Volume-1
Issue-1
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Prescription Analysis And Prevalence Of Potentially Inappropriate Medication Use In Older Adults; An Observational Study
Objectives: The objectives of the present study were to determine prevalence of potentially inappropriate medications and Adverse Drug Reactions in older adults and to collect doctors‟ responses regarding the PIM list or any other criteria to treat older adults in India. Method: This was an observational study conducted in different tertiary care hospitals of two districts, Erode and Salem after obtaining approval of the Institutional Ethics Committee. A sample of 250 older adults (60 years and above) and 97 doctors were included during the study period of 6 months from February 2019 to July 2019. Inappropriate medications were identified by using 2019 updated Beer‟s criteria. The causality of the adverse events was assessed by Naranjo Adverse Drug Reaction Probability Scale. Results: Out of the 250 prescriptions, only 86(34.4%) of the prescriptions were appropriate and 164(65.6%) were inappropriate. The most commonly inappropriate prescribed medications were diuretics, ranitidine and tramadol.A total of 74 ADRs was observed in 74 patients. Of these, 57(22.8%) ADRs were due to inappropriate medications listed in Beers criteria. There was a significant association between the occurrence of ADRs and the use of PIMs listed in 2019 updated Beer‟s criteria [χ2 = 6.08, P = 0.013 (df = 1)]. Conclusion: The study shows that there is a high prevalence of inappropriate medications and adverse drug reactions in the hospitalized older adults. Beer‟s criteria can be used as a guideline by the physicians while prescribing the drugs to the geriatric population.
Prescription Analysis And Prevalence Of Potentially Inappropriate Medication Use In Older Adults; An Observational Study
Dr. N. Senthil Kumar; Ms. Geena. K. Reji; Ms. Reema. K. A; Mr. Vijayarangan. S; Ms. Ramya. A
DOI : 10.5281/zenodo.7694301
Objectives: The objectives of the present study were to determine prevalence of potentially inappropriate medications and Adverse Drug Reactions in older adults and to collect doctors‟ responses regarding the PIM list or any other criteria to treat older adults in India. Method: This was an observational study conducted in different tertiary care hospitals of two districts, Erode and Salem after obtaining approval of the Institutional Ethics Committee. A sample of 250 older adults (60 years and above) and 97 doctors were included during the study period of 6 months from February 2019 to July 2019. Inappropriate medications were identified by using 2019 updated Beer‟s criteria. The causality of the adverse events was assessed by Naranjo Adverse Drug Reaction Probability Scale. Results: Out of the 250 prescriptions, only 86(34.4%) of the prescriptions were appropriate and 164(65.6%) were inappropriate. The most commonly inappropriate prescribed medications were diuretics, ranitidine and tramadol.A total of 74 ADRs was observed in 74 patients. Of these, 57(22.8%) ADRs were due to inappropriate medications listed in Beers criteria. There was a significant association between the occurrence of ADRs and the use of PIMs listed in 2019 updated Beer‟s criteria [χ2 = 6.08, P = 0.013 (df = 1)]. Conclusion: The study shows that there is a high prevalence of inappropriate medications and adverse drug reactions in the hospitalized older adults. Beer‟s criteria can be used as a guideline by the physicians while prescribing the drugs to the geriatric population.
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Situational Analysis: Gerontechnology and Older Persons Wellbeing in developing countries
The world is ageing increasingly, and developing countries are facing unprecedented growth. With the concurrent rapid growth in emerging digital technology, it provides a flourishing platform for Gerontechnology. The utilizationof technology for healthcare realignment is part of the solution under Global Strategy on Ageing and Health to support healthy ageing. Substantial evidence from developed countries has shown positive effects of various gerontechnologies on the wellbeing of the older persons. However, little is known in developing countries.Materials and methods:The importance gained fromthe interaction between ICTs and older adults observed in studies, takes us a further stepto review the pieces of literature to explore the acceptance and the impact of gerontechnology on the wellbeing among older persons. This rapid review was driven by the five phases of the Evidence-informed Decision-making (EIDM) methods and eleven papers were included for final extraction of the data.Result: Results showed that acceptance is low in countries like South Africa but high in Malaysia, where the accessibility is high. The popular devices are mobile phones, smartphones and computers. Case study revealed 35.5% of the participants who owned ICT devices are having chronic illness, andthis sheds lights on the high accessibility of the device among the older persons who have co-morbidity.Discussion: Building on this report and scarcity of quality research in this field, especially in the developing, confer the need for a larger future studies with a robust methodology. Conclusion: Another aspect is to give full support to efforts to make gerontechnology accessible to older Indian or Malaysian and within reach. The government will set in effect strategies to allow older citizens to utilize technology, and promote a positive climate that will make them utilize gerontechnology.
