bello University/Teaching Hospital Zaria, Kaduna State, Nigeria
2 Department of Pediatrics, University of Minnesota and Hennepin County Medical Center, Minneapolis, USA

Date of Web Publication23-Mar-2018

Correspondence Address:
Dr. Isa Abdulkadir
Department of Paediatrics, Faculty of Clinical Sciences, College of Health Sciences, Ahmadu Bello University/Teaching Hospital Zaria, Kaduna State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njbcs.njbcs_41_17

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  Abstract 


Context: Neonatal jaundice (NNJ) is a common cause of neonatal morbidity and mortality in sub-Saharan Africa. Fundamental to its successful management is the role of mothers and/caregivers in the care of the newborn. Maternal knowledge about NNJ partly determines the extent to which this role is effectively discharged. To assess the influence of educational instruction about NNJ on recipient mothers' knowledge of and ability to detect NNJ. Settings and Design: This was a postintervention cross-sectional comparative analysis. Patients and Methods: A postintervention cross-sectional comparative study involving mothers accessing immunization services at a tertiary health care facility in northwestern Nigeria was conducted. Two hundred and thirty-nine mothers were interviewed to determine their knowledge of and ability to detect jaundice in newborns. Comparison of knowledge about jaundice was made between categories of mothers who had earlier received educational instructions on NNJ and those who did not. This study was approved by the Health Research and Ethics Committee of the Ahmadu Bello University Teaching Hospital Zaria. Statistical Analysis Used: Information obtained was entered and analyzed using SPSS version 20. Results: The majority (74.1%) of mothers received instruction and education on NNJ during pregnancy all of whom attended antenatal care (ANC) in the tertiary facility. Most respondents (91.6%) were aware of NNJ while only 73.6% gave the appropriate definition of neonatal jaundice of which 82.8% were those who received educational instruction on NNJ during ANC. The degree of knowledge on NNJ was significantly correlated positively with receiving NNJ educational instruction (P = <0.001) and with social class P = 0.001. Conclusions: Receiving educational instruction on NNJ positively influenced mothers' knowledge of causes, signs of severity, identification, treatment, and complications of NNJ.

Keywords: Education, intervention, kernicterus, maternal, neonatal jaundice


How to cite this article:
Abdulkadir I, Adeoye G, Adebiyi MN, Hassan L, Abdullahi FL, Slusher TM, Ogala WN. Influence of maternal educational instruction on mothers' knowledge about neonatal jaundice. Niger J Basic Clin Sci 2018;15:37-41

How to cite this URL:
Abdulkadir I, Adeoye G, Adebiyi MN, Hassan L, Abdullahi FL, Slusher TM, Ogala WN. Influence of maternal educational instruction on mothers' knowledge about neonatal jaundice. Niger J Basic Clin Sci [serial online] 2018 [cited 2021 Jun 16];15:37-41. Available from: https://www.njbcs.net/text.asp?2018/15/1/37/228368




  Introduction Top


Despite readily identifiable causes of jaundice and widely recognized effective treatment with intensive phototherapy, neonatal jaundice (NNJ) continues to cause significant burden of disease and financial hardship to both healthcare facilities and families in low-middle income countries such as Nigeria. When severe and or improperly managed, NNJ may cause death or lifelong neurologic sequelae.[1],[2] Fundamental strategies for successful reduction of the burden of NNJ are prevention, early detection, and institution of appropriate optimal treatment and care. The high burden of NNJ, acute bilirubin encephalopathy, and subsequently death or kernicterus has been attributed to delay in the detection of jaundice and ultimately delay in accessing care.[3],[4] This has also been linked to mothers' lack of adequate knowledge on NNJ which stems from the lack of or paucity of information available and/or provided to mothers.[4],[5] Therefore, mothers and/care givers occupy an important position in the prevention and early detection of jaundice. Most methods developed to prevent kernicterus are expensive, but the cheapest option is to provide adequate information to mothers and expectant mothers, especially during antenatal clinic visits.[3] Ultimately, appropriate maternal knowledge will lead to improved newborn care practices, reduced neonatal exposure to risk factors for NNJ, and encourage appropriate neonatal care seeking behavior among mothers.[4]

This study aimed at assessing the influence of instruction and education of mothers, as a package of intervention, on their knowledge of and ability to detect NNJ.


