A Qualitative Analysis of Challenges Encountered in the Management of Neonatal Jaundice Among Health Workers in Selected Health Facilities in Ondo State
Main Article Content
Abstract
Background: Neonatal jaundice (NNJ) is a common condition in the newborn period and remains a significant cause of preventable morbidity and mortality in many low-and-middle-income countries, including Nigeria. Healthcare workers' capacity to provide evidence-based care is often constrained by systemic, infrastructural, and sociocultural challenges. This study explored the challenges encountered by healthcare workers in the management of neonatal jaundice among preterm and high-risk term neonates in selected tertiary health facilities in Ondo State, Nigeria.
Methods: A descriptive, cross-sectional qualitative design was employed between April and May 2025. Key informant interviews (KIIs) were conducted among doctors and nurses working in the neonatal units of three selected tertiary healthcare facilities. Eighteen participants (six from each facility) were purposively selected. Data were audio-recorded, transcribed verbatim, and analysed using thematic content analysis with the aid of NVivo version 11 software.
Results: The majority of participants were male (10/18). Several barriers to optimal management of neonatal jaundice were identified, including caregivers’ impatience and non-compliance with treatment, frequent power outages affecting diagnosis and phototherapy delivery, limited availability of functional equipment, financial constraints, and sociocultural and religious beliefs influencing healthcare-seeking behaviour.
Conclusion: Neonatal jaundice remains a major clinical and public health challenge in Nigeria. Systemic, infrastructural, and sociocultural barriers significantly hinder effective care. Strengthening neonatal services through improved infrastructure, consistent power supply, provision of appropriate diagnostic and treatment equipment, workforce training, and expanded health insurance coverage is essential to improve neonatal outcomes.
Downloads
Article Details
Section
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The Journal is owned, published and copyrighted by the Nigerian Medical Association, River state Branch. The copyright of papers published are vested in the journal and the publisher. In line with our open access policy and the Creative Commons Attribution License policy authors are allowed to share their work with an acknowledgement of the work's authorship and initial publication in this journal.
This is an open access journal which means that all content is freely available without charge to the user or his/her institution. Users are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles in this journal without asking prior permission from the publisher or the author.
The use of general descriptive names, trade names, trademarks, and so forth in this publication, even if not specifically identified, does not imply that these names are not protected by the relevant laws and regulations. While the advice and information in this journal are believed to be true and accurate on the date of its going to press, neither the authors, the editors, nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.
TNHJ also supports open access archiving of articles published in the journal after three months of publication. Authors are permitted and encouraged to post their work online (e.g, in institutional repositories or on their website) within the stated period, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access). All requests for permission for open access archiving outside this period should be sent to the editor via email to editor@tnhjph.com.
How to Cite
References
1. Salia SM, Afaya A, Wuni A, Ayanore MA, Salia E, Kporvi DD, et al. Knowledge, attitudes and practices regarding neonatal jaundice among caregivers in a tertiary health facility in Ghana. PLoS One. 2021;16(6 June):1–20.
2. Ansong-Assoku, B., Adnan, M., Daley, S., & Ankola P. Neonatal jaundice. StatPearls. 2024.
3. Slaughter JL, Kemper AR, Newman TB. Technical Report: Diagnosis and Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation. Pediatrics. 2022;150(3).
4. Huo Y, Peng C, Hou X, Feng Q. Clinical practice guideline revision: management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Chinese J Neonatol. 2023;38(09):513–24.
5. Nawaz H, Aslam M, Rehman T. Neonatal hyperbilirubinemia: Background and recent literature updates on the diagnosis and treatment. 2021;167–86.
6. Jayanti S, Ghersi-Egea JF, Strazielle N, Tiribelli C, Gazzin S. Severe neonatal hyperbilirubinemia and the brain: The old but still evolving story. Pediatr Med. 2021;4:0–3.
7. Ochigbo S, Ekpebe P, Nyong EE, Ikechukwu O, Ibeawuchi A, Eigbedion A, et al. Neonatal jaundice incidence, risk factors and outcomes in referral-level facilities in Nigeria. BJOG An Int J Obstet Gynaecol. 2024;131(S3):113–24.