Situational Analysis: Gerontechnology and Older Persons Wellbeing in developing countries
Abhishek Shivanand Lachyan, Wong Ming Fui, Bratati Banerjee, Rafdzah Ahmad Zaki
DOI : 10.5281/zenodo.7694307
The world is ageing increasingly, and developing countries are facing unprecedented growth. With the concurrent rapid growth in emerging digital technology, it provides a flourishing platform for Gerontechnology. The utilizationof technology for healthcare realignment is part of the solution under Global Strategy on Ageing and Health to support healthy ageing. Substantial evidence from developed countries has shown positive effects of various gerontechnologies on the wellbeing of the older persons. However, little is known in developing countries.Materials and methods:The importance gained fromthe interaction between ICTs and older adults observed in studies, takes us a further stepto review the pieces of literature to explore the acceptance and the impact of gerontechnology on the wellbeing among older persons. This rapid review was driven by the five phases of the Evidence-informed Decision-making (EIDM) methods and eleven papers were included for final extraction of the data.Result: Results showed that acceptance is low in countries like South Africa but high in Malaysia, where the accessibility is high. The popular devices are mobile phones, smartphones and computers. Case study revealed 35.5% of the participants who owned ICT devices are having chronic illness, andthis sheds lights on the high accessibility of the device among the older persons who have co-morbidity.Discussion: Building on this report and scarcity of quality research in this field, especially in the developing, confer the need for a larger future studies with a robust methodology. Conclusion: Another aspect is to give full support to efforts to make gerontechnology accessible to older Indian or Malaysian and within reach. The government will set in effect strategies to allow older citizens to utilize technology, and promote a positive climate that will make them utilize gerontechnology.
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EFFECTS OF SUBSTITUTING MAIZE FOR YELLOW COCOYAM (XANTHOSOMA SAGITTIFOLIUM) AS ENERY SOURCE FOR WEANER PIGS
The research was conducted to investigate the dietary effect of substituting maize for cocoyam (Xanthosoma Sagittifolium) as energy source for weaner pigs. The experiment was conducted at the Swine unit of the Teaching and Research Farm, University of Uyo, Uyo, Akwa Ibom State. The cocoyam was collected and processed by sundring to form a cocoyam corm meal (CCM).A total of 16 weaner pigs of large white were used for the study. The pigs were divided into 4 groups based on average initial weights (20-25kg) and each group of weaner pigs were respectively allocated to each of the four treatment diets using a completely randomized design (CRD). Each treatment group contained 2 replicates of 4pigs, 2male and 2female). These pigs were fed twice daily and water supplied ad-libitium. Four diets were formulated to contain 0%, 20%, 40% and 60% of CCM. Data were collected on growth performance and blood profile. Result revealed that there was significant (P>0.05) differences on all the growth performance parameters measured. No significant differences (P>0.05) were observed on all blood profile parameters measured except the albumin and creatinine. The albumin and creatinine values ranged from 2.63-3.52 g/dl and 0.90- 1.50mg/dl respectively. It can be concluded that weaner pigs fed 20% CCM based diet yielded best results in terms of performance and there was no detrimental effect on their blood profile. Implications and recommendations were made from the findings of the study.
