Maternal satisfaction with a novel filtered-sunlight phototherapy for newborn jaundice in Southwest Nigeria

  • BMC Pediatrics, Volume 14, No. 1, Year 2014

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Study Justification:
– The study aimed to assess maternal experience and satisfaction with a novel treatment for newborn jaundice using filtered sunlight phototherapy (FSPT) in a resource-limited setting with irregular access to conventional phototherapy.
– This study is important because it addresses the challenge of inadequate resources for acquiring and maintaining electric-powered phototherapy devices in many resource-limited settings.
– By evaluating maternal satisfaction with FSPT, the study provides valuable insights into the acceptability and effectiveness of this alternative treatment method.
Highlights:
– The study found that maternal satisfaction with FSPT was highest for the quality of nursing care received and lowest for the physical state of the test environment.
– Overall, mothers rated their satisfaction with FSPT and the observed effect of FSPT on their babies as quite satisfactory.
– Almost all mothers indicated willingness to use FSPT in the future or recommend it to others, despite some concerns about exposing newborns to sunlight.
Recommendations for Lay Reader:
– Based on the study findings, it is recommended to ensure that mothers receive adequate information about FSPT, have access to a good test environment, and receive friendly nursing care to enhance their satisfaction with the treatment.
– The study suggests that FSPT can be a satisfactory alternative to conventional electric-powered phototherapy for treating newborn jaundice in resource-limited settings.
Recommendations for Policy Maker:
– The study highlights the importance of addressing the lack of resources for acquiring and maintaining conventional phototherapy devices in resource-limited settings.
– Policy makers should consider the implementation of FSPT as a viable and cost-effective alternative for treating newborn jaundice in such settings.
– Investments should be made in providing adequate information, improving the test environment, and training healthcare providers to ensure the successful implementation of FSPT.
Key Role Players:
– Policy makers and government officials responsible for healthcare infrastructure and resource allocation.
– Healthcare providers, including pediatricians and nurses, who will be involved in the implementation of FSPT.
– Researchers and experts in neonatal care who can provide guidance and support in implementing FSPT.
Cost Items for Planning Recommendations:
– Training programs for healthcare providers on FSPT implementation.
– Procurement of necessary equipment and materials for FSPT, including the custom-made canopy and pre-tested window tinting films.
– Information materials and educational resources for mothers and healthcare providers.
– Monitoring and evaluation activities to assess the effectiveness and impact of FSPT implementation.
– Potential costs associated with improving the test environment, such as facility upgrades or renovations.

The strength of evidence for this abstract is 6 out of 10.
The evidence in the abstract is based on a cross-sectional satisfaction survey conducted among mothers of jaundiced infants treated with filtered sunlight phototherapy (FSPT) in a tropical setting. The study provides descriptive statistics and explores correlates of overall maternal satisfaction. However, the evidence is limited to a single study and does not include a comparison group or control. To improve the strength of the evidence, future research could include a randomized controlled trial comparing FSPT with conventional electric-powered phototherapy. Additionally, the study could be replicated in different settings to assess generalizability of the findings.

