Validity of neonatal jaundice evaluation by primary health-care workers and physicians in Karachi, Pakistan

Objective: The Purpose of this study was to validate primary health-care workers\u27 and physicians\u27 visual assessment of neonatal hyperbilirubinemia in Karachi, Pakistan. Study Design: We compared primary health-care workers\u27 and physicians\u27 clinical identification of jaundice in infants = 15 mg per 100 ml (260 mu mol l(-1)) with 83.3% sensitivity and 50.5% specificity, neonates aged 1 to 6 days were identified with 76.2% sensitivity and 60.7% specificity. Physicians identified neonates aged 1 to 20 days with hyperbilirubimemia \u3e= 15 mg per 100 ml (260 mmol l(-1)) with 51.4% sensitivity and 90.7% specificity, and neonates aged 1 to 6 days with 50% sensitivity and 88.5 % specificity. The primary health-care workers\u27 and physicians\u27 assessments showed fair interobserver agreement (k statistic 0.29). Conclusion: Primary health-care workers identified hyperbilirubinemic neonates with adequate sensitivity. With proper training and supervision, their assessment could improve the referral of hyperbilirubinemic neonates in low-resource settings in the developing world