PERINATOLOGY • Vol 24 • No. 1 • May–Aug 2023 • 5 importance of recognizing jaundice early after the neonate’s discharge from the hospital. Jaundice is one of the most common reasons for hospital readmission among neonates.1 Hence, early detection of significant jaundice improves the prognosis, as therapy can be instituted at a lower bilirubin level, and the need for aggressive treatments such as exchange transfusion can be averted. On the other hand, home remedies cause unnecessary delay in seeking treatment. Studies report 5% to 11% of neonates in India develop significant jaundice; hence, mothers and community health workers should be made aware of this condition and advised to seek medical help immediately.14,15 In this study, the mothers detected physiologic jaundice in 70% of the cases and pathologic jaundice in 26% of the cases. Early detection may have been the reason for early care seeking in these cases. A study conducted in Nepal reports poor maternal knowledge about neonatal jaundice as a hindrance to seeking care.16 The results of this study and that of Ayeni et al’s17 study show that many families faced challenges in utilizing the available maternal and child health care services because of the lack of adequate education and geographic isolation. This makes neonates susceptible to adverse outcomes and adds to the pool of preventable neonatal morbidity and mortality.17 Creating community awareness, early detection, and availability of phototherapy at peripheral health centers can considerably reduce referrals to tertiary care centers, the need for exchange transfusion, and the burden of kernicterus. Limitations The study’s results cannot be generalized, as this was a hospital-based study with an unknown population denominator. The sociodemographic determinants were self-reported and were not verified by observation or other proxy measures. Conclusion Neonates with severe jaundice were presented late at the health care facility. Low maternal education and poor utilization of maternal and child health care services were the risk factors for the late presentation. The Table 4. A Comparison of the Service Utilization Factors Between the Cases and Controls Variable Cases (n = 125), Frequency (%) Controls (n = 125), Frequency (%) COR (95% CI) P Value Number of ANC Visits < 5 75 (60) 84 (41.6) 2.10 (1.33–3.31)a .001 ≥ 5 50 (40) 118 (58.4) Nearest Public Health Facility, kmb < 1 12 (9.6) 9 (4.5) 0.92 (0.59–1.46) .75 1–5 39 (31.2) 77 (38.1) > 5 74 (59.2) 116 (57.4) Place of Delivery Institutional 93 (74.4) 174 (86.1) 0.46 (0.26–0.82)a .008 Home 32 (25.6) 28 (13.9) Availed Matriyaan Yes 39 (31.2) 104 (51.5) 0.42 (0.26–0.68)a .0004 No 86 (68.8) 98 (48.5) Diagnosis of Jaundice to Admission Delay, h < 48 52 (41.6) 122 (60.4) 0.46 (0.29–0.73)a .001 ≥ 48 73 (58.4) 80 (39.6) ANC, antenatal care. aP < .01; b< 1 km and 1–5 km categories were clubbed for COR calculation. Discussion We found low maternal age, primiparity, neonatal birth weight < 2.5 kg, and poor utilization of maternal and child health care services as the factors that increased the risk of severe jaundice at admission, in neonates. In this study, the mean TSB was 21.98 mg/dL in the cases and 12.2 mg/dL in the controls. In a study conducted in Northern Ethiopia, the TSB ranged from 15 to 19.9 mg/dL in the cases, while the controls had a mean TSB of 10.66 mg/dL.12 In this study, the onset of jaundice was between days 2 and 7 of life in 94.5% of the neonates, including both cases and controls. This finding is in agreement with the finding of Nepal et al’s study.13 This emphasizes the Research Article Datta M, et al. Determinants of Severe Neonatal Jaundice
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