Having a Diagnostic Guideline Could Save Many Infant Lives

by VR Sreeraman on  January 12, 2008 at 4:00 PM Child Health News   - G J E 4
Having a Diagnostic Guideline Could Save Many Infant Lives
A study published on Thursday said that keeping a checklist of the symptoms for severe illnesses could save many newborns in poor countries.

The guidelines could help village caregivers make speedy, accurate diagnoses of ailing infants, helping to identify those who need urgent hospitalisation, it says.

Some four million babies die every year during the first 28 days of life, three-quarters of them within seven days from causes ranging from infection, birth asphyxia and sepsis to pneumonia and meningitis.

Researchers in Bangladesh, Bolivia, Ghana, India, Pakistan and South Africa drew up the guidelines after selecting for study 3,177 babies under seven days old and 5,712 infants aged seven to 59 days.

Frontline healthworkers were asked to look for any of 12 important symptoms, any of which would prompt a referral to the next level of healthcare.

The results, checked afterwards by specialised paediatricians, showed a "sensitivity" rating of 87 percent, meaning that only 13 percent of the children who should have been referred to hospital were not.

The results also showed 74-percent accuracy for diagnosis.

When the list of symptoms was reduced to seven of the commonest items, the ratings remained virtually the same, which thus opened the way to a simpler format, said the study, published in the British weekly journal The Lancet.

In a commentary, also published in The Lancet, Franco Simini of the Universidad de la Republica in Uruguay, questioned the study's premise that difficult choices must be made in the face of scarce resources.

Failing to identify 13 percent of the babies as needing hospital care was too high a price to pay, he said.

"The use of scores ... is of great interest clinically," he wrote. "But lower mortality figures will be reached only if all patients are treated according to the same best available standards, with constant and easy access to higher level-facilities."

The UN Millennium Development Goal is to reduce child mortality by two-thirds by 2015 as compared to 1990 levels. At present, the world in on course for a reduction of only 27 percent, the authors say.

The seven symptoms named in the checklist are:

-- difficulty in feeding

-- movement only when stimulated

-- temperature below 35.5 C (95.9 F)

-- temperature above 37.5 C (99.5 F)

-- respiratory rate over 60 breaths per minute

-- severe chest indrawing

-- a history of convulsions

Source: AFP

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