EFFECTS OF SUBSTITUTING MAIZE FOR YELLOW COCOYAM (XANTHOSOMA SAGITTIFOLIUM) AS ENERY SOURCE FOR WEANER PIGS
R. P. Obongekpe
DOI : 10.5281/zenodo.7694337
The research was conducted to investigate the dietary effect of substituting maize for cocoyam (Xanthosoma Sagittifolium) as energy source for weaner pigs. The experiment was conducted at the Swine unit of the Teaching and Research Farm, University of Uyo, Uyo, Akwa Ibom State. The cocoyam was collected and processed by sundring to form a cocoyam corm meal (CCM).A total of 16 weaner pigs of large white were used for the study. The pigs were divided into 4 groups based on average initial weights (20-25kg) and each group of weaner pigs were respectively allocated to each of the four treatment diets using a completely randomized design (CRD). Each treatment group contained 2 replicates of 4pigs, 2male and 2female). These pigs were fed twice daily and water supplied ad-libitium. Four diets were formulated to contain 0%, 20%, 40% and 60% of CCM. Data were collected on growth performance and blood profile. Result revealed that there was significant (P>0.05) differences on all the growth performance parameters measured. No significant differences (P>0.05) were observed on all blood profile parameters measured except the albumin and creatinine. The albumin and creatinine values ranged from 2.63-3.52 g/dl and 0.90- 1.50mg/dl respectively. It can be concluded that weaner pigs fed 20% CCM based diet yielded best results in terms of performance and there was no detrimental effect on their blood profile. Implications and recommendations were made from the findings of the study.
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This study was conducted to evaluate the effect of apical dominance and fertilizer application on the yield and quality of Pectomech, a variant of tomato
Undoubtedly Ghanaians consume high amounts of tomatoes, thus the need to find sustainable ways of cultivating this vegetable to meet these high demands. This study was conducted to evaluate the effect of apical dominance and fertilizer application on the yield and quality of Pectomech, a variant of tomato. A field experiment was conducted in the Department of Theoretical and Applied Biology Experimental Gardens (KNUST). The experiment was carried out with a completely randomized block design with three replications for each of the four treatments. Only one variant of tomato was subjected fertilizer application, apical dominance, a combination of the two and a control. From results obtained from inducing apical dominance by pruning; the tomato plant doesn’t show strong apical dominance, thus shows more branching and bushy growth. The main aim of pruning is to maximize fruit yield. Also, careful pruning balances shoot growth and fruit production. The mean heights taken from all replications of each treatments was the major source of data used in this study. The average initial heights for both treated and control plants after 28 days of transplanting ranged from 43.6cm to 45.3cm. The mean heights for control tomato plants remained fairly stable (46.6cm) even at the third week of data collection. Tomato plants subjected to fertilizer application only attained a mean height of 48.3cm during this same time period. The difference in height between apical dominance plants (51.3cm) and apical dominance plus fertilizer application plants (51cm) during the third week was not appreciable with a narrow margin of 0.3cm favoring plants subjected to apical dominance only. Generally, plants treated with only fertilizer yielded but not as compared to plants subjected to both apical dominance plus fertilizer application. Furthermore, plants treated with only apical dominance equally gave good yields.
This study was conducted to evaluate the effect of apical dominance and fertilizer application on the yield and quality of Pectomech, a variant of tomato
Ampomah Yeboah Edward; Ansong Wisdom; Annor-Yeboah Samuel; Berko Jacqueline Agyapomaa; Harpreet Kaur
DOI : 10.5281/zenodo.7694355
Undoubtedly Ghanaians consume high amounts of tomatoes, thus the need to find sustainable ways of cultivating this vegetable to meet these high demands. This study was conducted to evaluate the effect of apical dominance and fertilizer application on the yield and quality of Pectomech, a variant of tomato. A field experiment was conducted in the Department of Theoretical and Applied Biology Experimental Gardens (KNUST). The experiment was carried out with a completely randomized block design with three replications for each of the four treatments. Only one variant of tomato was subjected fertilizer application, apical dominance, a combination of the two and a control. From results obtained from inducing apical dominance by pruning; the tomato plant doesn’t show strong apical dominance, thus shows more branching and bushy growth. The main aim of pruning is to maximize fruit yield. Also, careful pruning balances shoot growth and fruit production. The mean heights taken from all replications of each treatments was the major source of data used in this study. The average initial heights for both treated and control plants after 28 days of transplanting ranged from 43.6cm to 45.3cm. The mean heights for control tomato plants remained fairly stable (46.6cm) even at the third week of data collection. Tomato plants subjected to fertilizer application only attained a mean height of 48.3cm during this same time period. The difference in height between apical dominance plants (51.3cm) and apical dominance plus fertilizer application plants (51cm) during the third week was not appreciable with a narrow margin of 0.3cm favoring plants subjected to apical dominance only. Generally, plants treated with only fertilizer yielded but not as compared to plants subjected to both apical dominance plus fertilizer application. Furthermore, plants treated with only apical dominance equally gave good yields.
