The Accuracy of Caregiver's 'hot to touch' assessment in paediatric healthcare among children aged 6-35 months with medically-attended diarrhea: Findings from the EFGH-Shigella surveillance in Kenya, Malawi, Bangladesh and Peru, 2022-2024

IntroductionConfidence in caregivers assessment of fever in their children, compared to thermometer readings, could help guide prompt care seeking and appropriate treatment in settings where access to reliable diagnostic tools is limited. Here, we evaluated the accuracy and drivers of caregiver-reported hot-to-touch fever compared to digital thermometry among children in the Enterics for Global Health (EFGH) Shigella surveillance study. MethodsChildren aged 6-35 months with medically attended diarrhea (MAD) enrolled in Kenya, Malawi, Bangladesh, and Peru between August 2022 and August 2024 were included. We trained caregivers to assess and record daily hot-to-touch (subjective fever measurement) and digital (thermometer) axillary temperature (fever defined as [≥]37.5{degrees}C) readings over for 14 days post-enrolment. We calculated site specific and overall accuracy of hot-to-touch compared to thermometer-measured fever and used multivariable Poisson regression to identify factors associated with accurate detection. ResultsThe accuracy of caregiver-reported hot-to-touch assessment ranged from 62.1% to72.0% overall and was highest in Bangladesh (83.2%-96.1%) and lowest in Malawi (47.4%-53.4%) over the 14 day assessment period. Accuracy was higher in children with chest indrawing (aPR=1.29, 95% CI: 1.04-1.60) and low respiratory rate (aPR=1.20, 95% CI: 1.11-1.29) and in children from wealthier households (Quintile 5: aPR=1.21, 95% CI: 1.01-1.44). Accuracy was lower among caregivers from households with [≥]3 children (aPR=0.88, 95% CI: 0.79-0.99) and for children with low heart rate (aPR=0.76, 95% CI: 0.61-0.94). ConclusionSuboptimal accuracy of hot-to-touch compared to digital thermometers in detecting fever in this study supports the need for digital thermometer use and context-specific strategies to enhance early detection of fever, particularly in communities living in resource-poor settings.