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Agreement between clinical examination and parental morbidity histories for children in Nepal
J Katz1, K P West, S C LeClerq
1Department of International Health, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD 21205-2103, USA.
Insights
Parental health histories for child morbidity show varying agreement with clinical exams. Agreement was excellent for ear infections and measles but poor for diarrhea and fever, impacting prevalence estimates.
Area of Science:
- Child health
- Epidemiology
- Global health
Background:
- Parental histories are crucial for estimating child morbidity and intervention effectiveness.
- Limited research exists on the concordance between parental reports and clinical assessments in child health.
Purpose of the Study:
- To compare parental morbidity histories with clinical examination findings in pre-school-age children.
- To assess the agreement and its impact on prevalence estimates for various childhood illnesses.
Main Methods:
- A comparative study in rural Nepal involving 814 children.
- Parents provided same-day morbidity histories, followed by masked clinical examinations 2-4 hours later.
- Clinical signs assessed included temperature, respiratory rate, stool examination, ear discharge, and cough.
Main Results:
- Excellent agreement was found for ear infection (kappa=0.75) and measles rash (kappa=0.74).
- Moderate to poor agreement was observed for diarrhea (kappa=0.21) and fever (kappa=0.31).
- No significant agreement was noted for dysentery, rapid breathing, or cough. Prevalence estimates differed based on data source (history vs. clinical exam).
Conclusions:
- The agreement between parental histories and clinical examinations for child morbidity is condition-specific.
- Discrepancies in agreement affect the accuracy of morbidity prevalence estimates.
- Clinical examination may provide more accurate prevalence data for certain conditions compared to parental recall.
Abstract:
Parental histories are often used to estimate the prevalence and the impact of interventions on child morbidity, but few studies have examined the agreement between parental histories and clinical examination. We compared clinical findings with a same-day parental morbidity history for pre-school-age children in rural Nepal. A 15 per cent sample of children from 40 wards in Sarlahi district, Nepal, was selected for participation and 814 same-day morbidity histories were obtained from parents. A clinician, masked to the parent's history, visited the household 2-4 h later and examined the child for signs of morbidity symptoms about which the parent had previously been questioned. Signs included measurement of temperature, respiratory rate, examination of stools, ear discharge, and presence of persistent cough. Agreement between the history and clinical examination was excellent for ear infection (kappa = 0.75) and history of measles rash (kappa = 0.74), moderate to poor for diarrhoea (kappa = 0.21) and fever (kappa = 0.31), and there was no evidence of agreement for dysentery (kappa = -0.01), rapid breathing (kappa = 0.06), and cough (kappa = 0.09). The prevalence of dysentery, fever, cough, and rapid breathing was lower if clinical signs rather than histories were used. The prevalence of diarrhoea was higher if the presence of a loose stool in a cup rather than a history was used. The prevalence of ear infections and measles was comparable with both methods. The agreement between histories and clinical examination varies by morbidity type, as does the prevalence of morbidity estimated by one or other method.