Solar-powered phototherapy for severe neonatal hyperbilirubinemia in low-resource settings: a multicentre implementation study in Nigeria

Severe neonatal hyperbilirubinemia remains a leading cause of preventable neonatal morbidity and mortality in low- and middle-income countries (LMICs), where unreliable electricity supply, limited specialist availability, and high treatment costs constrain access to effective phototherapy. There is limited evidence on scalable, climate-resilient phototherapy solutions suitable for decentralised care delivery. We conducted a multicentre implementation study evaluating a fully solar-powered total-body phototherapy system deployed across tertiary and grassroots healthcare facilities in Nigeria between February 2024 and January 2026. The study followed a phased design: (1) specialist-controlled observational deployment at a tertiary hospital, (2) corroborative deployment at additional tertiary centres across climatic regions, and (3) task-shifted grassroots implementation in mission-owned hospitals. Neonates with moderate-to-severe hyperbilirubinemia were treated according to standard clinical protocols. Primary outcomes were successful reduction of bilirubin to [≤]11.5 mg/dL, treatment duration, safety, and operational feasibility under electricity-independent conditions. Across all phases, nearly 2000 neonates have been screened and more than 650 neonates received treatment with the solar-powered phototherapy system. All treated neonates achieved bilirubin reduction to the predefined safety threshold, with a mean treatment duration of 19.2 {+/-} 13 hours during the initial observational phase. No treatment interruptions due to power failure occurred, and no phototherapy-related adverse events, neurological complications, or treatment-related mortality were observed. Treatment was safely delivered by junior clinicians and health assistants under task-shifted models in grassroots settings. The intervention eliminated the need for exchange blood transfusion among treated neonates and substantially reduced hospitalisation duration compared with conventional care pathways. This study demonstrates that fully solar-powered phototherapy can be safely, effectively, and sustainably implemented across multiple levels of the health system in a low-resource setting. By removing dependence on grid electricity and specialist personnel, the intervention addresses key structural barriers to neonatal care while supporting task shifting and climate-resilient service delivery. The findings support policy consideration of decentralised, infrastructure-independent phototherapy as a strategy to reduce neonatal morbidity and mortality in LMICs.