https://doi.org/10.15218/ejnm.2022.08 Erbil j. nurs. midwifery, Vol. 5, No. (2), Nov 2022 Original Article Mothers’ Knowledge Regarding Home Care Management of Neonatal Jaundice in Qaladze - Sulaymaniyah City ABSTRACT INTRODUCTION Jaundice is a yellow coloring of the skin and/or the whites of the eyes, a common condition in babies. When bilirubin accumulates in the skin of infants, the skin turns yellow. High bilirubin levels in the blood is a condition known as Background and Objectives: Jaundice is the most common condition requiring medical attention in newborn babies. The mother has a significant role in reducing the effects. Early discharge of mothers and neonates from the hospitals increased the responsibility of mothers in recognizing jaundice has increased. This study aimed to assess the level of the mothers’ knowledge regarding home care management of neonatal jaundice. Methods: A quantitative, cross-sectional descriptive study was carried out in the Neona- tal Intensive Care Unit at Shahidan Qaladze Teaching Hospital from the period of January 2021 to March 2022. Purposive (non-probability) sampling techniques were used to re- cruit participants. The study sample included 114 mothers. Data was collected using a questionnaire prepared by the investigator, and direct interviews were conducted. De- scriptive statistics including, frequencies and percentages, and inferential statistical anal- ysis of Chi-square was used to analyze the data. Results: The results show that 34.2% of the mothers were between 26-32 years. Con- cerning occupation, more than three-quarters (86%) of the sample were housewives. The study demonstrated that the majority (64.9%) of mothers did not have enough in- formation about jaundice. There was a statistically significant association between par- ents’ relatives and the source of information regarding the mother’s knowledge. The study showed a statistically significant association between mothers’ knowledge and early initiation of breastfeeding. Factors associated with mother’s knowledge include the mother’s age, occupation, years of formal education, residency areas, received health education on neonate jaundice, and the source of information. Conclusion and Recommendations: The study concluded that most mothers had a defi- cit of knowledge regarding home care management of neonatal jaundice. It is recom- mended to provide mothers with comprehensive health education about neonatal jaun- dice care to improve their knowledge and practice in caring for neonates with jaundice. Keywords: Mothers; Neonatal; Intensive Care Units; Home Care Services. Banaz Kamal Mohammad; Department of Pediatrics, College of Nursing, Sulaimania University, Sulaimania, Kurdistan region, Iraq. (Correspondence: Banazkamal72@gmail.com) Shukir Saleem Hasan; Department of Nursing, College of Nursing, Hawler Medical University and Tishk International University, Erbil, Kurdistan Region, Iraq. 72 Received: 04/01/2022 Accepted: 26/03/2022 Published: 30/11/2022 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. mailto:Banazkamal72@gmail.com https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2022.08 Erbil j. nurs. midwifery, Vol. 5, No. (2), Nov 2022 Original Article hyperbilirubinemia [1About half of term and 80% of preterm babies get jaundice, which arises two to four days after birth and goes away on its own within one to two weeks without treatment [2]. The main symptom is a yellowish skin color that appears and extends to the face, chest, ab- domen, legs, and soles of the feet. Clinical indicators of hyperbilirubinemia include hepatomegaly, poor weight gain, lethargy or irritability, poor breastfeeding or bottle- feeding, and visual jaundice (yellow of the sclera) [3]. Subtypes of neonatal jaundice include jaundice due to breastfeeding, jaundice due to breast milk, and hemolytic jaundice due to Rhesus factor (Rh) incom- patibility, and ABO blood group incompati- bility [4]. Poor feeding, high-pitched cries, convulsions, hearing loss, cerebral palsy, and mental retardation are all side effects of jaundice [5]. Kernicterus is a dangerous consequence connected with jaundice and can cause cerebral palsy and deafness if not appropriately treated [6]. a mother with blood group O or rhesus negative, rapid rise of total serum bilirubin (TSB), sepsis, lactation failure in exclusive breastfeeding, high pre-discharge bilirubin level, cephalohaematoma or bruises, ba- bies of diabetic mothers [7]. Jaundice is a common reason for re-admission to the hospital after an early discharge of a new- born baby. “In a study conducted in the Iraqi-Kurdistan region, the neonatal mor- tality rate was 37 deaths per 1000 live births” [9]. In 2002, 18% of