8. World Health Organization (WHO). Newborns: Improving Survival and Well-being. 2024;(Mlcc):1–5.
9. Moges N, Dessie AM, Anley DT, Zemene MA, Gebeyehu NA, Adella GA, et al. Burden of early neonatal mortality in Sub-Saharan Africa. A systematic review and meta-analysis. PLoS One [Internet]. 2024;19(7 July):1–14. Available from: http://dx.doi.org/10.1371/journal.pone.0306297
10. Barclay E, Ojo I, Hake A, Oyenuga A, Satrom K, Lund T, et al. Neonatal Jaundice: Knowledge and Practices of Healthcare Providers and Trainees in Southwest Nigeria. Am J Trop Med Hyg. 2022;107(2):328–35.
11. Chime OH, Eneh CI, Asinobi IN, Ekwochi U, Ndu IK, Nduagubam OC, et al. Caregivers perception of common neonatal illnesses and their management among rural dwellers in Enugu state, Nigeria: a qualitative study. BMC Public Health. 2023;23(1):1–11.
12. Wennberg RP, Imam ZO, Shwe DD, Hassan L, Farouk ZL, Turner LE, et al. Antenatal jaundice instruction and acute bilirubin encephalopathy in Nigeria. Pediatr Res. 2024;95(5):1301–7.
13. Ezeudu CE, Osuorah CDI, Iloh ON, Iloh KK, Onukwuli VO, Igbokwe OO, et al. Phototherapy services for newborns with jaundice: Availability and practices in Southeast Nigeria. Ann Clin Biomed Res. 2022;3(3).
14. Bello DA, Adelere EA, Folorunso-Ako O, Nwanya E, Ogunbadejo J, Onyeike-Nelson O. The Interaction of Health Education on Knowledge of Signs, Causes, Complications of Neonatal Jaundice and its Management among Pregnant Women. African J Heal Nurs Midwifery. 2024;7(4):94–110.
15. Abdulkadir I, Sleeth C, Diala U. Phototherapy in a Low-Resource Setting. 2022;1–7.
16. Isong I, Nkwonji MN. nursing support for parents during the identification and thesis centria university of applied sciences Bachelor of Health Care, Nursing December 2021. 2021;(December).
17. Tariq M, Sarwar H, Ume-Aimen, Hassan N, Qadir A, Ashraf S. Effect of Educational Interventions on Nurses’ Knowledge, Practice, and Management of Hyperbilirubinemia in Neonates. 2025;III(Vi).
18. Esan DT, Muhammad F, Ogunkorode A, Obialor B, Ramos C. Traditional beliefs in the management and prevention of neonatal jaundice in Ado-Ekiti, Nigeria. Enfermería Clínica (English Ed [Internet]. 2022;32:S73–6. Available from: https://doi.org/10.1016/j.enfcle.2021.09.006
19. Rahimi S, khatooni M. Saturation in qualitative research: An evolutionary concept analysis. Int J Nurs Stud Adv. 2024;6(January):100174.
20. Mokuolu OA, Adesiyun OO, Ibrahim OR, Suberu HD, Ibrahim S, Bello SO, et al. Appraising Neonatal Morbidity and Mortality in a Developing Country Categorized by Gestational Age Grouping and Implications for Targeted Interventions. Front Pediatr. 2022;10(May):1–12.
21. Olusanya BO, Kaplan M, Hansen TWR. Neonatal hyperbilirubinaemia: a global perspective. Lancet Child Adolesc Heal [Internet]. 2018;2(8):610–20. Available from: http://dx.doi.org/10.1016/S2352-4642(18)30139-1
22. Folayan MO, Olowokeere A, Lusher J, Aina O, Gascon A, Martínez-Pérez GZ. A qualitative insight into researchers’ perceptions of gender inequality in medical and dental research institutions in Nigeria. PLoS One. 2023;18(4 April):1–15.
23. Abubakar I, Sarah L D, Angell B, Sanuade O, Abimbola S, Aishatu Lawal Adamu, Ifedayo MO, et al. The Lancet Nigeria Commission: investing in health and the future of the nation. Lancet. 2022;399.