Background: In many resource-limited settings, the availability of effective phototherapy for jaundiced infants is frequently hampered by lack of, or inadequate resources to acquire and maintain conventional electric-powered phototherapy devices. This study set out to ascertain maternal experience and satisfaction with a novel treatment of infants with significant hyperbilirubinemia using filtered sunlight phototherapy (FSPT) in a tropical setting with irregular access to effective conventional phototherapy.Methods: A cross-sectional satisfaction survey was conducted among mothers of jaundiced infants treated with FSPT in an inner-city maternity hospital in Lagos, Nigeria from November 2013 to March 2014. Mothers’ experience during treatment was elicited with a pretested questionnaire consisting of closed and open-ended items. Satisfaction was rated on a five-point Likert scale. Correlates of overall maternal satisfaction were explored with descriptive and inferential non-parametric statistics.Results: A total of 191 mothers were surveyed, 77 (40%) of whom had no prior knowledge of neonatal jaundice. Maternal satisfaction was highest for quality of nursing care received (mean: 4.72 ± 0.55, median: 5[IQR: 5-5]) and lowest for physical state of the test environment (mean: 3.85 ± 0.74, median: 4[IQR: 3-4]). The overall rating (mean: 4.17 ± 0.58, median: 4[IQR: 4-5]) and the observed effect of FSPT on the babies (mean: 4.34 ± 0.58, 4[IQR: 4-5]) were quite satisfactory. FSPT experience was significantly correlated with the adequacy of information received (p < 0.0005), test environment (p = 0.002) and the observed effect of FSPT on the child (p < 0.0005). Almost all mothers (98.4%) indicated willingness to use FSPT in future or recommend it to others, although some (30 or 15.7%) disliked the idea of exposing newborns to sunlight.Conclusions: Mothers of jaundiced newborns in this population are likely to be satisfied with FSPT where it is inevitable as an alternative to conventional electric-powered phototherapy. Adequate information, good test environment and friendly nursing care must be ensured for satisfactory maternal experience. © 2014 Olusanya et al.; licensee BioMed Central Ltd.

This cross-sectional survey was conducted at the Island Maternity Hospital (IMH) in Lagos, Nigeria among consenting mothers whose newborns were treated for jaundice using FSPT between November 2013 and April 2014. IMH is a public health institution owned and managed by the Lagos State Government. It is the oldest maternity hospital in Nigeria providing specialist services to several private and public hospitals within metropolitan Lagos. The newborn unit in IMH is managed exclusively by a team of pediatricians drawn from a nearby children’s hospital also owned by the state government. The study was conducted according to the guidelines laid down in the Declaration of Helsinki, and ethical approval for all procedures involving human subjects were approved by the Lagos State Government Health Service Commission (Ref: SHMB/728/VOL. VII/962). As a requirement for obtaining informed consent under the institutional ethical approval for the substantive study, mothers were given a standardized and documented package of information on the FSPT and provided with opportunity to seek clarification on any aspects [14]. Information on the significance of jaundice in newborns, purpose of the intervention, description of FSPT, the procedures and requirements for tests, potential risks such as dehydration, hypothermia, hyperthermia and sunburn were included. Mothers were assured of frequent monitoring by a dedicated health worker and the confidentiality of all personal information. It was also emphasized that their participation was optional and could be withdrawn at any stage of the study at their request. FSPT was delivered to eligible infants through a custom-made canopy covered with pre-tested (in vitro and in vivo) window tinting films as previously described (see Figure 1) [14,15]. The films were duly approved by the National Agency for Food and Drug Administration and Control of Nigeria. This intervention was offered at no charge to parents as part of the package of newborn care in this publicly-funded hospital. A typical canopy for filtered sunlight phototherapy with seating capacity for four mother-infant pairs and two nursing staff. The survey instrument (Additional file 1) was adapted from a questionnaire on maternal knowledge, attitude and practice regarding neonatal jaundice that has been successfully implemented in three cities in Nigeria [17]. The three-part questionnaire was administered by a trained research worker not directly involved with clinical management under the pilot studies [14,15]. The first part of the questionnaire included socio-demographic data of respondents such as maternal age, marital status, ethnicity, religion, number of children as well as self and spouse’s educational status. The next part mainly consisted of seven Likert-type closed-ended questions requiring the respondents to rank their experience with FSPT as ‘Very Good’ , ‘Good’ , ‘Fair’ , ‘Poor’ and ‘Very Poor’ , scored as 5 to 1 respectively. The third part was predominantly open-ended seeking to establish the respondent’s prior experience with an infant with jaundice and the actions taken compared to FSPT. It also elicited the respondent’s likes or dislikes about FSPT as well as disposition to future use or recommendation of FSPT. The overall study design was guided by relevant recommendations for patient satisfaction surveys in general [18,19]. The required sample size was calculated using single population proportion formula (n = (Z 1-α/2)2 p (1-p)/ d2) with the following assumptions: expected proportion (p) of the study participants who were satisfied with FSPT (75%), marginal error (d) 5% and confidence interval of 95%. We postulated that 75% of mothers whose infants were treated over a two-year period will be satisfied based on evidence from local studies reporting sunlight exposure of jaundiced infants as a general practice [11,12]. The minimum sample size was computed as 183, after allowance for a 5% non-participation rate. The quantitative data was analyzed with descriptive and nonparametric inferential statistics using IBM SPSS Statistics for Windows, Version 20.0 (Armonk, NY: IBM Corp) software. The socio-demographic characteristics of the respondents sub-divided into those with or without prior knowledge of neonatal jaundice were summarized in a frequency table. The mean (± standard deviation) and median (plus interquartile range) scores for the Likert-type items were computed to rank the satisfaction levels for the seven dimensions. The correlation between these seven dimensions was assessed with Spearman’s rho coefficients. Differences in satisfaction levels across selected demographic variables (ethnicity, religion, maternal and paternal education, number of children and prior knowledge of neonatal jaundice) were evaluated with Kruskal-Wallis or Mann–Whitney U- test as appropriate because the numeric dependent variables were non-Gaussian. P-values less than or equal to 0.05 were considered statistically significant. The specific responses to the open-ended questions on the mothers’ likes and dislikes about FSPT were analyzed with ATLASti 7.1.8 qualitative data analysis software coded into common themes such as patient information on FSPT, nature of treatment, test environment and quality of nursing care. Mothers with blank and non-specific responses were excluded. The overall reporting was guided by the STROBE checklist (Additional file 2).