neonatal admis- sions at the National Hospital of Pediatrics (NHP) were admitted with hyperbiliru- binemia [8]. Among Turkish infants, jaun- dice is seen in 10.5 % of term infants and 25.3 % of near-term infants [10]. A study confirmed that 75% of neonatal mortality occurs in though Asia and Sub Haran Afri- can, deaths occurring within the first 28 days, and add that more than third of neo- natal death occurs in Ethiopia [11]. Neonatal jaundice is increased in infants of East Asian, American Indian, and Greek descent. African infants are affected less often than non-African infants [10]. Early detection and treatment of ureteric neo- nates may help to reduce difficulties [6]. In newborns, jaundice is the most prevalent ailment that necessitates medical treat- ment, such as jaundice presentation sites, danger signs, causes, complications, diag- nosis ways, and effective treatments, are included with in mothers’ awareness re- garding home care management of neona- tal jaundice [12]. According to the non- official census at Shahidan Qaladze there were 250 neonatal jaundices admitted to the hospital last year [13]. The goal of this study is to assess mothers’ knowledge re- garding home care management of neona- tal jaundice. This study was a descriptive-analytic cross- sectional study using a quantitative design. The research was conducted between Jan- uary 2021 and the end of March 2022. The sample was a non-probability (purposive) sample of 114 eligible mothers based on a formula devised by Yamane in 1967 [14], as follows n=N/1+ N (e)2; (N= Total Num- ber e= Alpha errors of 0.05). Eligibility cri- teria included mothers who were admitted with their neonate with jaundice. Mothers who attended Shahidan Qaladeze Teaching Hospital in Qladadeze sub-district in Sulay- maniyah city of the Iraqi Kurdistan region were recruited. Prior to the interview, an administrative agreement was taken from the Faculty of Nursing/Sulaymani Universi- ty's scientific and ethical committee, and the Shahidan Qaladeze Teaching Hospital's scientific and ethical committee. Verbal consent was received from mothers who accepted to participate. Personal infor- mation, such as phone numbers, and 73 METHODS Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2022.08 Erbil j. nurs. midwifery, Vol. 5, No. (2), Nov 2022 Original Article status. Around half (57%) of the respond- ents were pregnant more than once (multigravida), and 43% had one child (primigravida). Sixty-four percent of moth- ers had no previous history of neonatal jaundice. Mothers breastfeeding exclusive- ly accounted for 61.4% of the sample. The study revealed that 68.4% of mothers had received health education about neonatal jaundice and 18.4% received health educa- tion on neonatal jaundice from their rela- tives. A statistically significant association was found between mothers' knowledge of home care management and parame- ters such as source of information (p- value=0.030), and relative between par- ents (p-value=0.036) respectively (Table 2). Table 3 indicates a statistically significant link between mother’s knowledge and the initiation of breastfeeding (colostrum). Table 4 shows a statistically significant re- lationship between mothers’ knowledge of home care management and parameters such as source of information (p- value=0.00), occupation (p-value=0.04), and health education (p-value=0.05). The study found non-significant associa- tion between mothers’ experiences of home care management and their age (p= 0.64). Part I: Socio demographic characteristics of mothers (Table 1) Most of the respondents were 26-32 years of age. This study is like a study carried out by an Iraqi researcher, who revealed that 43.2% of caregivers were aged between 26-31 [16]. In contrast, a study conducted in Nigeria revealed that most of respondents were aged 20-35 years [17].The current study found that housewives made up the largest percent- age of participants. This finding is con- sistent with a study conducted in Karbala which found that more than three quarters addresses, were not included in the tool, and the researcher agreed to keep the data secure for anonymity and confidentiality. The questionnaire consisted of two parts. Part 1 gathered information regarding par- ticipants’ socio-demographic characteris- tics, and part 2 assessed mother’s knowledge regarding home care manage- ment of neonatal jaundice. The knowledge items were rated on a two-point dichoto- mous scale (Know and Don’t Know) and scored as 1 for correct and 0 for incorrect. Data was collected through direct (face-to- face) interviews for about 25 to 35 minutes. The validity of the study instru- ment was first determined by a panel of 20 experts