Ashura Bakari, MD
Nominated From: University of Michigan
Research Site: Komfo Anokye Teaching Hospital
Research Area: Newborn Health
Primary Mentor: Cheryl Moyer
Home monitoring for neonatal jaundice: a randomized controlled trial in Kumasi, Ghana
Bilirubin-induced brain damage is the most devastating consequence of severe neonatal jaundice (NNJ), often leading to irreversible neurologic disability and death. Low- and Middle-Income Countries (LMICs) carry a high burden of bilirubin-induced mortality and severe chronic morbidity, with sub-Saharan Africa accounting for 35% of the global burden of bilirubin-induced brain damage.
Early identification of jaundice is crucial in the management of hyperbilirubinemia. Infants benefit from prompt and appropriate care with phototherapy or exchange blood transfusion when presenting sufficiently early at the health facility. Yet we know that delayed identification of neonatal jaundice remains a challenge. At Suntreso Government Hospital in Kumasi, Ghana, the site of this proposed research, previous Fogarty-funded research indicated that 30% (279/994) of newborns admitted to the Mother and Baby Unit over a 16-month period had a diagnosis of neonatal jaundice. In addition, the average age at jaundice presentation was 4.8 days, even though symptoms were noticed on average at 3.6 days. It is clear that more needs to be done to prompt rapid identification of and care-seeking for newborns with suspected jaundice.
One recent study found that an icterometer –a non-invasive screening tool for identifying degrees of jaundice based on blanching a newborn’s skin and comparing it to the icterometer’s color spectrum – can help mothers identify jaundice in their newborns earlier to facilitate prompt and appropriate care. The icterometer has documented significant diagnostic accuracy in both white and black newborn populations. However, the icterometer has not been used by mothers in Ghana, nor has it been tested against routine postnatal counseling (standard of care) to determine if it improves prompt identification and care-seeking for newborn jaundice.
This study will test whether adding home-based screening for jaundice using a simple icterometer will increase the number of newborns identified as having jaundice, the timeliness of symptom recognition, and the timeliness of care-seeking when compared to routine postnatal care counseling regarding jaundice recognition. This will be accomplished by randomly assigning women to receive an icterometer during their postnatal care counseling or not, and tracking newborn outcomes (across both groups) with phone follow-up in the first week of life. Because the latest iteration of the icterometer has been tested primarily among white and Asian infants, we intend to start our study by testing its validity in Ghanaian infants.
Neonatal jaundice is a common and treatable condition. However, it often develops after newborns have been discharged from the hospital and can be challenging to identify in dark-skinned infants. Failure to recognize this condition early can lead to death or lifelong disability.I hope to address this diagnostic conundrum with an icterometer – a sort of plastic ruler with a yellow gradient used to diagnose jaundice. It is cheap, portable, and non-invasive. Previous work around icterometers has focused mostly on light-skinned infants . This project will examine the validity of using the icterometer in dark-skinned infants, as a screening tool – that is, whether it is accurate in determining which children need further assessment of potential jaundice. Further knowledge of the icterometer’s validity in the study population will pave the way for possible interventions, including home use of icterometers by either community health nurses or mothers. We hypothesise that mothers sent home with the icterometer will identify jaundice in their babies and seek treatment earlier, thereby reducing neonatal severe morbidity and mortality .