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Influence of Defensive Pessimism and Assertiveness on Civic EngagementAmong Rural Dwellers in Akwa Ibom State
The study investigated the influence of Defensive Pessimism and Assertiveness on Civic Engagement among rural dwellers in AkwaIbom State. Four hundred and thirty two (432) participants were randomly selected from five local government in AkwaIbom State(Abak, Itu, OrukAnam, IkotEKpene and Oron local government areas)consisting of 217males and 215females. Their age range range were from 18- 65 and their mean age was 41.5. A 2x2 factorial design was adopted for the study. Three instruments were used in the study: Defensive Pessimism Questionnaire (DPQ) developed by Norem and Canton (1986), Rathus Assertiveness Schedule developed by Spencer Rathus (1973) and Civic Engagement Scale (CES) developed by Doolittle and Faul (2013). A two way Analyses of Variance (ANOVA) was used to analyse the data. The result showed that there is no significant influence of defensive pessimism on civic engagement among rural dwellers. The result also revealed that there is a significant influence of assertiveness on civic engagement among rural dwellers [F(1, 428)= 7.00, p< .05]. The result also revealed that there is no interaction influence between defensive pessimism and assertiveness on civic engagement among rural dwellers. It was therefore concluded that assertiveness is a predictor of civic engagement among rural dwellers. Implications and recommendations for future study were made.
Influence of Defensive Pessimism and Assertiveness on Civic EngagementAmong Rural Dwellers in Akwa Ibom State
U. S. Isaiah
DOI : 10.5281/zenodo.7694326
The study investigated the influence of Defensive Pessimism and Assertiveness on Civic Engagement among rural dwellers in AkwaIbom State. Four hundred and thirty two (432) participants were randomly selected from five local government in AkwaIbom State(Abak, Itu, OrukAnam, IkotEKpene and Oron local government areas)consisting of 217males and 215females. Their age range range were from 18- 65 and their mean age was 41.5. A 2x2 factorial design was adopted for the study. Three instruments were used in the study: Defensive Pessimism Questionnaire (DPQ) developed by Norem and Canton (1986), Rathus Assertiveness Schedule developed by Spencer Rathus (1973) and Civic Engagement Scale (CES) developed by Doolittle and Faul (2013). A two way Analyses of Variance (ANOVA) was used to analyse the data. The result showed that there is no significant influence of defensive pessimism on civic engagement among rural dwellers. The result also revealed that there is a significant influence of assertiveness on civic engagement among rural dwellers [F(1, 428)= 7.00, p< .05]. The result also revealed that there is no interaction influence between defensive pessimism and assertiveness on civic engagement among rural dwellers. It was therefore concluded that assertiveness is a predictor of civic engagement among rural dwellers. Implications and recommendations for future study were made.
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Evaluation Of The Nutritive Value Of Pinapple Wastes And Malted SorphumSprouts Based Diet On Pigs
The study was conducted to evaluate the nutritive value of Pineapple waste and malted sorghum sprout (PWMSM or MSPW) based diet on pigs. The experiment was conducted at the Swine unit of the Teaching and Research Farm, University of Uyo, Uyo, AkwaIbom State. The malted sorghum sprout and pineapple waste was at ratio 1:2 (weight/weight) respectively. A total of 40 grower pigs of large white were used for the study. The pigs were divided into 4 groups based on average initial weights (20-25kg) and each group of grower pigs were respectively allocated to each of the four treatment diets using a completely randomized design (CRD). Each treatment group contained 2 replicates of 10 pigs 5male and 5female). These pigs were fed twice daily and water supplied ad-libitium. Four diets were formulated to contain 0%, 20%, 40% and 60% of MSPW. Data were collected on growth performance and blood profile. Result revealed that there was no significant (P>0.05) differences on all the growth performance parameters measured. The highest value of average daily weight gain (19.21 g/day) was observed in pigs fed 20% MSPW while the lowest value was obtained in pigs fed 40% MSPW pigs placed on 20% MSPW had the best feed conversion ratio value . (17.15). No significant differences (P>0.05) were observed on all blood profile parameters measured except the albumin and creatinine. The albumin and creatinine values ranged from 2.63-3.52 g/dl and 0.90- 1.50mg/dl respectively. It can be concluded that grower pigs fed 20% MSPW based diet yielded best results in terms of performance and there was no detrimental effect on their blood profile. Implications and recommendations were made from the findings of the study
Evaluation Of The Nutritive Value Of Pinapple Wastes And Malted SorphumSprouts Based Diet On Pigs
R. P. Obongekpe
DOI : 10.5281/zenodo.7694351
