Knowledge, Observation and Practices Related to Neonatal Jaundice in a Rural Community in Kano, Nigeria.

BACKGROUND: Neonatal jaundice (NNJ) is a common condition and when not adequately treated leads to acute bilirubin encephalopathy/kernicterus. This largely preventable condition is an important cause of death and disability in low- and middle-income countries. Education, early detection and effective management are key for prevention and require an understanding of community knowledge and practices to foster appropriate behavior to prevent severe NNJ. Therefore, the aim of this study was to identify knowledge, observation for jaundice (both active and passive) and practices related to NNJ in northern Nigeria. METHODS: This descriptive, correlational and cross-sectional study enrolled 298 household members with an average age of 29.8 years in Kano, Nigeria. A structured questionnaire regarding knowledge of, potential sequelae and causes and local practices related to NNJ was administered and data were analyzed using descriptive and Chi-square statistics. RESULTS: Participants reported: 85% NNJ to be a sign of illness; 3% understood that NNJ could cause brain damage; 94% did not actively observe for jaundice in their newborns; 56% did not know what causes NNJ; 88% would seek care if their newborn developed jaundice. Significant relationships between educational levels and what study participants would do if a newborn develops jaundice and between occupation, educational level and knowledge about causes of NNJ were noted, consistent with a difference in active jaundice observation between ethnic groups. CONCLUSION: A public health approach to NNJ with a strong community education program is a crucial next step in the fight to eliminate severe NNJ.

Factors Influencing Neonatal Practice in a Rural Community in Kano (Northern), Nigeria.

Nigeria has the highest number of neonatal and under-five deaths in Africa. Socio-cultural determinants play an important role in disease burden in low-middle income countries. This study aimed to describe knowledge, attitudes and neonatal care practice among household caregivers in a rural community in Nigeria, specifically uvulectomy, female genital mutilation (FGM), failure to routinely immunize and unsafe cord care. Further, relationships between demographic characteristics and knowledge, attitudes and neonatal care practices among caregivers were analyzed. The study design was descriptive correlational and cross-sectional. Consented caregivers (N = 298) were enrolled and interviewed using a structured questionnaire. Data were collected on demographic characteristics of the study participants and practice of uvulectomy, FGM, immunization and cord care. Statistically significant correlations were found between the practice of uvulectomy, FGM and failure to immunize based on occupation (p = 0.0202, p = 0.0290, p = 0.0071) and educational level (p =< 0.0001, p =< 0.0001, p =< 0.0001), with variations by ethnicity. Intense, preventative health measures and maternal education to eliminate harmful care practices are essential to influence outcomes.

Comparison of maternal milk (breastmilk) expression methods in an African nursery.

OBJECTIVE: This study compares maternal milk volumes (MMVs) of Ugandan mothers whose infants were in a special care nursery and who used one of three maternal milk expression techniques: double electric breast pump, single non-electric manual breast pump, and hand breastmilk expression. SUBJECTS AND METHODS: A convenience sample of 161 Ugandan mothers of infants who were either too immature or ill to independently feed from the breast yet healthy enough to survive in an environment without ventilator support (birth weights, 0.84-3.8 kg) were assigned to one of three maternal milk expressions: Group 1, double electric breast pump (n=55); Group 2, single non-electric manual breast pump (n=59); and Group 3, hand breastmilk expression (n=47). Data were collected over a 7-day period (from day 1 postpartum to day 7 postpartum), and mean MMVs were measured and compared among the groups. RESULTS: The mean daily MMVs were as follows: Group 1, mean=647 mL (SD=310); Group 2, mean=520 mL (SD=298); and Group 3, mean=434 mL (SD=291). Results from one-way analysis of variance revealed significant differences in the mean MMV based on the method of maternal milk expression (p=0.0019). Further analysis using Tukey's HSD Test revealed significant differences in the MMV between Groups 1 and 3 (p < 0.01), but not between Groups 1 and 2 or between Groups 2 and 3. CONCLUSIONS: Electric breast pumps provided the highest mean MMV; however, many mothers obtained adequate feeding volumes for their infants' daily nutritional needs with the single non-electric manual breast pump and hand breastmilk expression.

Appalachian women: health beliefs, self-care, and basic conditioning factors.

