Human Touch vs. Axillary Digital Thermometry for Detection of Neonatal Hypothermia at Community Level

Abstract

We examined the diagnostic accuracy of human touch (HT) method in assessing hypothermia against axillary digital thermometry (ADT) by a trained non-medical field investigator (who supervised activities of community health volunteers) in seven villages of Agra district, Uttar Pradesh, India.

Body temperature of 148 newborns born between March and August 2005 was measured at four points in time for each enrolled newborn (within 48 h and on days 7, 30 and 60) by the field investigator under the axilla using a digital thermometer and by HT method using standard methodology. Total observations were 533.

Hypothermia assessed by HT was in agreement with hypothermia assessed by axillary method (<36.5_C) in 498 out of the 533 observations. There were only 35 (6.7%) mismatched measurements. Kappa value of 0.73 (95% confidence interval 0.65–0.81) showed a good agreement between the two tests. The sensitivity and specificity of HT method to correctly identify hypothermic (true positive) and non-hypothermic babies (true negative) was 74% and 96.7%, respectively. A positive and negative likelihood ratio of 22 (cut off >9) and 0.26 (cut off <0.5), respectively, also indicated that HT had a high diagnostic accuracy

HT is a simple, quick, inexpensive and programmatically important method. However, being a subjective assessment, its reliability depends on the investigator being adequately trained and competent in making consistently accurate assessments. There is also a need to assess whether with training and supervision even the less literate mothers, traditional birth attendants and community health volunteers can accurately assess mild and moderate hypothermia before promoting HT for early identification of neonatal risk in community-based programs.

Keywords: India, rural communities, newborn care, less-literate mothers, newborn sickness

JEL Classification: D10, D19, I1, I10, I12,I3, I30, I31, J13, R20, Z10