The study mentioned in the provided text focuses on maternal satisfaction with a novel filtered-sunlight phototherapy (FSPT) for newborn jaundice in Southwest Nigeria. The researchers conducted a cross-sectional satisfaction survey among mothers of jaundiced infants treated with FSPT in an inner-city maternity hospital in Lagos, Nigeria. The study aimed to assess maternal experience and satisfaction with FSPT as an alternative to conventional electric-powered phototherapy.

Some key findings from the study include:

1. Maternal satisfaction was highest for the quality of nursing care received and lowest for the physical state of the test environment.
2. Overall, mothers rated their satisfaction with FSPT and the observed effect of FSPT on their babies as quite satisfactory.
3. Maternal satisfaction with FSPT was significantly correlated with the adequacy of information received, the test environment, and the observed effect of FSPT on the child.
4. Almost all mothers indicated willingness to use FSPT in the future or recommend it to others, although some expressed concerns about exposing newborns to sunlight.

Based on these findings, some potential recommendations for improving access to maternal health in relation to FSPT could include:

1. Ensuring that mothers receive adequate information about FSPT, including its purpose, procedures, potential risks, and benefits.
2. Improving the physical state of the test environment to enhance maternal satisfaction.
3. Providing friendly and supportive nursing care to mothers and their infants during FSPT treatment.
4. Addressing concerns about sunlight exposure by implementing measures to minimize the risks associated with FSPT, such as ensuring appropriate monitoring and protection from excessive heat or sunburn.

These recommendations aim to enhance the overall maternal experience and satisfaction with FSPT as an alternative treatment for newborn jaundice in resource-limited settings.
AI Innovations Description
The recommendation that can be developed into an innovation to improve access to maternal health is the use of filtered sunlight phototherapy (FSPT) for treating newborn jaundice in resource-limited settings. This recommendation is based on a study conducted in Southwest Nigeria, where the availability of conventional electric-powered phototherapy devices is limited. The study found that mothers were satisfied with the use of FSPT as an alternative to conventional phototherapy.

