The Invisible Ocular Risks of Neonatal Phototherapy Among Caregivers in Tanzania Clinical Settings: A Mixed-Methods Study

Background: Neonatal phototherapy is the standard treatment for hyperbilirubinemia and is critical in preventing kernicterus. While its clinical effectiveness for neonates is well established, the occupational health risks to caregivers exposed to phototherapy light remain poorly explored, particularly in low- and middle-income countries. This study assessed the ocular effects of neonatal phototherapy on caregivers working in clinical settings in Tanzania. Methods: A mixed-methods study was conducted in selected urban and rural hospitals in Tanzania. Quantitative data were collected through a cross-sectional survey of 200 caregivers involved in neonatal phototherapy, assessing exposure duration, ocular symptoms, use of protective measures, and safety training. Qualitative data were obtained through semi-structured interviews with 25 caregivers and were analyzed thematically. Quantitative data were analyzed using descriptive statistics, chi-square tests, and odds ratios. Results: Overall, 75% of caregivers reported at least one ocular symptom associated with phototherapy exposure. The most frequently reported symptoms were eye strain (58%), dryness or irritation (45%), blurred vision (28%), and photophobia (21%). Caregivers exposed to phototherapy for more than four hours per day were significantly more likely to report ocular symptoms (χ2, p = 0.012). Those who did not use protective eyewear were 2.7 times more likely to experience photophobia and irritation (OR: 2.7; 95% CI: 1.8–3.9). Only 29% of caregivers reported using eye protection, and 35% had received formal safety training. Caregivers who received training were 60% less likely to report ocular symptoms (p < 0.01). Qualitative analysis identified five themes: lack of awareness and protective measures, psychological stress and burnout, institutional gaps in occupational safety, low trust in the healthcare system, and strong professional dedication despite personal health risks. Conclusions: Caregivers exposed to neonatal phototherapy in Tanzanian hospitals experience a high burden of ocular symptoms, driven by prolonged exposure, limited protective practices, and inadequate safety training. Integrating caregiver-focused occupational safety policies, mandatory use of protective eyewear, and structured training into neonatal care programs is essential to safeguard caregiver health and strengthen neonatal service delivery in resource-limited settings.