The study was conducted to evaluate the nutritive value of Pineapple waste and malted sorghum sprout (PWMSM or MSPW) based diet on pigs. The experiment was conducted at the Swine unit of the Teaching and Research Farm, University of Uyo, Uyo, AkwaIbom State. The malted sorghum sprout and pineapple waste was at ratio 1:2 (weight/weight) respectively. A total of 40 grower pigs of large white were used for the study. The pigs were divided into 4 groups based on average initial weights (20-25kg) and each group of grower pigs were respectively allocated to each of the four treatment diets using a completely randomized design (CRD). Each treatment group contained 2 replicates of 10 pigs 5male and 5female). These pigs were fed twice daily and water supplied ad-libitium. Four diets were formulated to contain 0%, 20%, 40% and 60% of MSPW. Data were collected on growth performance and blood profile. Result revealed that there was no significant (P>0.05) differences on all the growth performance parameters measured. The highest value of average daily weight gain (19.21 g/day) was observed in pigs fed 20% MSPW while the lowest value was obtained in pigs fed 40% MSPW pigs placed on 20% MSPW had the best feed conversion ratio value . (17.15). No significant differences (P>0.05) were observed on all blood profile parameters measured except the albumin and creatinine. The albumin and creatinine values ranged from 2.63-3.52 g/dl and 0.90- 1.50mg/dl respectively. It can be concluded that grower pigs fed 20% MSPW based diet yielded best results in terms of performance and there was no detrimental effect on their blood profile. Implications and recommendations were made from the findings of the study
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Growth Performance And Economic Impact Of Broilerchicken Fed Concentrates Supplemented With Processed Cocoa Pod Waste
The study was conducted to examine the performance growth and economic impacts of broiler chicken fed concentrates supplemented with processed cocoa pod waste. The experiment was conducted at the Teaching and Research Farm, University of Uyo, Uyo, Akwa Ibom State. Cocoa pod waste or husk was collected and processed by ash treatment to form a processed cocoa pod husk meal (PCHM). Three experimental diets were formulated at both the starter and finisher phases, in which PCHM was included at 0, 5 and 10% and designated as diets 1, 2 and 3, respectively. One hundred and eighty 1-day-old Arbor Acres broiler chicks were randomly distributed to three dietary treatments (10 birds/replicate; 60 birds/treatment) in a completely randomized design. The growth performance, carcass, relative internal organ weights and haemato biochemical indices were determined. Histological examination of the liver and heart samples was also determined. Results: The PCHM inclusion did affect (P < 0.05) the performance characteristics of the broiler chicks and also for the feed intake that significantly (P < 0.05) increased in birds fed 8% of PCHM-inclusive diet at the starter phase. The carcass traits, relative internal organ weights, haematological indices and serum biochemical indices of the broiler chickens were similar (P > 0.05) across the dietary treatments. The serum glutathione peroxidase and catalase concentration were higher (P < 0.05) in birds fed PCHM-inclusive diets compared to those fed the control diet. Implications and recommendations were made from the findings of the study.
Growth Performance And Economic Impact Of Broilerchicken Fed Concentrates Supplemented With Processed Cocoa Pod Waste
R. P. Obongekpe
DOI : 10.5281/zenodo.7694343
The study was conducted to examine the performance growth and economic impacts of broiler chicken fed concentrates supplemented with processed cocoa pod waste. The experiment was conducted at the Teaching and Research Farm, University of Uyo, Uyo, Akwa Ibom State. Cocoa pod waste or husk was collected and processed by ash treatment to form a processed cocoa pod husk meal (PCHM). Three experimental diets were formulated at both the starter and finisher phases, in which PCHM was included at 0, 5 and 10% and designated as diets 1, 2 and 3, respectively. One hundred and eighty 1-day-old Arbor Acres broiler chicks were randomly distributed to three dietary treatments (10 birds/replicate; 60 birds/treatment) in a completely randomized design. The growth performance, carcass, relative internal organ weights and haemato biochemical indices were determined. Histological examination of the liver and heart samples was also determined. Results: The PCHM inclusion did affect (P < 0.05) the performance characteristics of the broiler chicks and also for the feed intake that significantly (P < 0.05) increased in birds fed 8% of PCHM-inclusive diet at the starter phase. The carcass traits, relative internal organ weights, haematological indices and serum biochemical indices of the broiler chickens were similar (P > 0.05) across the dietary treatments. The serum glutathione peroxidase and catalase concentration were higher (P < 0.05) in birds fed PCHM-inclusive diets compared to those fed the control diet. Implications and recommendations were made from the findings of the study.
