Assessment of Fever in African Children: Implication for Malaria Trials

Sunny Oyakhirome Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon; Institute for Tropical Medicine, Department of Parasitology, University of Tübingen, Tübingen, Germany

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Katharina Profanter Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon; Institute for Tropical Medicine, Department of Parasitology, University of Tübingen, Tübingen, Germany

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Peter G. Kremsner Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon; Institute for Tropical Medicine, Department of Parasitology, University of Tübingen, Tübingen, Germany

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We evaluated methods for assessing body temperature by comparing subjective assessment of fever by parents and doctors with objective axillary, tympanic, and rectal measurements of body temperature in 1000 children ≤ 10-years-old who presented at outpatient clinics with recent history of fever. Sensitivity of subjective assessment of fever were higher at thresholds of ≥ 38.3°C with specificity as low as 60%. Axillary methods showed better specificity at fever thresholds of > 38.0°C with maximum sensitivity of 63% at thresholds of ≥ 37.5°C. Bland-Altman analysis showed wide limits of agreement between objective methods of measurements: −1°C to 3°C for comparison of rectal and axillary, −1°C to 2°C for rectal and tympanic, and −1°C to 2°C for tympanic and axillary measurements. A choice of method to measure body temperature for diagnosis of fever in African children should be informed by a trade off between its specificity and sensitivity that considers thresholds > 38.0°C.

Author Notes

*Address correspondence to Sunny Oyakhirome, Medical Research Unit, Albert Schweitzer Hospital, B.P. 118, Lambaréné, Gabon. E-mail: drsunnysmcn@hotmail.com

Authors' addresses: Sunny Oyakhirome and Katharina Profanter, Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon, E-mails: drsunnysmcn@hotmail.com and katharinaprofanter@yahoo.de. Peter G. Kremsner, Department of Parasitology, Institute of Tropical Medicine, University of Tubingen, Tubingen, Germany, E-mail: peter.kremsner@uni-tuebingen.de.

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