from various fields. It assessed the consistency, precision, repeatability, and trustworthiness of research. It demon- strates the extent to which the survey in- strument is free of bias and ensures con- sistent measurement throughout and across the various elements in the instru- ments [15]. Pearson correlation(r) was used to determine the reliability (r=0.81) and indicated that the scale is sufficiently trustworthy. A pilot study was conducted on 15 mothers. The data were processed using SPSS software version 25 for statisti- cal analysis (frequency and percentage). The association between the variables was determined using inferential statistical analysis (Chi-square and regression). It is considered statistically significant if the p- value is equal and less than 0.05 and re- jects the null hypothesis. The socio-demographic characteristics of mothers are presented in Table 1. The re- sults show that 34.2% of the mothers were between 26-32 years. Concerning occupa- tion, more than three-quarters (86%) of the sample were housewives. The results showed that more than half (68.4%) of the sample are of middle level socioeconomic 74 RESULTS DISCUSSION Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2022.08 Erbil j. nurs. midwifery, Vol. 5, No. (2), Nov 2022 Original Article (79.5%) of mothers providing home care were housewives [18]. In terms of the par- ticipants’ economic status, the results sug- gest that 68.4% had a middle economic status. This is contradicted by a study con- ducted by researchers in Vietnam which found that the average household econo- my was middle level [8]. In Karbala, a study found that 60% of the mothers have a low socioeconomic status [18]. The current study showed that around half (57%) of mothers were pregnant more than once (multigravida), and 43% had one child (primigravida). Similar results were also found in a study in Ghana which men- tioned that 55% of the sample were nullip- arous and 45% were primigravida [19]. Ac- cording to the type of feeding, 61.4% of mothers started exclusive breastfeeding. This finding is consistent with an Iraqi re- searcher which found that 65.2% of wom- en exclusively breastfed their children [16]. According to the current study, less than a quarter of mothers (64.9%) have never heard of newborn hyperbilirubinemia, with relatives accounting for 18.4% of infor- mation and social media accounting for 14.0%. This contradicts the findings in Gha- na which found that 82.7% of women had heard of neonatal jaundice. The primary source of knowledge concerning newborn jaundice was the school (34.6^), followed by friends (15.4%) [20].Part II: Association between sociodemographic characteristics and mother’s knowledge regarding neona- tal jaundice (Table 2)Our study found no statistically significant relationship be- tween mothers’ knowledge of newborn jaundice and their age, level of education, or socioeconomic status. This contradicts the findings in Karbala which found that the mothers’ knowledge was substantially related to their age, degree of education, and socioeconomic status at a p-value of 0.05 [18]. No significant association be- tween occupational and residential status of mothers was found at a p-value of 0.05. Furthermore, our findings contradict the findings of a study carried out in Egypt which found that mother’s knowledge was influenced greatly by the degree of educa- tion, age, parity, and past history [12]. An- other study found that knowledge was substantially connected with a history of neonatal jaundice, a child’’s birth rank, and the mother’s age [20]. This contradicted the findings of the present investigation, which found no statistically significant link between mother’s knowledge, mother’s age, and previous history of jaundice. Also, the findings of the present study diasa- grees with a study conducted in Iraq which found that older women’s knowledge, atti- tude, and behavior about several aspects of neonatal jaundice were considerably better than younger women’s [21]. In con- trast to the earlier study was carried out in Egypt [22], our study found that occupa- tion and residency had no effect on moth- ers’ knowledge. Working mothers and those who live in cities had much higher levels of knowledge than other mothers. Similar findings were observed in an Indian study by Gopalakrishnan et al., [23]. The respondents’ degree of education, as well as the number of prior babies that had ne- onatal jaundice, were found to have a sub- stantial impact on their understanding of the condition in this study. However, there was no correlation between the mother’s age and their expertise (p=0.005). The cur- rent study found a statistically significant relationship