  Patients and Methods Top


The study was a postintervention cross-sectional comparative analysis. Instructional materials developed by the Stop Kernicterus in Nigeria (SKIN) research team were used to provide training for nurses working in the various arms of the tertiary health facility where expectant mothers as well as newborns accessed care. The tertiary health care facility in northwestern Nigeria offers primary, secondary, and tertiary health care and receives referral from Kaduna and its neighboring states. During the intervention, nurses/midwives specifically received training on tools targeting mothers to educate them on the causes of jaundice, risk for jaundice including harmful newborn practices, detection of jaundice, signs of severe jaundice, and what and where to access care for jaundiced newborns. Information was subsequently and repeatedly disseminated to mothers at every contact during antenatal visits, postpartum/postnatal care and in the immunization clinic by the trained health care providers over a 6-month period (June to November 2015). Key activities at the antenatal and immunization clinics included a 45–60 minutes' group talk on jaundice including risk, causes, signs of severity, complications of, and demonstration of where and how to look for jaundice followed by a 10-minute individual mother–healthcare provider interactive session providing an opportunity for further demonstration, knowledge check, and reinforcement. At the end of the interactive sessions mothers received educational materials on jaundice. Antenatal care (ANC) was defined as having at least one contact with the clinic/facility for obstetric care. At the postnatal ward, mothers received individual educational materials on jaundice and instruction on identification of jaundice in the newborn to take home.

Data collection began at the end of the intervention period at the immunization clinic; where mothers who accessed ANC care and/delivered at the tertiary health facility and those who did not sought immunization for their babies. At the immunization clinic, mothers who consented were consecutively enrolled and interviewed. Mothers were interviewed using a pretested structured questionnaire. Information obtained was entered and analyzed using SPSS version 20. The questionnaire was divided into sections to assess knowledge of causes, signs, and complications of severe jaundice and treatment for NNJ. Responses were scored, graded, and categorized into poor (score ≤40%), fair (41–60%), or good (>60%) on a summative scale. Reception of educational instruction was defined as at least one contact and participation in the information dissemination program in the tertiary facility during the preceding months. Mothers were categorized into those who received educational instruction and those who did not. Respondents who received educational instructions also graded their perception of information received as poorly, fairly, or well understood. Comparison of knowledge of and ability to detect NNJ was made between mothers who received educational instruction on jaundice in the newborn and those who did not, and outcomes were tested for significance.

Ethical approval for the study was obtained from the Health Research and Ethics Committee of the Ahmadu Bello University Teaching Hospital Zaria.


  Results Top


A total of 239 mothers were interviewed of whom 177 (74.1%) received educational instruction on NNJ. The mean age of the respondents was 28.9 ± 5.5 years while the mean ages for those who received educational instruction and those (62 mothers) who did not were 29.33 ± 5.20 and 27.55 ± 6.01, respectively. The age group 20–29 years had the highest (51.9%) respondents [Figure 1]. One hundred and sixty respondents were multiparous (66.9%) while the remaining 79 (33.1%) were primiparous. Overall, approximately 2% of the respondents had no formal education, and 75.2% had tertiary education. In addition, 51% of the respondents were unemployed and 50.4% belonged to social class 2 [Table 1]. A total of 80.7% of the mothers who received educational instruction had tertiary education, 12.5% had secondary education, 5.1% had primary education, and 1.7% had no education. Approximately half (52.1%) of these recipient mothers belonged to social class 2, while 24.3%, 23.1%, and 0.5% belonged to social class 1, 3, and 4, respectively. On the other hand, 59.7% of mothers who did not receive instruction had tertiary education, 24.2% secondary education while 12.9% had primary education and 3.2% had no education. 45.8% of these non-recipient mothers belonged to social class 2, while 28.8%, 15.3% and 10.1% belong to social class 3, 1, and 4, respectively.
Figure 1: Frequency distribution of age of respondents

