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Challenges and recommendations to improve implementation of phototherapy among neonates in Malawian hospitals Kinshella, Mai-Lei Woo; Salimu, Sangwani; Chiwaya, Brandina; Chikoti, Felix; Chirambo, Lusungu; Mwaungulu, Ephrida; Banda, Mwai; Hiwa, Tamanda; Vidler, Marianne; Molyneux, Elizabeth M.; et al.

Abstract

Background Severe neonatal jaundice can result in long term morbidities and mortality when left untreated. Phototherapy is the main-stay intervention for treating moderate jaundice and for prevention of the development of severe jaundice. However, in resource-limited health care settings, phototherapy has been inconsistently used. The objective of this study is to evaluate barriers and facilitators for phototherapy to treat neonatal jaundice at Malawian hospitals. Methods We conducted a convergent mixed-method study comprised of a facility assessment and qualitative interviews with healthcare workers and caregivers in southern Malawi. The facility assessment was conducted at three secondary-level hospitals in rural districts. In-depth interviews following a semi-structured topic guide were conducted at a district hospital and a tertiary-level hospital. Interviews were thematically analysed in NVivo 12 software (QSR International, Melbourne, Australia). Results The facility assessment found critical gaps in initiating and monitoring phototherapy in all facilities. Based on a total of 31 interviews, participants identified key challenges in diagnosing neonatal jaundice, counselling caregivers, and availability of infrastructure. Participants emphasized the need for transcutaneous bilirubinometers to guide treatment decisions. Caregivers were sometimes fearful of potential harmful effects of phototherapy, which required adequate explanation to mothers and family members in non-medical language. Task shifting and engaging peer support for caregivers with concerns about phototherapy was recommended. Conclusion Implementation of a therapeutic intervention is limited if accurate diagnostic tests are unavailable. The scale up of therapeutic interventions, such as phototherapy for neonatal jaundice, requires careful holistic attention to infrastructural needs, supportive services such as laboratory integration as well as trained human resources.

Item Metadata

Title
Challenges and recommendations to improve implementation of phototherapy among neonates in Malawian hospitals
Creator
Kinshella, Mai-Lei Woo; Salimu, Sangwani; Chiwaya, Brandina; Chikoti, Felix; Chirambo, Lusungu; Mwaungulu, Ephrida; Banda, Mwai; Hiwa, Tamanda; Vidler, Marianne; Molyneux, Elizabeth M.; Dube, Queen; Mfutso-Bengo, Joseph; Goldfarb, David M.; Kawaza, Kondwani; Nyondo-Mipando, Alinane L.
Contributor
Children's Hospital (Vancouver, B.C.); Women's Hospital (Vancouver, B.C.)
Publisher
BioMed Central
Date Issued
2022-06-27
Description
Background Severe neonatal jaundice can result in long term morbidities and mortality when left untreated. Phototherapy is the main-stay intervention for treating moderate jaundice and for prevention of the development of severe jaundice. However, in resource-limited health care settings, phototherapy has been inconsistently used. The objective of this study is to evaluate barriers and facilitators for phototherapy to treat neonatal jaundice at Malawian hospitals. Methods We conducted a convergent mixed-method study comprised of a facility assessment and qualitative interviews with healthcare workers and caregivers in southern Malawi. The facility assessment was conducted at three secondary-level hospitals in rural districts. In-depth interviews following a semi-structured topic guide were conducted at a district hospital and a tertiary-level hospital. Interviews were thematically analysed in NVivo 12 software (QSR International, Melbourne, Australia). Results The facility assessment found critical gaps in initiating and monitoring phototherapy in all facilities. Based on a total of 31 interviews, participants identified key challenges in diagnosing neonatal jaundice, counselling caregivers, and availability of infrastructure. Participants emphasized the need for transcutaneous bilirubinometers to guide treatment decisions. Caregivers were sometimes fearful of potential harmful effects of phototherapy, which required adequate explanation to mothers and family members in non-medical language. Task shifting and engaging peer support for caregivers with concerns about phototherapy was recommended. Conclusion Implementation of a therapeutic intervention is limited if accurate diagnostic tests are unavailable. The scale up of therapeutic interventions, such as phototherapy for neonatal jaundice, requires careful holistic attention to infrastructural needs, supportive services such as laboratory integration as well as trained human resources.
Subject
Phototherapy; Neonatal jaundice; Neonates; Preterm births
Genre
Article
Type
Text
Language
eng
Date Available
2022-11-22
Provider
Vancouver : University of British Columbia Library
Rights
Attribution 4.0 International (CC BY 4.0)
DOI
10.14288/1.0422013
URI
http://hdl.handle.net/2429/83178
Affiliation
Medicine, Faculty of; Non UBC; Obstetrics and Gynaecology, Department of; Pathology and Laboratory Medicine, Department of
Citation
BMC Pediatrics. 2022 Jun 27;22(1):367
Publisher DOI
10.1186/s12887-022-03430-y
Peer Review Status
Reviewed
Scholarly Level
Faculty; Researcher
Copyright Holder
The Author(s)
Rights URI
http://creativecommons.org/licenses/by/4.0/
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Attribution 4.0 International (CC BY 4.0)