title: Validity of neonatal jaundice evaluation by primary health-care workers and physicians in Karachi, Pakistan.
abstract: OBJECTIVE
  The purpose of this study was to validate primary health-care workers' and physicians' visual assessment of neonatal hyperbilirubinemia in Karachi, Pakistan.
  
  
  METHODS
  We compared primary health-care workers' and physicians' clinical identification of jaundice in infants <60 days old.
  
  
  RESULTS
  Primary health-care workers identified 1- to 20-day-old neonates with hyperbilirubinemia > or =15 mg per 100 ml (260 micromol l(-1)) with 83.3% sensitivity and 50.5% specificity; neonates aged 1 to 6 days were identified with 76.2% sensitivity and 60.7% specificity. Physicians identified neonates aged 1 to 20 days with hyperbilirubimemia > or =15 mg per 100 ml (260 micromol l(-1)) with 51.4% sensitivity and 90.7% specificity, and neonates aged 1 to 6 days with 50% sensitivity and 88.5 % specificity. The primary health-care workers' and physicians' assessments showed fair interobserver agreement (kappa statistic 0.29).
  
  
  CONCLUSIONS
  Primary health-care workers identified hyperbilirubinemic neonates with adequate sensitivity. With proper training and supervision, their assessment could improve the referral of hyperbilirubinemic neonates in low-resource settings in the developing world.
authors.affiliation: Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: L
authors.initials: L
authors.lastname: Hatzenbuehler
authors.forename: A K M
authors.initials: AK
authors.lastname: Zaidi
authors.forename: S
authors.initials: S
authors.lastname: Sundar
authors.forename: S
authors.initials: S
authors.lastname: Sultana
authors.forename: F
authors.initials: F
authors.lastname: Abbasi
authors.forename: A
authors.initials: A
authors.lastname: Rizvi
authors.forename: G L
authors.initials: GL
authors.lastname: Darmstadt
mesh_terms: D001663:Bilirubin / Q000097:blood; D003150:Community Health Workers; D003906:Developing Countries; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000175:diagnosis*; D015588:Observer Variation; D010154:Pakistan; D010808:Physical Examination; D010823:Physician Assistants; D010820:Physicians; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: D001663:Bilirubin