Author's response to reviews

Transcription

1 Author's response to reviews Title: Neonatal jaundice and its management: knowledge, attitude and practice of community health workers in Nigeria Authors: Olusoga B. Ogunfowora Olusoji J. Daniel Version: 5 Date: 18 November 2005 see over Author's response to reviews:

2 DR. O. B. OGUNFOWORA, Department of Paediatrics, Olabisi Onabanjo University, P.M.B. 2022, Sagamu. Nigeria. August 27, 2005 The Editor-in-Chief, BMC Public Health, Dear Sir, SUBMISSION OF REVISED MANUSCRIPT MS: We hereby submit our manuscript entitled Neonatal jaundice and its management: knowledge, attitude and practice of community health workers in Nigeria. The article has been carefully revised in the light of comments made and issues raised by the reviewers. Reviewer #1 (Dr. Davenport) GENERAL COMMENTS: 1. The title should reflect who the health workers were. Done. We have replaced primary health care workers with community health workers in Nigeria. MINOR ESSENTIAL REVISIONS: 2. Abbreviations should be spelled out in tables or as legend to them (CHEW, SCHEW). These abbreviations have been spelled out as a footnote to table 1 page Discussion on relatively newer forms of pharmacological treatment of jaundice in the primary care setting in Nigeria is inappropriate. We have deleted this segment of the discussion.

3 Reviewer #2 (Dr. Tiribelli) MAJOR COMPULSORY REVISIONS: 1. The authors refer to neonatal jaundice and state that this is possibly related to unconjugated bilirubin. Neonatal jaundice is ALWAYS due to unconjugated moiety of the pigment. We have revised the sentence to read Jaundice due to unconjugated hyperbilirubinemia is also the most common clinical problem in the neonatal period in many parts of the world [2,5-8]. 2. The percentage of the responders and how potential selection bias was removed need to be indicated better. The percentage of responders has now been included under Results thus: Sixty-six (93%) of 71 health workers in the six randomlyselected community health facilities agreed to participate in the survey. The 5 others withheld their consent for undisclosed reasons. We have also mentioned under Methods that the health centres were randomly selected and Medical doctors were excluded from the survey. 3. Different types of treatment were used to reduce the jaundice. Any report on the effectiveness of the different treatment? This may be useful in prospective studies and needs to be reported. We have no report on this as our study was questionnaire-based. Reviewer #3 (Dr.Kaplan): MAJOR REVISION 1. How do the authors themselves define neonatal jaundice? We have included the correct definition of neonatal jaundice in the Results segment as yellowish discolouration of the eyes and skin of a baby in the first month (or twenty-eight days) of life due to bilirubin accumulation. 2. Neonatal jaundice is not necessarily synonymous with hyperbilirubinemia. Are the two concepts differentiated in the questionnaire? We did not differentiate these two concepts in the questionnaire. The reason is that the study population consists mainly of rural 2

4 health workers who are not trained to carry out blood investigations with regard to jaundice and as such are not expected to know the subject in such fine detail. The language of the questionnaire was deliberately made simple for the same reason. 3. G-6-PD Deficiency is very common in Nigeria and a major cause of kernicterus and death (Slusher et al, J Pediatr, 1995). It is therefore surprising that this entity was not mentioned in the paper. This comment has been addressed on page 9 of the manuscript thus: In Nigeria, the leading causes of significant jaundice among neonates include ABO blood group incompatibility, prematurity, sepsis and glucose-6-phosphate dehydrogenase deficiency [10, 11]. It was rather surprising that less than half of the participants identified all three of these conditions in the questionnaire. Glucose-6-phosphate dehydrogenase was deliberately left out of the questionnaire on the grounds of being too technical for community health workers to understand. 4. Some of the questions may have been inappropriate. For example, clofibrate is not used widely and very little has been published on the subject. There was no question on clofibrate in the questionnaire. The comment that we made on clofibrate under Discussion has been deleted. 5. In order to make the paper comprehensible to reviewers and readers, it is essential to supply the questions asked and the correct answers. We have now provided the questionnaire as an additional file to the manuscript. Correct answers to the questions have been mentioned under Results. For example, Question 6 tested the ability of the health workers to recognize signs of danger or complications in NNJ and only 30 (45.5%) were able to choose the six correct answers which were: refusal of feed, high-pitched cry, arching of the back, convulsions, down-turning of the eyes and fever. DISCRERIONARY REVISION: Having determined that there is a lack of knowledge among health workers, it would be interesting to know what the authors plan is to correct the situation. We plan to write a proposal based on our research findings to the relevant authorities within the Sagamu Local Government Council 3

5 and the other Local Government Councils in Ogun State for the organization of training workshops for community health workers on the subject of neonatal jaundice. We hope you find the article suitable for publication in your esteemed journal. Thank you. Yours faithfully, Olusoga B. Ogunfowora, FWACP. 4