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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.
Authors' addresses: Sunny Oyakhirome and Katharina Profanter, Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon, E-mails: email@example.com and firstname.lastname@example.org. Peter G. Kremsner, Department of Parasitology, Institute of Tropical Medicine, University of Tubingen, Tubingen, Germany, E-mail: email@example.com.