The purposes of this study were to: (a) describe the health beliefs and self-care of Appalachian women; and (b) describe the relationships among health beliefs, self-care, and the basic conditioning factors of Appalachian women. Orem's SCDNT was used as the theory for this study. This study used qualitative and quantitative methodologies. The study participants included 129 Appalachian women. Health beliefs and self-care were described. Significant correlations were found between components of the basic conditioning factors and definition of health beliefs and self-care. The outcomes from this research study support that Appalachian women do participate in self-care in promoting their health.

Developmental disabilities: improving competence in care using virtual patients.

Nurse practitioners (NPs) have an increasingly important role in health care provision in the United States. However, most nurses report that they receive little or no clinical training in the area of developmental disabilities. A core development team consisting of NP faculty members from three universities, one physician assistant faculty member, the parents of children with developmental disabilities, and educational specialists developed two multimedia interactive pediatric instructional modules in CD-ROM format: one involving a child with Down syndrome and the other, an infant born at 26 weeks gestation. Participants were required to make decisions about proper clinical interaction throughout the cases. The modules on CD were piloted with NP students at three universities. Effectiveness study results demonstrated significant gains in both knowledge and comfort level regarding the care of patients with developmental disabilities.

Caring for children with intellectual and developmental disabilities: virtual patient instruction improves students' knowledge and comfort level.

Nurses play a vital role in providing health care to children with developmental disability (DD) throughout the United States. Unfortunately, most nurses continue to report that they receive little or no clinical education in the area of DDs. In response to this need, a core development team consisting of nurse practitioners and nursing faculty from three universities, one physician assistant faculty, parents of children with DD, and educational specialists developed two multimedia (virtual patient) pediatric instructional modules in CD-ROM format--one involving a child with Down syndrome, and the other involving an infant born at 26 weeks' gestation. Participants were required to make clinical decisions throughout the cases. The modules on CD were piloted with nursing students from three universities. Results of the effectiveness study demonstrated significant gains in knowledge and comfort level regarding the care of children with DD.

Electric breast pump use increases maternal milk volume in African nurseries.

Health experts worldwide recognize breastmilk as the superior infant food. Recommendations from the American Academy of Pediatrics and the World Health Organization (WHO) identify exclusive breastfeeding for the first half-year of life and continuation of breastfeeding into toddlerhood as offering maximum protection from illness, providing a substrate for immunological protection. Data from developed countries identify increasing morbidity and mortality rates for infants who have never received breastmilk in life and demonstrate that infants benefit from exclusive breastfeeding, especially, in areas of severe poverty. Preterm infants, most at risk for morbidity and mortality in developing countries, are identified as needing their own mother's milk for survival. Exclusive feeding of own mothers' milk (OMM) is associated with improved infant survival; however, inadequate maternal milk volume (MMV) often necessitates adding artificial feedings or exogenous substances to OMM. The objective of this study was to compare mean daily MMV for mothers of premature or sick infants in special care nurseries (SCN) using one of three methods of OMM expression: electric breast pump, non-electric pedal breast pump, and hand (manual) expression. We studied 65 mothers whose infants were cared for in two SCN in Africa (Kenya and Nigeria) and were unable to feed directly at the breast. In this randomized trial, mothers were randomly assigned to one of three milk expression groups at birth. MMV, the dependent variable, was measured for an average of 8.7 days. MMV for the electric and pedal pump and hand milk expression was 578 +/- 228 ml (n = 22), 463 +/- 302 ml (n = 24) and 323 +/- 199 ml (n = 19), respectively. Data were evaluated using a one-way ANOVA (p = 0.014). The Tukey revealed significant differences (p < 0.01) between electric breast pump expression and hand expression but not between the electric and pedal pump or the pedal pump and hand expression. Findings revealed greater MMV with electric breast pumps than hand-expression for mothers of infants in African nurseries. This data has important implications for international policy if exclusive OMM feeding is to be achieved for the vulnerable infant. Funded by West Virginia University Department of Research and Graduate Studies HSC Grant # 2U023U; Non-monetary donations of breast pumps and breast pump kits were made by Medela (Medela, Inc., McHenry, IL, USA).

Meeting the health care needs of medically underserved, uninsured, & underinsured Appalachians.

There is the need for critical changes in the United States health care system to meet the rising costs of health care and the massive number of people without health insurance. The Berea Health Ministry Rural Health Clinic (BHMRHC) is a nurse-managed, rural primary health care clinic that was designed to respond to the health care needs of the underserved, uninsured, and underinsured populations in a designated nine county area of Appalachian Kentucky. The process used in the development and implementation of BHMRHC is described as a model to assist in the future development of similar clinics.