Doctoral Degrees (Epidemiology and Biostatistics)

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Browsing Doctoral Degrees (Epidemiology and Biostatistics) by Subject "Bilirubin -- Testing -- Africa"

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    Transcutaneous bilirubin screening for hyperbilirubinemia in African newborns
    (Stellenbosch : Stellenbosch University, 2019-04) Okwundu, Charles I.; Wiysonge, Charles S.; Smith, Johan; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Epidemiology and Biostatistics.
    ENGLISH SUMMARY : Background: In many parts of the world, including African countries, apparently healthy newborns are usually discharged home early. Serum bilirubin levels usually peaks on postnatal days 3 to 5, by when many newborns have already been discharged home. Severe neonatal hyperbilirubinemia constitutes an important cause of neonatal mortality and morbidity in Africa. There is a need for ways of identifying newborns at risk of severe jaundice before hospital discharge especially in developing countries with poor health systems and inadequate follow-up procedures after discharge from hospital. Objectives: The objective of this combination of studies is to provide evidence for the use of transcutaneous bilirubin (TcB) screening in a population of indigenous African newborns. Methods: We summarized the available evidence on the accuracy and effectiveness of TcB screening in two Cochrane systematic reviews. In the first systematic review, we summarized the evidence on the effectiveness of TcB screening in newborns. The second review summarized the evidence on the accuracy of TcB measurement compared to total serum bilirubin (TsB) measurement. We also conducted research on the effects of TcB screening and on the accuracy of the TcB measurement in a population of South African newborns. Results: For our first systematic review, we did not identify any randomized controlled trial that assessed the effect of TcB screening on readmission for jaundice or on the incidence of severe hyperbilirubinemia in newborns. Findings from included observational studies from North America suggest that universal pre-discharge TcB screening in newborns reduces readmission for hyperbilirubinemia and also reduces the incidence of severe hyperbilirubinemia. We conducted a randomized controlled trial of TcB screening in an indigenous population of African newborns from South Africa. Findings from our trial confirmed that TcB screening reliably identified newborns at risk of severe hyperbilirubinemia and led to a 75% reduction in the readmission rate for hyperbilirubinemia and up to 73% decrease in the incidence of severe hyperbilirubinemia. However, the effect of TcB screening on kernicterus and bilirubin induced neurology dysfunction is not known. Findings from our second systematic review of accuracy of TcB measurement compared to TsB measurement in the laboratory, suggest a significant correlation coefficient of up to 0.98 between these two measurements. However, there are mixed findings from the included studies on the effect of various factors including: gestational age, race, postnatal age, TsB concentration, on the correlation. Also, there are limited studies in indigenous African newborns. Our cross-sectional study on the accuracy of the TcB measurement in a population of South African newborns showed a good correlation between TcB measurement and TsB measured in the laboratory. Conclusion: The TcB tool can be used to reliably estimate TsB in African newborns and can help identify newborns who need phototherapy before hospital discharge. We recommend that every newborn should be assessed for hyperbilirubinemia using objective means of measuring or estimating serum bilirubin measurement such as the TcB or TsB before discharge from hospital. This could go a long way in reducing hyperbilirubinemia related readmissions and incidence of severe hyperbilirubinemia. Pre-discharge TcB screening in newborns can therefore be used to identify newborns in need of phototherapy or those who are at risk of readmission for hyperbilirubinemia after discharge.