To implement this recommendation as an innovation, the following steps can be taken:

1. Develop and test a prototype of a custom-made canopy covered with pre-tested window tinting films that can be used for FSPT. This canopy should be designed to accommodate multiple mother-infant pairs and nursing staff.

2. Seek approval from relevant regulatory authorities, such as the National Agency for Food and Drug Administration and Control, for the use of the window tinting films in FSPT.

3. Provide training and education to healthcare providers on the use of FSPT and its benefits as an alternative to conventional phototherapy.

4. Establish guidelines and protocols for the use of FSPT in maternity hospitals and healthcare facilities. These guidelines should include information on the indications for FSPT, the procedures and requirements for tests, and the potential risks and precautions associated with FSPT.

5. Conduct awareness campaigns and educational programs for expectant mothers and their families to increase knowledge and understanding of newborn jaundice and the use of FSPT as a treatment option.

6. Monitor and evaluate the implementation of FSPT in healthcare facilities to assess its effectiveness and identify areas for improvement.

By implementing FSPT as an innovation, access to effective phototherapy for newborn jaundice can be improved in resource-limited settings where conventional electric-powered phototherapy devices are not readily available. This can contribute to better maternal and neonatal health outcomes.
AI Innovations Methodology
The study described in the provided text focuses on maternal satisfaction with a novel filtered-sunlight phototherapy (FSPT) for newborn jaundice in Southwest Nigeria. The goal of the study was to assess the experience and satisfaction of mothers whose infants were treated with FSPT, which is an alternative to conventional electric-powered phototherapy that is often limited in resource-limited settings.

To improve access to maternal health, here are some potential recommendations based on the study:

1. Increase awareness: Since a significant number of mothers surveyed had no prior knowledge of neonatal jaundice, it is important to increase awareness about this condition and its treatment options. This can be done through community education programs, antenatal care sessions, and information campaigns.

2. Training healthcare providers: Ensuring that healthcare providers are knowledgeable about FSPT and its benefits can help improve access to this alternative treatment. Training programs can be implemented to educate healthcare providers about FSPT and its proper administration.

3. Improve test environment: The study found that the physical state of the test environment had the lowest satisfaction rating. Enhancing the test environment by providing comfortable seating, adequate lighting, and privacy can contribute to a more positive experience for mothers and infants.

4. Enhance information provision: The study showed that the adequacy of information received was significantly correlated with maternal satisfaction. Providing clear and comprehensive information about FSPT, its benefits, and any potential risks can help mothers make informed decisions and feel more satisfied with the treatment.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Baseline assessment: Conduct a survey or data collection to establish the current level of access to maternal health services, including the availability and utilization of FSPT.

2. Introduce the recommendations: Implement the recommendations mentioned above, such as increasing awareness, training healthcare providers, improving the test environment, and enhancing information provision.

3. Monitor and collect data: Continuously monitor the implementation of the recommendations and collect data on various indicators, such as the number of mothers receiving FSPT, satisfaction levels, and any changes in access to maternal health services.

4. Analyze the data: Analyze the collected data to assess the impact of the recommendations on improving access to maternal health. This can include comparing pre- and post-implementation data, conducting statistical analyses, and identifying any trends or patterns.

5. Evaluate outcomes: Evaluate the outcomes of the recommendations by assessing the changes in access to maternal health services, maternal satisfaction levels, and other relevant indicators. This evaluation can help determine the effectiveness of the recommendations and identify areas for further improvement.

By following this methodology, it is possible to simulate the impact of the recommendations on improving access to maternal health and assess the effectiveness of the interventions implemented.

Statistics:
Citations: 7
Authors: 5
Identifiers:
DOI: 10.1186/1471-2431-14-180
Research Areas:
Community Interventions, Food Security, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants
Study Countries:
Nigeria
Study Design:
Cross Sectional Study, randomised-control-trial
Study Approach:
Mixed-methods, Qualitative, Quantitative
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