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

J Perinatol. 2010 Sep;30(9):616-21. doi: 10.1038/jp.2010.13. Epub 2010 Apr 1.


Objective: The purpose of this study was to validate primary health-care workers' and physicians' visual assessment of neonatal hyperbilirubinemia in Karachi, Pakistan.

Study design: We compared primary health-care workers' and physicians' clinical identification of jaundice in infants <60 days old.

Result: Primary health-care workers identified 1- to 20-day-old neonates with hyperbilirubinemia > or =15 mg per 100 ml (260 micromol 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 > or =15 mg per 100 ml (260 micromol 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' and physicians' assessments showed fair interobserver agreement (kappa 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.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Bilirubin / blood
  • Community Health Workers
  • Developing Countries
  • Humans
  • Infant
  • Infant, Newborn
  • Jaundice, Neonatal / diagnosis*
  • Observer Variation
  • Pakistan
  • Physical Examination*
  • Physician Assistants
  • Physicians
  • Sensitivity and Specificity
  • Severity of Illness Index*


  • Bilirubin