Community health worker knowledge and perceptions of neonatal jaundice in Kumasi, Ghana

Neonatal jaundice is a leading cause of death and disability among newborns in sub-Saharan Africa, due in large part to late identification of an otherwise treatable illness. The burden of NNJ recognition and care-seeking falls on infant caretakers and community health workers (CHWs), who are in charge of both maternal education and neonatal home visits. This study sought to understand community health workers’ (CHW) knowledge and perceptions of community beliefs surrounding neonatal jaundice (NNJ), a treatable but potentially fatal condition prevalent in sub-Saharan Africa. In this cross-sectional qualitative study, CHWs in Kumasi, Ghana, completed in-depth interviews with trained research assistants using a semi-structured interview guide. Interviews were audiotaped, transcribed verbatim, and analyzed using grounded theory methodology. Knowledge of NNJ varied widely among the 23 respondents: 74% knew NNJ could cause death, 57% knew how to screen for NNJ. 35% of CHWs favored home treatment (sunlight therapy or watchful waiting). Three main themes emerged: CHWs perceived that caregivers prefer home treatment, equating hospital care with death; sunlight and herbs are the most common home treatments; and caregivers attribute NNJ to supernatural causes, delaying jaundice diagnosis. Incomplete understanding of NNJ among trained CHWs and local communities will require improved education among both groups to improve outcomes.