PALPATION AS A METHOD OF FEVER DETERMINATION IN MALAWIAN CHILDREN WHOARE LESS-THAN 5 YEARS OLD - HOW RELIABLE IS IT

Fever is a common occurrence in children who are <5 years old and palp ation of the forehead may or may not be a reliable method for determin ing fever in such children. In a study of 1120 Malawian children of th is age attending outpatient's clinics, each child's mother and a clini cal officer (GO) were asked to palpate the child's forehead and decide whether the child was febrile (felt warm or very warm) or afebrile (f elt normal). The rectal temperature of each child was then taken using a thermometer and the child considered febrile if this temperature wa s greater than or equal to 38 degrees C. Using palpation, mothers judg ed 973 (86.9%) of 1120 children to be febrile and CO judged 565 (50.4% ) of 1118 to be febrile, whereas thermometer readings indicated 410(36 .7%) to be truly febrile. False-positives (i.e. afebrile children judg ed to be febrile by palpation) accounted for 574 (59.0%) of the 973 ch ildren who were considered febrile by their mothers and 228 (40.4%) of the 565 children so considered by CO; mothers reported significantly more false-positives than CO (P<0.05). False-negatives (i.e. febrile c hildren judged to be afebrile by palpation) accounted for 11 (7.5%) of the 147 children who were considered afebrile by their mothers and 73 (13.2%) of the 553 children so considered by CO; CO reported signific antly more false-negatives than mothers (P<0.05). Overall, mothers wer e as likely as CO to misjudge a child (721/1120 v. 781/1118; P>0.05). Although the sensitivity of mothers and CO in determining fever was si milar (97.3% v. 82.2%; P>0.05), CO gave a higher degree of specificity than the mothers (67.8% v. 19.2%; P<0.000001). Although the present r esults indicate that palpation is not a reliable method of determining fever in children who are <5 years old, caregivers should continue to use palpation as a useful first step in deciding when a child needs t o be referred.