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Table 1: Sociodemographic characteristics of respondents

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The majority 96.7% (231) of the respondents attended antenatal clinic with 88.3% (204) of them receiving ANC at a tertiary centre [Table 1]. Approximately two-thirds of the respondents 66.5% (159/239) delivered their index baby in the tertiary centre while 10.5% (25/239) delivered at home.

One hundred and seventy-seven (74.1%) of the 239 mothers who received educational instruction on NNJ during pregnancy had their ANC in the tertiary facility. Of the overall 204 mothers who attended ANC in the tertiary hospital, majority (177, 86.8%) received information on NNJ out of which 92.7% (164/177) felt they understood it well. None of the 27 respondents who received ANC outside the tertiary facility received any information on NNJ prior to delivery. Among the 159 mothers who delivered in the tertiary centre, 132 (83.0%) received information on jaundice, and majority of them [93.2% (123)] understood the information well. About 82.6% of the total respondents received information on NNJ at the immunization clinic.

Although majority of the respondents [91.6% (218/239)] were aware of NNJ, only 73.6% (176) gave an appropriate definition of NNJ, of which 82.8% received educational instruction on NNJ during ANC. Overall, 92.8% of the respondents knew how to check for jaundice while 91.1% knew where to check for jaundice. About 11.3% had no knowledge of the causes of NNJ while 88.7% had varying degree of knowledge of the causes of NNJ (including 48.1%, 32.2%, and 8.4% who had poor, fair, and good knowledge, respectively). The knowledge of signs of severe NNJ was poor in 54.8%, fair in 18%, and good in 15.5% while 11.7% had no knowledge of the signs of severe NNJ. While 91.2% had some knowledge on the treatment of NNJ, only 3.3% had good knowledge and 8.8% had no knowledge at all. About 86.6% had varying degree of knowledge of the complications of NNJ while the remaining 13.4% had no knowledge of the complications of NNJ.

The degree of knowledge on NNJ was correlated positively with social class, as the higher the social class the higher the level of awareness (P = 0.001). Knowledge on jaundice in those who received educational instruction was significantly higher 173 (97.7%) when compared to those who received no such instruction 45 (68%) (P = <0.001). One hundred and seventy-one (98.3%) of the mothers who received educational instruction on NNJ could appropriately check for jaundice, while only 47 (77%) of those who did not receive instruction could (P< 0.001).

Knowledge of the causes of jaundice was significantly better in mothers who received educational instruction on NNJ (94.4% vs. 75.8%. P = <0.001) and so was knowledge on signs of severe jaundice (92.7% vs 75.8%, P = <0.001). Knowledge regarding treatment of NNJ was higher in those who received instructions (94.4% vs. 82.3%; P = 0.015) [Table 2], whereas knowledge of complications of NNJ did not statistically differ between the 2 groups but was still higher in mothers who received educational instruction on NNJ (89.1% vs. 79%; P = 0.071) [Table 3].
Table 2: Degree of knowledge on treatment of neonatal jaundice among respondents

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Table 3: Degree of Knowledge on complications of neonatal jaundice among respondents

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  Discussion Top


The sociodemographic parameters of the respondents showed that approximately half of the respondents were aged between 20 and 29 years, which is in keeping with the national reproductive demographics in Nigeria.[6] In contrast, however, to the national and regional data, only 2% did not have formal education, with majority (96.7%) of the respondents receiving ANC and more than two-third delivering in a hospital facility probably a bias introduced by the level of care, location, and access to the hospital such that only highly motivated, socioeconomically advantaged individuals with support attended the facility.

