Abstract

The study entitled “Assessing nurse’s knowledge on the challenges face in the management of jaundice” was carried out in the Bukemue integrated health center. To assess nurses’ knowledge on jaundice, to ascertain nurse’s knowledge on the management of jaundice, to identify the challenges nurses face in the management of jaundice.

Participants were selected using convenient sampling technique, in which they took part in the study at their convenient time base on their various duties. The results are based on the research objectives. With respect ot the first objective, 78% of the respondents gave the right answer on the causes of neonatal jaundice which is in accordance with HANSEN ET AL., 2017. 84% of the respondent gave the right answer on the management of neonatal jaundice, with respect to the third objective, 74% of the respondent gave the right answer on the prevention of neonatal jaundice.

With respect to the first objective, 78% of the respondents were able to outline the causes of neonatal jaundice with respect to the second objective which is nurses knowledge on the management of neonatal jaundice, 84% of the respondents stated that management of neonatal jaundice are; Feeding/hydration, phototherapy and transfusion.

And 74% of the nurses stated that neonatal jaundice can be prevented through early intravenous immunoglobulin and early exchange transfusion. With respect to the first objective, nurses should improve themselves as far as the definition, causes and risk factors of neonatal jaundice. Regarding second objective, they should improve their knowledge more on the management of neonatal jaundice. This can be done by organizing seminars by the appropriate authorities in the hospitals, in order to reinforce the nurse’s knowledge as far as management is concerned.

CHAPTER ONE

GENERAL INTRODUCTION

Introduction

This chapter describes the background of the study, problem statement, research objectives, research question, significant of study, scope of study, and definitions of terms.

1.1 Background to the Study

Jaundice comes from the French word jaune which means yellow. The history of neonatal jaundice can be stressed as far back to many hundreds of years, when newborns were observed to be jaundiced as far as the 19th century (Maamouri G et al 2015). One of the writers was Jean Baptist Thiomote Bumes in 1806 and he thought neconium retention was associated with and related to jaundice. In 1853 Condie stated that newborn jaundice was related to failure release of neconium after birth and Bumes believe that maternal milk especially colostrums is beneficial to the correction of neonatal jaundice (Maamour G et al 2015).

In this same 19th century William Cashore stated that jaundice was self-limited as newborns breastfed but became higher as formula feeding was introduce in large and growing percentage of newborns. By 1885 – 1891 jaundice was observed and notice during the first week of life that is 10 to 14 days of life in newborns associated with anemia, abnormal neurology and even death.

The cause was not known until few years later when blood group was discovered (Amiri M et al, 2014) By the 1940s, Rhesus group was discovered for recurrent jaundice with families, research on hemolytic disease of the new born in the 1940s and 1950s improve in the management such as intrauterine transfusion. Neonatal jaundice is one of the most and nine dangerous signs of neonatal illness recognized by the World

Health Organization (WHO). Management of jaundice varies with practitioners and there is need for increase knowledge to promote treatment (WHO, 2014 Protocol) shows that jaundice occur in 60% of term babies and 80% of preterm babies worldwide, while more than 1 out of 10 children breast fed have jaundice within the first month of life and 5 to 10% have clinical signs that require management in order to prevent neurotoxicity (Mateo PC et al, 2013). If severe jaundice develops it can lead to acute Bilirubin encephalopathy or kernicterus with a significant risk of neonatal mortality and long term neurodevelopment of sequelae such as cerebral palsy, sensor neural hearing loss, intellectual difficulties or gross developmental delays (Rockville M et al., 2016).

