Human Touch to Detect Hypothermia in Neonates in Indian Slum Dwellings

Indian Journal of Pediatrics, Volume 77, Issue 7, pp. 759-762, 2010

4 Pages Posted: 19 May 2016

See all articles by Siddharth Agarwal

Siddharth Agarwal

Urban Health Resource Centre; Dept. of International Health, JHBSPH

Vani Sethi

Urban Health Resource Centre

Karishma Srivastava

Urban Health Resource Centre

Prabhat K Jha

Urban Health Resource Centre

Abdullah H Baqui

Johns Hopkins University - Bloomberg School of Public Health

Date Written: July 2010

Abstract

Objective: To assess the validity of human touch (HT) method to measure hypothermia compared against axillary digital thermometry (ADT) and study association of hypothermia with poor suckle and underweight status in newborns and environmental temperature in 11 slums of Indore city, India.

Methods: Field supervisors of slum-based health volunteers measured body temperature of 152 newborns by HT and ADT, observed suckling and weighed newborns. Underweight status was determined using WHO growth standards.

Results: Hypothermia prevalence (axillary temperature <36.5oC) was 30.9%. Hypothermia was insignificantly associated with poor suckle (31% vs 19.7%, p=0.21) and undernutrition (33.3% vs 25.3%, p=0.4). Hypothermia assessed by HT was in agreement, with hypothermia assessed by ADT (<36.5°C), in 107 out of 152 observations. Kappa value of 0.38 (95% C.I. 0.33-0.43) showed a moderate agreement between the two tests. Taking ADT as gold standard, sensitivity and specificity of HT method to correctly identify hypothermic (true positive) and non-hypothermic babies (true negative) was 74.5% and 68.5% respectively.

Significantly higher percentage of newborns were assessed mildly hypothermic and fewer as warm by HT (p<0.05). Hypothermia rates differed significantly by season. Hypothermia rates were 17.4%, 37.2% and 36.3% in dry summer, wet summer and winter season respectively. High neonatal hypothermia even during wet and dry summer, could possibly be contributed to: a) poor thermal care practices in slum households; b) thermal care was possibly neglected assuming that thermal protection is not relevant in warm season; and c) physiological vulnerability of newborns to hypothermia owing to3 – i) incompletely developed thermo-regulatory capacity, ii) relative to body-weight, the body surface of the newborn being approximately 3 times, iii) the rate of heat loss being approximately 4 times that of the adult and iv) insulating layer of subcutaneous fat that produces and conserves heat being thinner. Hence, health programs should continue to emphasize on thermal protection at birth and hypothermia identification, even during summer or in areas with sufficiently warm climate.

Conclusions: HT emerged simpler and programmatically feasible. Overestimation by HT prompted FEW to counsel for extra warmth/ care, which was not disadvantageous, since in slum households thermal care practices are sub-optimal. High neonatal hypothermia even during wet and dry summer, could possibly be contributed to: a) poor thermal care practices in slum households; b) thermal care was possibly neglected assuming that thermal protection is not relevant in warm season; and c) physiological vulnerability of newborns to hypothermia owing to3 – i) incompletely developed thermo-regulatory capacity, ii) relative to body-weight, the body surface of the newborn being approximately 3 times, iii) the rate of heat loss being approximately 4 times that of the adult and iv) insulating layer of subcutaneous fat that produces and conserves heat being thinner. Hence, health programs should continue to emphasize on thermal protection at birth and hypothermia identification, even during summer or in areas with sufficiently warm climate. FEWs reported that HT method was simpler to use and enabled FEW to focus on counseling and prompt appropriate management/referral. There is a need to examine whether trained and supervised community-based health workers and mothers can use HT accurately to identify and manage hypothermia and other simple signs of newborn illness using minimal algorithm at home and more confidently refer such newborns to proximal facilities linked to the program to ensure prompt management of illness.

Keywords: Urban Poor, Urban Vulnerable, Slums, Newborn Care, Hypothermia, Thermal Care at Home

JEL Classification: I00, I1, I10, I12, I18, I19, I3, I30, I31, N35, P46, R00, R29

Suggested Citation

Agarwal, Siddharth and Sethi, Vani and Srivastava, Karishma and Jha, Prabhat K and Baqui, Abdullah H, Human Touch to Detect Hypothermia in Neonates in Indian Slum Dwellings (July 2010). Indian Journal of Pediatrics, Volume 77, Issue 7, pp. 759-762, 2010 , Available at SSRN: https://ssrn.com/abstract=2781763

Siddharth Agarwal (Contact Author)

Urban Health Resource Centre ( email )

136, Humayunpur, First Floor
Safdarjung Enclave
New Delhi, Delhi 110029
India
911126199771 (Phone)

HOME PAGE: http://uhrc.in/name-CmodsDownload.html

Dept. of International Health, JHBSPH ( email )

Wolfe Street
Baltimore, MD 21205
United States

Vani Sethi

Urban Health Resource Centre ( email )

136, Humayunpur, First Floor
Safdarjung Enclave
New Delhi, Delhi 110029
India

Karishma Srivastava

Urban Health Resource Centre ( email )

136, Humayunpur, First Floor
Safdarjung Enclave
New Delhi, Delhi 110029
India

Prabhat K Jha

Urban Health Resource Centre ( email )

136, Humayunpur, First Floor
Safdarjung Enclave
New Delhi, Delhi 110029
India

Abdullah H Baqui

Johns Hopkins University - Bloomberg School of Public Health ( email )

615 North Wolfe Street
Baltimore, MD 21205
United States

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