24. Olatubi M, Ibitoye O, Sadibo O, Bolarinwa O, Adamolekun MM. Prevalence of neonatal jaundice at a tertiary health institution in Ondo state, Nigeria. J Pre-Clinical Clin Res. 2019;13(3):114–7.
25. Olusanya BO, Slusher TM, Imosemi DO, Emokpae AA. Maternal detection of neonatal jaundice during birth hospitalization using a novel two-color icterometer. PLoS One. 2017;12(8):1–11.
26. Ogunlesi TA, Olanrewaju DM. Socio-demographic factors and appropriate health care-seeking behavior for childhood illnesses. J Trop Pediatr. 2015;56(6):379–85.
27. Olusanya BO, Osibanjo FB, Mabogunje CA, Slusher TM, Olowe SA. The burden and management of neonatal jaundice in Nigeria: A scoping review of the literature. Niger J Clin Pract. 2016;19(1):1–17.
28. Satrom KM, Farouk ZL, Slusher TM. Management challenges in the treatment of severe hyperbilirubinemia in low- and middle-income countries: Encouraging advancements, remaining gaps, and future opportunities. Front Pediatr. 2023;11(February):1–9.
29. Olusanya BO, Teeple S, Kassebaum NJ. The contribution of neonatal jaundice to global child mortality: Findings from the GBD 2016 Study. Pediatrics. 2018;141(2).
30. Maisels MJ, Watchko JF, Bhutani VK, Stevenson DK. An approach to the management of hyperbilirubinemia in the preterm infant less than 35 weeks of gestation. J Perinatol [Internet]. 2018;32(9):660–4. Available from: http://dx.doi.org/10.1038/jp.2012.71
31. Bhutani VK, Zipursky A, Blencowe H, Khanna R, Sgro M, Ebbesen F, et al. Neonatal hyperbilirubinemia and rhesus disease of the newborn: Incidence and impairment estimates for 2010 at regional and global levels. Pediatr Res. 2023;74(SUPPL. 1):86–100.
32. Ezenwa B, Akinbolagbe Y, Fajolu I, Akintan P, Agaga L, Ezeaka V. Current practices regarding treatment of neonatal jaundice by neonatal care practitioners in Nigeria. Iran J Neonatol. 2018;9(4):7–14.
33. Ogunfowora OB, Daniel OJ. Neonatal jaundice and its management: Knowledge, attitude and practice of community health workers in Nigeria. BMC Public Health. 2016;6:1–5.
34. Messersmith LJ, Ladha A, Kolhe C, Patel A, Summers JS, Rao SR, et al. Poor power quality is a major barrier to providing optimal care in special neonatal care units (SNCU) in Central India. Gates Open Res. 2022;6:1–14.
35. Gondwe A, Chipeta E, Hosseinipour MC, Mbaya B, Muula AS, Mwapasa V, et al. Facilitators of and barriers to blood donation among voluntary non-remunerated blood donors in sub-Saharan Africa: A scoping review. Vox Sang. 2025;(February):546–56.
36. Donkor DR, Ziblim SD, Dzantor EK, Asumah MN, Abdul-Mumin A. Neonatal Jaundice Management: Knowledge, Attitude, and Practice Among Nurses and Midwives in the Northern Region, Ghana. SAGE Open Nurs. 2023;9.
37. Iliyasu Z, Farouk Z, Lawal A, Bello MM, Nass NS, Aliyu MH. Care-seeking behavior for neonatal jaundice in rural northern Nigeria. Public Heal Pract [Internet]. 2020;1(March):100006. Available from: https://doi.org/10.1016/j.puhip.2020.100006
38. Audu L, Mairami A, Otuneye A, Mohammed-Nafi’u R, Mshelia L, Nwatah V, et al. Identifying Modifiable Socio-demographic Risk Factors for Severe Hyperbilirubinaemia in Late Preterm and Term Babies in Abuja, Nigeria. Br J Med Med Res. 2016;16(8):1–11.
39. Opara UC, Iheanacho PN, Petrucka P. Cultural and religious structures influencing the use of maternal health services in Nigeria: a focused ethnographic research. Reprod Health [Internet]. 2024;21(1). Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11656583/