Seven-sign checklist fights child mortality

Researchers have compiled a simple set of clinical signs that mothers and healthcare workers can use to identify severe illnesses in babies requiring hospital admission.

An estimated four million babies die globally each year, before they are a month old.

Three quarters die in their first week, largely from bacterial infections, birth complications and prematurity.

The checklist, published in the Lancet, aims to help mothers and front-line health workers identify serious illnesses in infants under two months old.

The first Integrated Management of Childhood Illness guidelines, developed during the mid-1990s, did not take the first week of life into account.

"Anyone looking after children, mothers, should know that if children are not feeding well, it is a sign of serious illness, they should take it to care," said lead author Martin Weber of the World Health Organisation.

Weber and colleagues from the WHO's Young Infants Clinical Signs Study Group studied 3,177 infants aged 0-6 days and 5,712 infants aged 7-59 days, brought to health facilities in Bangladesh, Bolivia, Ghana, India, Pakistan, and South Africa.

A trained health worker recorded the presence or absence of 31 clinical signs, such as difficulty in feeding and lethargy, and a paediatrician then assessed each case for severe illness.

The team eventually identified seven clinical signs that predicted severe illness in 85% of infants. These were:

• history of difficult feeding

• history of convulsions

• movement only when stimulated

• breathing rate of 60 breaths per minute or more

• severe chest indrawing

• temperature over 37.5 degrees Celsius or

• under 35.5 Celsius.

"It seems very simple, but these are messages we need to promote more widely," Weber said.

"Because the new checklist uses a smaller number of signs than before, its adoption would make training and implementation simpler and less costly. This can be of use all over the globe."