Approximately 74% of the respondents received educational instructions on NNJ all of whom were clients of the tertiary facility while none of those who had their ANC outside the facility received any instruction on NNJ. Other studies from Nigeria and Iran have documented varying rates of awareness of NNJ in women who attended ANC in a tertiary centre ranging 86–100%.[7],[8],[9],[10],[11],[12] Overall, 91.6% were aware of NNJ, and those who received educational instruction significantly had more knowledge on NNJ than those who did not receive instructions. Some mothers who did not receive educational instruction were aware of NNJ possibly because of its ubiquity. This awareness may also have resulted from the fact that, apart from a few who did not attend ANC, others did even though outside the tertiary facility and this may have exposed them to some information, albeit not the structured instructional one. The finding that mothers who received educational instruction comparatively had significantly more knowledge establishes the importance and efficiency of the structured educational instruction. The multiple dissemination point approach adopted to instruct and educate mothers, on the other hand, ensured that every mother who had contact with the facility had at least 1 in 3 chance of being informed of NNJ. Overall, these informed mothers are better equipped to be aware of jaundice and perhaps better positioned to avoid jaundice predisposing activities. Such informed mothers are also more likely to make appropriate decisions about their newborn if they developed jaundice.

The evidence showed that, despite awareness on neonatal jaundice among mothers due to instructions received, knowledge of facts (including causes of, signs, and complications of severe jaundice) about jaundice was not similarly encouraging. Varying degree of knowledge has also been documented by other studies.[13],[14],[15] Although 82.8% of those who appropriately defined jaundice were those who received educational instruction, one-fifth of them still could not define jaundice properly. The knowledge of causes of jaundice, which could inform instituting significant measures towards prevention, was also not as impressive as awareness as only 8.4% of the 87% who had some knowledge on causes of jaundice had good knowledge, whereas approximately half (48.1%) had poor knowledge of the causes of NNJ. In the same vein, the knowledge of signs of severe jaundice was poor in 58% of the respondents, and only 3.3% as well had good knowledge on the treatment of NNJ. These, on the whole, suggest a gap between awareness and knowledge which may be related to the details and process of delivering the information. The modality and process of dissemination of information may be an imperative determinant of understanding the information. This is supported by the fact that, in contrast to the poor knowledge of facts regarding NNJ, approximately 90% of the respondents knew and could demonstrate checking for jaundice. While factual knowledge on NNJ was disseminated via lectures and or information hand bills, checking for jaundice was taught to mothers by demonstration. The use of trainings/demonstrations, which are task-oriented, to disseminate information to mothers are likely to be more rewarding than predominant use of handouts and lectures which may result in information overload/impaired adult learning. This is consistent with newer adult learner theories. The study did not evaluate the impact of frequency of ANC attendance or the number of times information was received on the quality of knowledge. Frequency of receiving information may have contributed to the gap between awareness and knowledge. Presumably, more frequent attendance and reception of information could lead to both more and repeated information and training on NNJ with resultant improved knowledge.

Factors that significantly influenced the degree of knowledge on jaundice included receiving educational instruction and social class. The use of purposely designed educational instruction materials with focus on key themes in NNJ would have positively influenced the degree of knowledge in the recipient mothers. The low level of knowledge of jaundice in a study in Sri Lanka was attributed to low educational status; a determinant of social class, in the study group.[11] In this study, level of education could have played a more significant role in positively influencing degree of knowlegde since a larger proportion of the respondents (90%) had secondary level of education and above compared to 75% social classes 1 and 2.


  Conclusions Top


The study showed that receiving educational instructions on NNJ significantly influenced positively mother's knowledge of causes, signs of severity, identification, treatment, and complications of neonatal jaundice, as did social class. Therefore, strategizing to optimally improve the quality and delivery process of educational instructions on NNJ to mothers will strongly improve their knowledge on NNJ and as well equip and position them to take appropriate steps towards preventing and caring for their newborns with jaundice.

Recommendation

We recommend that mothers should receive educational instructions on jaundice at multiple points during their ANC to improve their knowledge and equip them to make informed decision.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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