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Effect of Newborn Jaundice Education on Recognition of Neonatal Jaundice Warning Signs among Mothers in Nigeria

Abstract

Neonatal jaundice is a common condition during the newborn period and may require prompt assessment when bilirubin levels become excessively elevated or when jaundice occurs under concerning circumstances. Severe or untreated neonatal hyperbilirubinaemia may result in serious neurological complications, including acute bilirubin encephalopathy and kernicterus. Mothers in Nigeria may have limited knowledge of normal versus concerning jaundice, appropriate monitoring, warning signs, and the importance of timely healthcare assessment. Cultural beliefs, misconceptions, reliance on unverified remedies, delayed recognition, financial constraints, transportation difficulties, and limited access to appropriate newborn healthcare services may further contribute to delays in seeking care. Newborn jaundice education provides an opportunity to improve mothers' understanding of neonatal jaundice and their ability to recognize warning signs requiring prompt professional assessment. Against this background, this study investigates the effect of newborn jaundice education on recognition of neonatal jaundice warning signs among mothers in Nigeria. The study will be anchored on the Health Belief Model, Health Literacy Theory, and Social Cognitive Theory. The Health Belief Model explains how mothers' perceptions of newborn vulnerability to jaundice-related complications, perceived severity of severe jaundice, perceived benefits of early recognition and treatment, perceived barriers, self-efficacy, and cues to action may influence recognition and healthcare-seeking decisions. Health Literacy Theory emphasizes mothers' ability to obtain, understand, evaluate, and apply reliable information about neonatal jaundice and appropriate healthcare services. Social Cognitive Theory emphasizes observational learning, behavioural modelling, self-efficacy, reinforcement, and social support in developing maternal newborn-health knowledge and recognition skills. Collectively, these theoretical perspectives provide a suitable framework for explaining how newborn jaundice education may influence recognition of neonatal jaundice warning signs among mothers in Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise mothers of newborns aged 0–28 days residing in selected urban, semi-urban, and rural communities across Nigeria. A multistage sampling technique will be used to select geopolitical zones, states, local government areas, communities, households, healthcare facilities, and eligible mothers. Newborn jaundice education will be assessed using indicators such as exposure to educational sessions, frequency and duration of education, information on normal newborn jaundice, concerning patterns of jaundice, early onset of jaundice, progression or worsening of jaundice, jaundice involving the palms and soles, poor feeding, excessive sleepiness or reduced responsiveness, abnormal muscle tone, high-pitched crying, fever, seizures, and other signs requiring urgent professional assessment. Recognition of neonatal jaundice warning signs will be assessed using indicators such as mothers' ability to identify abnormal jaundice from clinical descriptions or scenarios, recognize worsening jaundice, identify jaundice appearing unusually early, recognize extension of yellow discoloration to the palms or soles, identify associated poor feeding or abnormal behaviour, recognize neurological warning signs, distinguish potentially serious jaundice from uncomplicated newborn jaundice, identify situations requiring urgent healthcare assessment, and identify appropriate sources of neonatal care. Data will be collected using structured questionnaires, standardized neonatal jaundice knowledge assessment tools, scenario-based questions, postnatal education records where available, healthcare records where ethically and practically accessible, and pre-test and post-test assessments where a quasi-experimental intervention is adopted. Descriptive statistics will be used to summarize mothers' demographic and socioeconomic characteristics, newborn characteristics, previous exposure to newborn-health education, sources of jaundice information, and warning-sign recognition levels. Inferential statistical techniques, including chi-square tests, paired and independent t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of newborn jaundice education on recognition of neonatal jaundice warning signs. Where a quasi-experimental design is adopted, recognition scores before and after the educational intervention may be compared with those of a comparison group to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that newborn jaundice education has a significant positive effect on recognition of neonatal jaundice warning signs among mothers in Nigeria. Mothers exposed to structured, evidence-based, practical, and culturally appropriate jaundice education are expected to demonstrate greater ability to recognize potentially serious jaundice than mothers without comparable exposure. Education may improve mothers' understanding of normal and concerning jaundice, including unusually early onset, rapid progression, severe yellow discoloration, poor feeding, excessive sleepiness, abnormal behaviour, and neurological warning signs. It may also improve mothers' understanding of the importance of prompt professional assessment and reduce reliance on unverified home remedies or delayed healthcare-seeking. Practical education using visual materials, demonstrations, and clinical scenarios may further improve mothers' confidence in recognizing warning signs and taking appropriate action. However, cultural beliefs, misinformation, family influence, financial barriers, transportation difficulties, limited access to neonatal services, and inadequate postnatal counselling may reduce the effectiveness of education alone. The study therefore expects accessible, practical, culturally sensitive, repeated, and sustained newborn jaundice education, supported by effective referral and neonatal healthcare services, to contribute significantly to improved recognition of neonatal jaundice warning signs among mothers in Nigeria. The study is expected to contribute to the literature on neonatal jaundice, newborn health, maternal health education, neonatal illness recognition, postnatal care, health literacy, maternal and child health, neonatal emergency care, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, hospitals, maternity facilities, primary healthcare centres, nurses, midwives, community health workers, maternal and newborn health programmes, development partners, and policymakers regarding strategies for improving early recognition and management of neonatal jaundice. The study will also provide evidence-based recommendations for integrating standardized neonatal jaundice education into antenatal and postnatal care, strengthening maternal counselling and visual education, improving awareness of warning signs requiring urgent assessment, reducing harmful misconceptions about jaundice management, strengthening referral and follow-up systems, and developing sustainable maternal and newborn-health programmes that promote early recognition of neonatal jaundice complications across Nigeria.

Keywords: Newborn jaundice education, neonatal jaundice warning signs, jaundice recognition, mothers, newborns, neonatal health, postnatal care, maternal health education, neonatal hyperbilirubinaemia, health literacy, Nigeria, public health.