Despite global efforts, low and middle income countries continue to experience serious problems regarding neonatal outcomes due to neonatal jaundice. Neonatal jaundice is a common clinical problem worldwide. Globally, every year about 1.1 million neonates develop neonatal jaundice with or without Bilirubin encephalopathy and the vast majority reside in sub-Saharan Africa and South Asia. Strategies and information on determinants of neonatal jaundice in sub-Saharan Africa are limited. (WHO, 2012). Among these neonates, four hundred and eighty one thousand are term neonates of whom one hundred and fourteen thousand die annually and more than sixty-three thousand survive with a moderate or severe disability. Also, 75% of affected neonates reside in sub-Saharan Africa, including Ethiopia, Nigeria (WHO, 2012). Neonatal jaundice has been the reason for many readmission. It is estimated for 75% hospitalization which needs medical concern and hospital readmission of newborns. It results in brain encephalopathy which requires close attention, evaluation and treatment. It also increases the economic and social burden on the patient’s families and societies.

There are well-developed systems to identify, investigate and manage the problem in developed countries, but studies and development are still required to address the problem in poor countries (Olusanya and T. M. Slusher, 2015).

A study in developed countries reveals that blood incompatibilities are the main causes of neonatal jaundice, whereas prematurity, low birth weight, infection, and traditional practice such as herbal consumption and application of dusting powder were causes of neonatal jaundice (NNJ) in developing countries (Metterville J et al, 2012). Understanding of determinant factors of jaundice is crucial to prevent and control the problem. Investigating the factors among the cases is also important to prevent the devastating morbidity and mortality. An evidence-based strategy is needed for prevention, early detection, and treatment.

Neonatal jaundice (NNJ) is the yellow discoloration of the skin, sclera, and mucosa caused by excess accumulation of bilirubin in the tissue and plasma (serum bilirubin level should be in excess 7 mg/dl). It occurs in up to 60-80% of preterm and term as well as 10% of breastfeeding neonates (Dutta D et al., 2013). The bilirubin level in neonates is much higher than in adults because the life span of the erythrocytes is relatively short and the capacity for bilirubin elimination is lower than in adults; however, hyperbilirubinemia, or jaundice, is a life- threatening disorder in newborns (Rahman et al., 2016). According to Don Ostrow Trieste yellow retreat data collection by researchers in the different parts of the world is as follows. Jaundice incidence in high income countries from 1990 95%, Egypt 18-30% are at risk of severe neonatal jaundice 9 – 34% at risk of neonatal jaundice in Kenya and 27% are at risk in Nigeria and in Cameroon the risk of neonatal jaundice was 41.6% in June 2016 (Essomba et al., 2015).

In Nigeria, it is 100 times more than in developed countries (Slusher et al., 2016). The global burden of neonatal jaundice reported that the African region has the highest incidence of severe neonatal jaundice per 1000 live births (667.8 to 738.5) followed by the Southeast Asian (251.3 to 473.2) and Americas and European regions 4.4 and 3.7 respectively (Olusanya and T. M. Slusher, 2015). Ethiopia is one of the top ten countries with jaundice related neonatal mortality (Boo et al., 2016).

This research will be carried out in Bakemue integrated health center, within a period of 12 months that is from April 2021 to May 2022. It will involve nurses in order to assess their knowledge in the management and challenges of jaundice.

1.2 Problem Statement

Jaundice is one of the most and nine dangerous signs of neonatal illness recognized by the World Health Organization (WHO). Despite global efforts, low and middle-income countries continue to experience serious problems regarding neonatal outcomes due to neonatal jaundice. Globally, every year about 1.1 million neonates develop neonatal jaundice with or without Bilirubin encephalopathy and the vast majority reside in sub-Saharan Africa and South Asia.

Among these neonate, 48100 are term neonates of whom 114000 die annually and more than 63000 survive with a moderate or severe disability. Moreover, during internships, I came across women whose babies were diagnosed to be jaundiced, making a devastating experience for parents and caregivers. Finally with an observation from my younger sister three years ago actually tabled problem within the family.

1.3 Objectives

1.3.1 General Objectives

Assessing nurse’s knowledge on the challenges face in the management of jaundice in Bukemue integrated health center.

1.3.2 Specific Objective

1. To assess nurses knowledge on jaundice
2. To ascertain nurses knowledge on the management of jaundice
3. To identify the challenges nurses face in the management of jaundice

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