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Clinical Profile and Etiological Factors of Neonatal Jaundice from A Rural Area of Bangladesh
Background: Neonatal jaundice, characterized by the yellowing of a newborn's skin and eyes due to elevated bilirubin levels, is a common condition affecting infants worldwide. Understanding the clinical profile and etiological factors associated with neonatal jaundice is essential for effective management and prevention strategies. Neonatal jaundice is a common cause of newborn hospital admission. The risk factors, characteristics and outcomes related to neonatal jaundice in Bangladesh has have been studied so far. Aim of the study: The study aimed to study the clinical profile and underlying etiological factors leading to neonatal jaundice in this rural Bangladesh. Methods: This prospective observational study was conducted in the neonatology ward at Khulna Medical College and Hospital, Khulna, Bangladesh. The study was conducted from January 2020 to December 2020. A total of 98 neonates were admitted to our post-natal ward during the specified period. Result: A total of 98 participants were enrolled and analyzed. The gestational age distribution revealed that 88.78% of the study population was aged more than 37 weeks, 8.16% were in the 34-36-week range and 3.06% were in the 30-34-week range. Among the babies, 63% were male, and 37% were female. The distribution of birth weights showed that 3.06% weighed 1000-1500g, 5.10% weighed 1501-2000g, 8.16% weighed 2001-2500g, 58.16% weighed 2501-3000g, and 25.51% weighed more than 3000g. The etiology of neonatal jaundice in the study revealed that 43.88% had physiological jaundice, 24.49% had ABO incompatibility, and 8.16% had Rh incompatibility or idiopathy. Conclusion: This study concludes that physiological jaundice is our hospital's most common cause of neonatal jaundice. This is followed by ABO incompatibility, sepsis, Rh incompatibility and idiopathic cases.
Clinical Profile and Etiological Factors of Neonatal Jaundice from A Rural Area of Bangladesh
Dr. Nityananda Baruri; Dr. Goutam Kumar Lasker; Dr. Manoj Kumar Malakar; Dr. Gopal Chandra Roy
DOI : 10.5281/zenodo.7936532
Background: Neonatal jaundice, characterized by the yellowing of a newborn's skin and eyes due to elevated bilirubin levels, is a common condition affecting infants worldwide. Understanding the clinical profile and etiological factors associated with neonatal jaundice is essential for effective management and prevention strategies. Neonatal jaundice is a common cause of newborn hospital admission. The risk factors, characteristics and outcomes related to neonatal jaundice in Bangladesh has have been studied so far. Aim of the study: The study aimed to study the clinical profile and underlying etiological factors leading to neonatal jaundice in this rural Bangladesh. Methods: This prospective observational study was conducted in the neonatology ward at Khulna Medical College and Hospital, Khulna, Bangladesh. The study was conducted from January 2020 to December 2020. A total of 98 neonates were admitted to our post-natal ward during the specified period. Result: A total of 98 participants were enrolled and analyzed. The gestational age distribution revealed that 88.78% of the study population was aged more than 37 weeks, 8.16% were in the 34-36-week range and 3.06% were in the 30-34-week range. Among the babies, 63% were male, and 37% were female. The distribution of birth weights showed that 3.06% weighed 1000-1500g, 5.10% weighed 1501-2000g, 8.16% weighed 2001-2500g, 58.16% weighed 2501-3000g, and 25.51% weighed more than 3000g. The etiology of neonatal jaundice in the study revealed that 43.88% had physiological jaundice, 24.49% had ABO incompatibility, and 8.16% had Rh incompatibility or idiopathy. Conclusion: This study concludes that physiological jaundice is our hospital's most common cause of neonatal jaundice. This is followed by ABO incompatibility, sepsis, Rh incompatibility and idiopathic cases.