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

Search for other papers by Sunny Oyakhirome in
Current site
Google Scholar
PubMed
Close
,
Katharina Profanter Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon; Institute for Tropical Medicine, Department of Parasitology, University of Tübingen, Tübingen, Germany

Search for other papers by Katharina Profanter in
Current site
Google Scholar
PubMed
Close
, and
Peter G. Kremsner Medical Research Unit, Albert Schweitzer Hospital, Lambaréné, Gabon; Institute for Tropical Medicine, Department of Parasitology, University of Tübingen, Tübingen, Germany

Search for other papers by Peter G. Kremsner in
Current site
Google Scholar
PubMed
Close
Restricted access

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.

  • 1.

    Mackowiak PA, Wasserman SS, Levine MM, 1992. A critical appraisal of 98.6 degrees F, the upper limit of the normal body temperature, and other legacies of Carl Reinhold August Wunderlich. JAMA 268: 15781580.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Fischler MP, Reinhart WH, 1997. Fever: friend or enemy? Schweiz Med Wochenschr 127: 864870.

  • 3.

    Baraff LJ, Bass JW, Fleisher GR, 1993. Practice guideline for the management of infants and children 0 to 36 months of age with fever without source. Pediatrics 92: 112.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Marcy SM, Kohl KS, Daganc R, Nalin D, Blume M, Jones MC, Hansen J, Labadie J, Lee L, Martin BL, O’Brien K, Rothstein E, Vermeerm PThe Brighton Collaboration Fever Working Group, 2004. Fever as an adverse event following immunization: case definition and guidelines of data collection, analysis, and presentation. Vaccine 22: 551556.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Moorthy V, Reed Z, Smith PG, 2007. Measurement of malaria vaccine efficacy in phase III trials: report of a WHO consultation. Vaccine 25: 51155123.

  • 6.

    Wailoo MP, Petersen SA, Whittaker H, Goodenough P, 1989. Sleeping body temperatures in 3–4 month old infants. Arch Dis Child 64: 596599.

  • 7.

    Anderson ES, Petersen SA, Wailoo MP, 1990. Factors influencing the body temperature of 3–4 month old infants at home during the day. Arch Dis Child 65: 13081310.

  • 8.

    Rabinowitz RP, Cookson ST, Wasserman SS, Mackowiak PA, 1996. Effects of anatomic site, oral stimulation, and body position on estimates of body temperature. Arch Intern Med 156: 777780.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Anagnostakis D, Matsaniotis N, Grafakos S, Sarafidou E, 1993. Rectal-axillary temperature difference in febrile and afebrile infants and children. Clin Pediatr 32: 268272.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Terndrup TE, Allegra JR, Kealy JA, 1989. A comparison of oral, rectal, and tympanic membrane-derived temperature changes after ingestion of liquids and smoking. Am J Emerg Med 7: 150154.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Cone TE Jr, 1989. Diagnosis and treatment: children with fevers. Pediatrics 43: 290293.

  • 12.

    Herzog LW, Coyne LJ, 1993. What is fever? Normal temperature in infants less than 3 months old. Clin Pediatr 32: 14521456.

  • 13.

    Sequin J, Terry K, 1999. Neonatal infrared axillary thermometry. Clin Pediatr 38: 3540.

  • 14.

    Zehner JW, Terndrup TE, 1991. The impact of moderate ambient temperature variance on the relationship between oral, rectal, and tympanic membrane temperatures. Clin Pediatr 30: 6164.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Schellenberg JR, Greenwood BM, Gomez P, Menendez C, Alonso PL, 1994. Diurnal variation in body temperature of Gambian children. Trans R Soc Trop Med Hyg 88: 429431.

  • 16.

    Planche T, Krishna S, Kombila M, Engel K, Faucher JF, Ngou-Milama E, Kremsner PG, 2001. Comparison of methods for the rapid laboratory assessment of children with malaria. Am J Trop Med Hyg 65: 599602.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Bland JM, Altman DG, 1986. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1: 307310.

  • 18.

    Lell B, Brandts CH, Graninger W, Kremsner PG, 2000. The circadian rhythm of body temperature is preserved during malarial fever. Wien Klin Wochenschr 112: 10141015.

  • 19.

    Sowunmi A, 1995. Body temperature and malaria parasitaemia in rural African children. East Afr Med J 72: 427430.

  • 20.

    Blainey CG, 1974. Site selection in taking body temperature. Am J Nurs 74: 18591861.

  • 21.

    Kenney RD, Fortenberry JD, Surratt SS, Ribbeck BM, Thomas WJ, 1990. Evaluation of an infrared tympanic membrane thermometer in pediatric patients. Pediatrics 85: 854858.

  • 22.

    Romano MJ, Fortenberry JD, Autrey E, Harris S, Heyroth T, Parmeter P, Stein F, 1993. Infrared tympanic thermometry in the pediatric intensive care unit. Crit Care Med 21: 11811185.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Erickson RS, Woo TM, 1994. Accuracy of infrared thermometry and traditional temperature methods in young children. Heart Lung 23: 181195.

  • 24.

    Chamberlain JM, Terndrup TE, Alexander DT, Silverstone FA, Wolf-Klein G, O’Donnell R, Grandner J, 1995. Determination of normal ear temperature with an infrared emission detection thermometer. Ann Emerg Med 25: 1520.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Craig J, Lancaster G, Taylor S, Williamson P, Smyth R, 2002. Infrared ear thermometry compared with rectal thermometry in children: a systematic review. Lancet 360: 603.

  • 26.

    Craig JV, Lancaster GA, Williamson PR, Smyth RL, 2000. Temperature measured at the axilla compared with rectum in children and young people: systematic review. BMJ 320: 11741178.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Robinson JL, Seal RF, Spady DW, Joffres MR, 1998. Comparison of esophageal, rectal, axillary, bladder, tympanic, and pulmonary artery temperatures in children. J Pediatr 133: 553556.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Canadian Task Force on Preventive Health Care, 2003. New grades for recommendations from the Canadian Task Force on Preventive Health Care. CMAJ 169: 207208.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Singhi S, Sood V, 1990. Reliability of subjective assessment of fever by mothers. Indian J Pediatr 27: 811815.

  • 30.

    Whybrew K, Murray M, Morley C, 1998. Diagnosing fever by touch: observational study. BMJ 317: 321322.

  • 31.

    Bergeson PS, Steinfeld HJ, 1974. How dependable is palpation as a screening method for fever. Can touch substitute for thermometer readings? Clin Pediatr (Phila) 13: 350351.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Einterz EM, Bates ME, 1997. Fever in Africa: do patients know when they are hot? Lancet 350: 781.

  • 33.

    Ernst TN, Philip M, 1985. Temperature assessment by parental palpation. Am J Dis Child 139: 546.

  • 34.

    Graneto JW, Soglin DF, 1996. Maternal screening of childhood fever by palpation. Pediatr Emerg Care 12: 183184.

  • 35.

    Hooker EA, Smith SW, Miles T, King L, 1996. Subjective assessment of fever by parents: comparison with measurement by noncontact tympanic thermometer and calibrated rectal glass mercury thermometer. Ann Emerg Med 28: 313317.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Jaffe DM, 1995. what's hot and what's not: the gold standard for thermometry in emergency medicine. Ann Emerg Med 25: 9799.

Past two years Past Year Past 30 Days
Abstract Views 36 36 4
Full Text Views 303 56 3
PDF Downloads 81 25 1
 
Membership Banner
 
 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save