Neonatal jaundice detection in low-income Mexican settings: is there scope for mHealth innovation?

Abstract

Abstract Introduction Neonatal jaundice (NNJ) is a common and usually harmless condition, but undetected severe cases can cause brain damage and disabilities in thousands of babies each year. Low- and middle-income countries often lack accurate methods for detection and rely primarily on visual assessment (VA), resulting in a higher incidence of consequences. Norwegian researchers developed an easy-to-use and affordable smartphone app (Picterus) to detect NNJ that has shown higher accuracy than VA in Norwegian and Mexican neonates. We evaluated the feasibility of implementing Picterus in low-income settings in Mexico to improve outcomes for affected newborns. Methods Qualitative methods, including 1 focus group, 15 semi structured interviews, and 4 observations, were used in urban and rural health facilities in Oaxaca, Mexico, with medical doctors, nurses, and health authorities as participants. Results Four themes were identified through thematic analysis guided by the Consolidated Framework for Implementation Research: (1) the current process to detect NNJ, (2) participants’ needs to improve it, (3) feasibility of implementing Picterus in the health system, and (4) users’ expectations from the app. The findings indicate deficiencies in the current process of NNJ detection and a desire among participants for a more accurate tool. Picterus was perceived as an easy-to-use and useful tool compatible with the work routine; however, barriers to adoption were identified, primarily related to internet deficiencies and costs. Conclusions Picterus has the potential to improve NNJ detection but contextual barriers must be addressed for a successful implementation in the setting. Additionally, there is scope to optimize VA to strengthen NNJ detection. Key messages • Prevalence of severe consequences of NNJ is higher in LMIC compared to high-income ones reflecting an unjust but preventable health inequity with significant health, social and economic costs. • Picterus offers a reliable and accessible tool to bridge the gap in NNJ detection, potentially improving outcomes for affected newborns in all settings.