between maternal education and awareness of neonatal jaundice (p= 0.020), as well as the number of previous babies who had experienced neonatal jaundice and respondents’ knowledge of neonatal jaundice (p=0.0001). A study dis- covered in Baghdad shows a statistically significant relationship between mother’s knowledge and mother’s age (p=0.001) [24] and an Iraqi researcher found 75 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2022.08 Erbil j. nurs. midwifery, Vol. 5, No. (2), Nov 2022 Original Article 76 and the need to seek early hospital care when neonatal jaundice is detected [28- 29]. The study found that most mothers lacked knowledge and procedures for managing newborn jaundice care at home. It was suggested that mothers of children with newborn jaundice receive comprehensive health education regard- ing neonatal jaundice care to improve their knowledge and practice. The authors acknowledge the mothers who participated in the study and Qaladeze Shahida Hospital for their support and participation. Ethical approval was obtained from the scientific and ethical committee at the Faculty of Nursing/ Sulaymani University, and Shahidan Qaladeze Teaching Hospi- tal. Verbal permission was taken from the mothers before conductng the inter- views. The tool did not consist of person- al information such as personal phone number, address, personal information, and the researcher promised to keep the data for confidentiality and anonymity The authors (s) report no conflict of interest. The authors (s) report no funding support. [1] Mansor MN, Yaacob S, Hariharan M, Basah SN, Jamil SA, Khidir MM, and et al,. Jaun- dice in newborn monitoring using color detection method. Procedia Engineering. 2012 Jan 1; 29:1631-5. a statistically significant relationship be- tween mothers’ level of education and their practices [25]. According to our find- ings, there is a statistically significant link between parents’ relatives and the source of information on the mother’s expertise. Our findings contradict with a study con- ducted in Nigeria which found no influence of source of information and mother’s knowledge on neonatal jaundice, and no relationship between a relative of parents and mother’s knowledge on neonatal jaun- dice [26].Part III- Association between bio- graphical information of neonatal jaundice and mother’s knowledge (Table 3)There was no statistical link between mothers’ educational levels and the age of their newborns. A similar study in Karbala found no significant link between mothers’ knowledge and neonatal age (p=0.016). The current study found a statistically sig- nificant link between mother’s knowledge and biographical information of newborns related breastfeeding (colostrum) initia- tion which is consistent with a study con- ducted in Karbala which found a link be- tween mothers’ knowledge and colostrum in terms of socio-demographic variables [27].Part V: Identify the factors associated with mothers’ knowledge regarding home care management (Table 4)Our result re- veals a statistically significant relationship between mothers’ knowledge of home care management and parameters like source of information, occupation, and health education, years of schooling, and residential area, with p-values of 0.00 and 0.05, 0.010, and 0.034, respectively. A study in Mosul, Iraq discovered a statisti- cally significant relationship between the age of the care, level of education, occupa- tion, and residential areas, and homecare management of neonatal jaundice babies [24]. A study conducted in Ghana reported that health education should emphasize phototherapy as the main treatment plan, CONCLUSION Acknowledgment Ethical considerations CONFLICT OF INTEREST FUNDING REFERENCES Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2022.08 Erbil j. nurs. midwifery, Vol. 5, No. (2), Nov 2022 Original Article [13] Non-official Census of Shahidan Qaladeze Teaching Hospital, 2020, No 124 in 10, 01, 2021. [14] Chawarwan SA. Home care Management of Preterm Baby among Mothers attending Neonatal Intensive Care Unit in Erbil city, 2019; 26-27. (MSc. Thesis) [15] Mohajan HK. Two criteria for good measure- ments in research: Validity and reliability. Annals of Spiru Haret University. Economic Series. 2017;17(4):59-82. [16] Al Doori NM, Ameen WA, Talib M. Mother’s Knowledge of Initiative Breast Feeding in Relation to Neonatal Jaundice. Medico Legal Update. 2020 Jul 24;20(3):1436-41. [17] Ezeaka CV, Ugwu RO, Mukhtar-Yola M, Eku- re EN, Olusanya BO. Pattern and predictors of maternal care-seeking practices for se- vere neonatal jaundice in Nigeria: a multi- centre survey. BMC health services research. 