Introduction
Sunlight exposure has many health benefits for newborns and infants. It helps the body produce vitamin D, preventing rickets in children, and is used to treat neonatal jaundice during the neonatal period.1–3 Vitamin D everyday requirements can be obtained by 30 to 60 min of exposure to sunlight in the morning.4 Vitamin D plays a vital role in bone metabolism through regulation of calcium and phosphate homeostasis.1 Exposure of neonatal skin to sunlight in the morning is significant to producing nocturnal melatonin sooner, which helps them sleep better.5 Morning sunlight exposure supports the neonatal physiological system to break down indirect bilirubin.3
Timely and proper practice of neonatal sunlight exposure by mothers has many health benefits for neonates. The inadequate practice of exposure of neonates to sunshine by mothers leads to vitamin D deficiency, and jaundice is a common health problem in many developing countries, especially in sub-Saharan African countries such as Ethiopia.6 7
Ultraviolet (UV) radiation weakens the immune system. Skin dendritic cells are damaged by UV-B rays, which also cause regulatory T cells to generate the immunosuppressive cytokine IL-10.8 Pyrimidine dimerisation and DNA strand breaks are induced by UV light. Additional effects of UV radiation include externalisation of nuclear antigens on cell surfaces and production of neoantigens, which can exacerbate autoimmune illnesses such as lupus. Another problem associated with chronic UV radiation exposure is photoaging. Numerous epidemiological research showed that sunlight exposure is one of the primary risk factors for the development of melanoma and non-melanoma skin cancer.9 10 This risk is greatest in the white population, indicating that melanin has a protective effect.11 It has also been discovered that exposure to UV rays during childhood increases the risk of developing skin cancer compared with exposure later in life.12
In Middle East Asia, such as the northern parts of China, Mongolia and Afghanistan, mothers’ practice of sunlight exposure for neonates is poor. As a result, most neonates develop vitamin D deficiency and rickets.6 13 In Ethiopia, shortage of exposure to sunlight and inadequate vitamin D consumption are the main causes of rickets among children. According to a study conducted in Addis Ababa, Ethiopia, 41% of children under 3 years of age had vitamin D deficiency rickets, and the incidence was higher among infants.14 A study conducted in Jimma, Ethiopia, showed that 10.5% of children under 5 years of age had rickets, with the main identified causes being lack of exposure to sunlight and inadequate intake of vitamin D, and the highest rate (11%) occurred in infants.15–17
Although daily sunlight exposure remains the cheapest, safest and most effective method of prevention of rickets, significant numbers of children are not properly exposed to sunlight. According to recent studies in Ethiopia among mothers, 55.4% in Debre Markos town, 52% in the South Gondar zone and 34.3% in Debre Berhan town had poor practice of exposing neonates to sunlight.18–20 Numerous factors may be associated with the practice of neonatal sunlight exposure among mothers. These factors include sociodemographic factors such as age, marital status, educational status, occupation of mother, neonatal age, family size, place of residence, type of housing, educational status of the husband, household monthly income,18–24 maternal and neonatal-related factors such as antenatal care (ANC) follow-up, place of delivery, gestational age, birth weight, mother’s knowledge13 16 17 21 23 25 and fear of sunlight exposure.16 18 19 21 26 However, little is known about the practice of neonatal sunlight exposure among mothers in Ethiopia. Thus, this study aimed to assess the practices and factors associated with neonatal sunlight exposure among mothers visiting public hospitals in Addis Ababa, Ethiopia, 2020.