An evaluation of phototherapy services in newborn units in Kaduna State Nigeria

Abstract

Abstract: Background Phototherapy (PT) for unconjugated hyperbilirubinaemia remains an important and invaluable intervention in the management of neonatal jaundice when appropriately and optimally employed. The efficiency of PT greatly depends on the irradiance of the device, which is measured using an irradiance meter. Available optimal phototherapy is a key desirable newborn service that should be offered and accessible in secondary and tertiary health care facilities. Objective: The study aimed at determining the availability and irradiance measure of phototherapy devices in neonatal units in Kaduna state, Northwestern Nigeria.

Materials and Methods: The study was an action research survey of all hospitals providing newborn care in Kaduna state including public and private profit and nonprofit faith based facilities. Phototherapy devices in use in the facilities were documented (types, brand and bulbs). The average irradiance of PT device was measured using model 22 Olympic Bili – MeterTM at facility traditional PT distance and distance of optimal irradiance was also determined and documented. Facilities were introduced to and educated on protocols on neonatal jaundice and how to ensure optimization of irradiance and management of neonatal jaundice.

Results: None of the 31 public secondary health care facilities operated a newborn unit nor provided management for neonatal jaundice. Overall 15 facilities provided PT services of which 87%were non-government facilities made up of 15% faith based and 85% private for profit facilities. Only 13.3% facilities had PT devices which offered irradiance (> 10 µW/cm2 / nm) suitable for conventional PT at the facilities’ traditional PT distance this however, increased to 7 (46.7%) facilities with adjusted distances. Only 3 (20%) facilities had devices that could offer intensive PT (irradiance > 30 µW/cm2 / nm) at varying distances. None of the surveyed facilities had a radiometer nor knew irradiance of their PT devices and neither did any have a written protocol for the management of neonatal jaundice. Expertise for and availability of exchange blood transfusion (EBT) services was available only in 26.7% of the facilities.

Conclusions: Private health care facilities constitute a major provider of neonatal jaundice healthcare services however the services were grossly suboptimal and inadequate and will need significant and urgent improvement to enhance newborn health and indices.

Keywords: phototherapy, neonatal jaundice, newborn care, kernicterus, action research