Effectiveness of prenatal intervention on neonatal hyperbilirubinemia management in rural Bangladesh: Results from a cluster-randomized trial.

OBJECTIVES

Nearly 80 % of severe neonatal hyperbilirubinemia cases are identified too late for medical treatment in lower-middle-income countries. Parents' understanding of neonatal jaundice is crucial for early detection and effective treatment. This study evaluated the effectiveness of prenatal sensitization in improving maternal knowledge and attitude toward neonatal hyperbilirubinemia management in Bangladesh.

STUDY DESIGN

Cluster-randomized trial.

METHODS

Between September 2019 and March 2021, a prospective home-based intervention trial on neonatal hyperbilirubinemia was conducted in 20 interventions and comparison clusters through community health workers (CHW). Participants were pregnant women in their second or third trimester of pregnancy. Proportion-based difference-in-difference (DID) was calculated to determine changes in the mother's knowledge and attitude towards newborn jaundice.

RESULTS

A total of 539 pregnant women were enrolled, 273 in the intervention, and 266 in the comparison arm. Following the intervention, participant's overall knowledge level about neonatal hyperbilirubinemia increased significantly (DID: 24.9, 95%CI: 19.2, 30.7) from baseline (33.2 %) to endline (70.5 %). Knowledge of newborn jaundice management showed the most improvement (DID: 60), followed by danger signs detection (DID: 40.0). The intervention also enhanced participants' positive attitudes regarding neonatal hyperbilirubinemia (DID: 13.1, 95%CI: 8.1, 18.0). Mothers with improved knowledge of neonatal hyperbilirubinemia were nearly five times more likely to have a favorable attitude toward it than those with counterparts.

CONCLUSIONS

CHW-led home-based prenatal sensitization interventions substantially improved mothers' awareness and attitudes toward neonatal hyperbilirubinemia detection and management. Integrating such sensitization into prenatal care of the existing health system could be a practical approach to improve neonatal health outcomes in Bangladesh.