Limited research about nursing mentorship in low- and middle-income countries (LMICs) is holding science back. This article describes the strengths and challenges associated with global health research mentorship for doctorally prepared nurses whose scholarship focuses on LMICs. Using reflexive narrative accounts from current and former nurse mentors and nurse mentees who participated in a NIH-funded global health doctoral research program, emerging themes revealed the perspectives of mentors and mentees, producing a global health mentoring model for nursing research mentorship relevant to LMICs. Identified themes, which applied across roles and primary affiliations, included 1) collaborative mentor–mentee relationships and 2) enthusiasm for global health nursing. Our global health nursing research mentor–mentee interaction systems conceptual model focuses on nursing science mentoring in LMICs incorporating interpersonal, institutional, and cultural factors. We describe successful components of global nurse researcher mentorship and summarize directions for future research in the field. Our model can be used to create more effective mentee-centered mentoring for nurses or health professionals conducting global research. To advance science, we encourage doctorally prepared nurses to support mentee-centered research mentorship experiences that are sensitive to the unique needs of interdisciplinary global health scholarship.

Background: Neonatal jaundice (NNJ) remains a leading cause of newborn mortality in much of sub-Saharan Africa. We sought to examine the validity of using a hand-held icterometer as a screening tool to determine which newborns need further assessment. Additionally, we sought to assess the feasibility of its use among mothers. Methods: We recruited and trained healthcare workers at one large district hospital in Ghana to use a hand-held icterometer known as the Bili-Ruler^TM. We recruited mothers of 341 newborns aged 0 to 2 weeks at the same hospital. Mothers watched a standardized training video, after which they blanched the skin of the newborn’s nose and compared it with the yellow shades numbered one to six on the icterometer. Each newborn was also assessed with a transcutaneous bilirubin meter (TCB). Research assistants and health care workers screened the same newborns, recorded their scores separately, and were blinded to each other’s readings. In the second phase of this study, we recruited 100 new mothers to take the Bili-Ruler home with them, instructing them to check their newborns twice daily. We interviewed them 1–2 weeks later to determine the acceptability and feasibility of its use. Results: Out of 341 newborns screened, 20 had elevated TCB indicative of hyperbilirubinemia. Healthcare workers’ Bili-Ruler ratings had a strong and significant correlation with TCB scores, as did the ratings of researchers and mothers. When comparing Bili-Ruler scores against TCB, sensitivity across all three raters was 80% (95% CI 75.6–84.3), specificity ranged from 61.1% (healthcare providers) to 66.7% (researchers), positive predictive value ranged from 11.4% (healthcare providers) to 13.0% (researchers), and negative predictive value was 98.0% or higher across all raters. Area under the ROC curve ranged from 0.71 for healthcare providers to 0.73 for researchers. Mothers AUC was 0.72. In terms of acceptability and feasibility, the Bili-Ruler was widely accepted by the mothers and family. In total, 98% of mothers reported using it, and 90.8% used it 3 or more days in the first week after birth. Moreover, 89.8% used it more than twice per day. Conclusions: A hand-held, low-tech icterometer is an important potential mechanism for improving early jaundice identification in low-resource settings. Further studies using larger sample sizes with a higher prevalence of hyperbilirubinemia are warranted.

Neonatal jaundice (NNJ) is a leading cause of death in the early neonatal period, disproportionately affecting newborns in sub-Saharan Africa. In a setting without access to rapid assessment via transcutaneous bilirubin meter, we sought to determine how closely the diagnosis and treatment of neonatal jaundice at an urban district hospital aligned with retrospective assessment and treatment recommendations using the BiliApp (based on the UK NICE Guideline CG98). This retrospective chart review study aimed to identify: (1) What percent of admissions within 8 days of birth to the Mother and Baby Unit (MBU) at our study site were admitted for a primary diagnosis of neonatal jaundice, and what characterized those admissions? (2) How did treatment provided compare to the recommendations of the United Kingdom NICE Guideline CG98 via the “BiliApp”? and (3) Among those with jaundice, what factors were associated with an increased likelihood of severity indicative of the need for blood exchange therapy? The charts of all neonates admitted to the MBU at Suntreso Government Hospital (SGH), in Kumasi, Ghana, in 2020 were reviewed by trained research assistants. Data were collected regarding demographics, reason for admission, diagnostic markers (e.g., serum bilirubin level), treatments performed in the hospital, and outcome. Data were analyzed using Stata 18.0. There were 1059 newborns admitted to the MBU in 2020 at less than 8 days of age. A total of 179 (16.9%) were admitted with a primary diagnosis of neonatal jaundice. According to the BiliApp, 29.4% (n = 50) of newborns admitted for jaundice had bilirubin levels that were normal or below the phototherapy threshold for their gestational age on admission; 25.3% (n = 43) were at or near the threshold for phototherapy; 21.2% (n = 36) were above the phototherapy threshold; and 24.1% (n = 41) were above the blood exchange therapy threshold. The BiliApp recommended no treatment for 21.2% (n = 36) of newborns, repeated assessment for 33.6% (n = 57), phototherapy for 21.2% (n = 36), and exchange therapy for 24.1% (n = 41). By comparison, 8.2% (n = 14) of neonates admitted for jaundice received no treatment, 77.8% (n = 133) received phototherapy only, and 14.0% (n = 24) received both phototherapy and exchange therapy. Without sufficient data on G6PD status and parent/newborn blood type to include in the analysis, the biggest risk factors for a BiliApp recommendation of exchange therapy included serum bilirubin level (OR 1.01, p < 0.001) and gestational age (OR 0.51, p < 0.001), even after controlling for breastfeeding and male sex of the newborn. Without access to rapid assessment tools, many providers in low-resource settings are put in a position to presumptively treat newborns suspected of having jaundice, rather than waiting for serum lab tests to return. Given the cost of transcutaneous bilirubin meters, additional options for rapid diagnostic testing are warranted.

Background: Respiratory distress is a leading cause of preterm infant mortality in sub-Saharan Africa. Bubble continuous positive airway pressure (CPAP) is emerging as a potentially safe, cost-effective way of delivering noninvasive respiratory support in low-income and middle-income countries. However, without healthcare providers who are knowledgeable and skilled in the use of this technology, suboptimal neonatal care and related health disparities are likely to persist. Objective: We hypothesized that an Internet-based, blended curriculum on bubble CPAP for bedside providers in low-resource mother-baby units (MBUs) could be developed and implemented and lead to improvements in clinical knowledge, reasoning, and learner confidence in bubble CPAP. Methods: Clinical educators from Israel, Ghana, and the United States used the analysis, design, development, implementation, and evaluation (ADDIE) design framework to create an online curriculum for two MBUs in Kumasi, in the Ashanti Region of Ghana. Participants completed pre and post curriculum knowledge tests and completed surveys on their perspectives. Results: Fifty-four interdisciplinary health professionals from the MBUs participated in the curriculum. Median knowledge test scores improved from 64% (interquartile range [IQR] = 50–72%) to 81% (IQR = 71–89%) after participation in the curriculum (P < 0.001). Learners reported high levels of confidence with bubble CPAP after participating in the curriculum and evaluated the curricular components highly. Conclusion: An online curriculum was successfully implemented and led to changes in healthcare worker knowledge in bubble CPAP. This may be an effective way to deliver education to healthcare professionals in resource-constrained countries and warrants further study.

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