Maternal Instruction About Jaundice and the Incidence of Acute Bilirubin Encephalopathy in Nigeria

Richard P. Wennberg, Stephen Oguche, Zainab Imam, Zubaida L. Farouk, Isa Abdulkadir, Paul D. Sampson, Tina M. Slusher, Fidelia Bode-Thomas, Bose O. Toma, Christopher S. Yilgwan, David Shwe, Akinyemi O. Ofakunrin, Udochukwu M. Diala, Chris Isichei, Victor Pam, Zuwaira Hassan, Shehu U. Abdullahi, Fatima Usman, Binta W. Jibir, Idris Y. MohammedHadiza A. Usman, Muhammed Abdusalam, Aisha Kuliya-Gwarzo, Fatima I. Tsiga-Ahmad, Laila Umar, William N. Ogala, Fatimatu Abdullahi, Laila Hassan, Saratu Purdue, Troy Lund, Carlos D. Coda-Zabetta

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Objective: To evaluate whether teaching mothers about neonatal jaundice will decrease the incidence of acute bilirubin encephalopathy among infants admitted for jaundice. Study design: This was a multicenter, before–after and cross-sectional study. Baseline incidences of encephalopathy were obtained at 4 collaborating medical centers between January 2014 and May 2015 (Phase 1). Structured jaundice instruction was then offered (May to November 2015; Phase 2) in antenatal clinics and postpartum. Descriptive statistics and logistic regression models compared 3 groups: 843 Phase 1 controls, 338 Phase 2 infants whose mothers received both antenatal and postnatal instruction (group A), and 215 Phase 2 infants whose mothers received no instruction (group B) either because the program was not offered to them or by choice. Results: Acute bilirubin encephalopathy occurred in 147 of 843 (17%) Phase 1 and 85 of 659 (13%) Phase 2 admissions, which included 63 of 215 (29%) group B and 5 of 338 (1.5%) group A infants. OR for having acute bilirubin encephalopathy, comparing group A and group B infants adjusted for confounding risk factors, was 0.12 (95% CI 0.03-0.60). Delayed care-seeking (defined as an admission total bilirubin ≥18 mg/dL at age ≥48 hours) was the strongest single predictor of acute bilirubin encephalopathy (OR 11.4; 6.6-19.5). Instruction decreased delay from 49% to 17%. Other major risk factors were home births (OR 2.67; 1.69-4.22) and hemolytic disease (hematocrit ≤35% plus bilirubin ≥20 mg/dL) (OR 3.03; 1.77-5.18). The greater rate of acute bilirubin encephalopathy with home vs hospital birth disappeared if mothers received jaundice instruction. Conclusions: Providing information about jaundice to mothers was associated with a reduction in the incidence of bilirubin encephalopathy per hospital admission.

Original languageEnglish (US)
Pages (from-to)47-54.e4
JournalJournal of Pediatrics
StatePublished - Jun 2020

Bibliographical note

Funding Information:
Supported in part by Saving Lives at Birth partners: the United States Agency for International Development, the Government of Norway, the Bill & Melinda Gates Foundation, Grand Challenges Canada, and the UK Government (FOG award no. AID-OAA-F-13-00072 to Bilimetrix s.r.l.). The study was conceived while performing validation studies for a point of care bilirubin assay (Bilistick) supported by Bilimetrix s.r.l. Bilimetrix provided support for bilirubin assays, teaching materials, and data collation and storage. The design, execution, analysis, and manuscript preparation are solely the product of the Stop Kernicterus in Nigeria coalition and may or may not reflect the opinion of the sponsors.

Publisher Copyright:
© 2020 Elsevier Inc.


  • acute bilirubin encephalopathy
  • hyperbilirubinemia
  • kernicterus
  • low-middle income country
  • maternal instruction
  • neonatal jaundice
  • risk factors


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