2014 Dec;14(1):1-0. [18] Hussein HS, Aziz AR. Assessment of mothers' knowledge and beliefs toward care of neo- natal jaundice in pediatric teaching hospital in Holy Karbala City. Reading and Writing an Interdisciplinary Journal. 2016; 8(8). [19] Adoba P, Ephraim RK, Kontor KA, Bentsil JJ, Adu P, Anderson M, and et al. Knowledge level and determinants of neonatal jaundice: a cross-sectional study in the Effutu Munici- pality of Ghana. International journal of pe- diatrics. 2018 Mar 1;2018. [20] Khalesi N, Rakhshani F. Knowledge, attitude and behaviour of mothers on neonatal jaun- dice. The Journal of the Pakistan Medical Association. 2008 Dec;58(12):671-4 [21] Al-Zamili AH, Saadoon ZA. Knowledge, Atti- tude and Practice of Mothers to Neonatal Jaundice. Medico Legal Update. 2020 Apr 9;20(1):1065-70. [22] Moawad EM, Abdallah EA, Ali YZ. Percep- tions, practices, and traditional beliefs relat- ed to neonatal jaundice among Egyptian mothers: A cross-sectional descriptive study. Medicine (Baltimore). 2016 Sep;95(36). [23] Gopalakrishnan S. Assessment of knowledge regarding new-born care among mothers in Kancheepuram district, Tamil Nadu. Interna- tional Journal of community medicine and public health. 2014 Oct;1(1):58. [24] Hameed NN, Abdul-Hussain NJ, Ahmed ME. Assessment of mother's Knowledge, practic- es and believes toward home management of Neonatal jaundice in two pediatric teach- ing hospitals. Journal of the Faculty of Medi- cine Baghdad. 2019;61(3, 4). 77 [2] Jardine LA, Woodgate P. Neonatal jaundice. American Family Physician. 2012 Apr 15;85 (8):824-5. [3] Cohen RS, Wong RJ, Stevenson DK. Under- standing neonatal jaundice: a perspective on causation. Pediatrics & Neonatology. 2010 Jun 1;51(3):143-8. [4] Ullah S, Rahman K, Hedayati M. Hyperbiliru- binemia in neonates: types, causes, clinical examinations, preventive measures and treatments: a narrative review article. Irani- an journal of public health. 2016 May;45 (5):558. [5] Hamad KJ, Khalil HM. Assessment of Knowledge of Neonatal Jaundice among Mothers Attending Maternal and Pediatric Hospital in Soran City. Polytechnic Journal. 2019 Jun 30;9(1):32-6. [6] Boskabadi H, Ashrafzadeh F, Azarkish F, Khakshour A. Complications of neonatal jaundice and the predisposing factors in newborns. Journal of Babol University of Medical Sciences. 2015 Sep 10;17(9):7-13. [7] Wan AS, Daud SM, Teh SH, Choo YM, Kutty FM. Management of neonatal jaundice in primary care. Malaysian family physician: Malaysian Family Physician. 2016;11(2- 3):16. [8] Le LT, Partridge JC, Tran BH, Le VT, Duong TK, Nguyen HT, and et al,. Care practices and traditional beliefs related to neonatal jaundice in northern Vietnam: a population- based, cross-sectional descriptive study. BMC pediatrics. 2014 Dec; 14(1):1-8. [9] Moazzem Hossain SM, El Nakib S, Ibrahim S, Al-Harun A, Muhammad S, Zaka N. Mater- nal and neonatal health in select districts of Iraq: findings from a recent household sur- vey. Journal of Pregnancy and Child Health. 2018;5(395):10-4172. [10] Zimmerman JJ, Fuhrman BP. Pediatric Criti- cal Care E-Book. Elsevier Health Sciences; 2011 Mar 24; 6 (1): 96-105. [11] Lake EA, Abera GB, Azeze GA, Gebeyew NA, Demissie BW. Magnitude of neonatal jaundice and its associated factor in neona- tal intensive care units of Mekelle city pub- lic hospitals, Northern Ethiopia. Internation- al journal of pediatrics. 2019 Apr 39(4) : . 159–163. [12] Allahony DM, Hegazy NN, Kasemy ZA, Bahgat EM. Mothers' perception toward neonatal jaundice in Kafr El-batanoon vil- lage, Menoufia, Egypt. Menoufia medical journal. 2016;29(3):743. Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2022.08 Erbil j. nurs. midwifery, Vol. 5, No. (2), Nov 2022 Original Article [25] Jamil EI, Jamil NF. Knowledge & Health Seeking Behavior of Newly Delivered Moth- ers Regarding Neonatal Jaundice. Iraqi Jour- nal of Community Medicine. 2017;30(2). [26] Ogunfowora OB, Daniel OJ. Neonatal jaun- dice and its management: knowledge, atti- tude and practice of community health workers in Nigeria. BMC Public Health. 2006 Dec;6(1):1-5. [27] Hussein KA, Aziz AR. Assessment of knowledge and attitude of colostrum among postnatal mothers. Mosul Journal of Nurs- ing. 2013 Mar 1;1(1):1-6. [28] Salia SM, Afaya A, Wuni A, Ayanore MA, Salia E, Kporvi DD, and et al. Knowledge, attitudes and practices regarding neonatal jaundice among caregivers in a tertiary health facility in Ghana. PloS one. 2021 Jun 4;16(6):e0251846. [29] Schuler C, Ntow GE, Agbozo F. Mothers' experiences with neonatal care for low-birth -weight infants at home; A qualitative study in the Hohoe Municipality. Ghana Journal of pediatric nursing. 2019 Mar 1; 45:e44-52. 78 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. https://creativecommons.org/licenses/by-nc-sa/4.0/