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Re: Thermospots: appropriate technology for the developing world

Dear Editor,

I read with interest the study by Green et al [1] regarding the use of ThermoSpots © in a low-income community setting.

Our study amongst premature or low-birth-weight babies in a hospital in rural Malawi [2] also confirmed that the ThermoSpot performed well. In 100 paired measurements comparing the ThermoSpot reading with that of a low-reading glass-mercury thermometer, the device correctly identified hypothermia in every case (2 out of 100 measurements). The ThermoSpot falsely identified hypothermia on 1 occasion. (sensitivity = 100%, specificity = 95%)

Furthermore, it was easy to show illiterate mothers how to interpret the appearance of the device during a 15 minute-long teaching session. One week later, all the mothers included in our study still understood the significance of each colour of the ThermoSpot disc, and in particular what they should do if it indicated hypothermia. In our special-care baby unit (SCBU) in a rural hospital in Northern Malawi, one nurse was often on duty for delivery suite, the post-natal ward and SCBU. Such a shortage of trained staff is commonplace in low-income settings. Regular measurement of each baby’s temperature by trained staff was often impossible. The knowledge that the mothers of the babies in SCBU could reliably identify and take steps to correct hypothermia was extremely helpful.

I agree with the authors’ conclusion that the ThemoSpot is both reliable and appropriate technology for healthcare in the developing world, and would commend their use.

N Kennedy Dept Child Health, Queen’s University Belfast, Grosvenor Rd, Belfast BT12 6BJ

References:

1. Green DA, Kumar A, Khanna R. Neonatal hypothermia detection by ThermoSpots in Indian urban slum dwellings. Arch Dis Child Fetal Neonatal Ed 2006;91:F96-F98

Send letter to journal:
Re: ThermoSpot - a non-invasive hypothermia indicator for neonates, infants and children

Dear Editor,

The responses by the Associate Editor, Martin Ward Platt and Dr Neil Kennedy to the Study by Green et al [1] are very encouraging to Professor David Morley, CBE and myself as the originators and designers of the ThermoSpot.

This latest Study only confirms what we have known for a long time in so far that the ThermoSpot is a very simple device, reliable and easy for even non-trained medical volunteers to use it effectively. There is now sufficient evidence, in our view, from not only this Study but also several others [2,3,4,5,6,7,8] that the ThermoSpot has been validated and can be used with confidence.

This device is the first 'low cost' neonatal hypothermia indicator ever to be made available for use and it should now be possible, through research projects, to identify the extent of this problem. Furthermore, it should enable midwives, traditional birth attendants (TBA's) and village health workers (VHW's) to empower mothers generally on the importance of keeping their babies warm immediately following birth. Such use of the ThermoSpot, if widely adopted, should assist in reducing the current quite unacceptable mortality levels in the first 28 days of life. Here is a tool to support the worthy aims of the Millennium Development Goals(MDG4)[9].

John Zeal

Patient Temperature Specialist Camborne Consultants, Dorset, England. E-mail: temperaturedoc@aol.com

References:

1. Green D A, Kumar A, Khanna R. Neonatal hypothermia detection by ThermoSpot in Indian urban slum dwellings. Archives of Disease in Childhood - Fetal and Neonatal Edition. 2006: 91: 96-98.

2. Morley D, Blumenthal I. A new neonatal hypothermia indicator. Lancet.2000: 355: 659-660.

3. Kennedy D, Gondwe L, Morley D C. Temperature Monitoring with ThermoSpots in Malawi. Lancet. 2000: 355:1364.

4. Morley D, Kennedy N. Hypothermia: prevention at community level. Tropical Doctor: 2002: 32: 22-24.

5. Kambarami R, Chidede O, Pereira N, ThermoSpot in the detection of neonatal hypothermia. Annals of Tropical Pediatrics. 2002: 22: 219-223.

6. Zeal J, Kambarami R. ThermoSpot in the detection of neonatal hypothermia. Annals of Tropical Pediatrics. (Letters to the Editor) 2003: 23: 87-88.

7. Morrice J S, Manda L S T, Kacheche A, Hypothermia and the use of ThermoSpots. Tropical Doctor. (Letter to the Editor): 2003: 33: 253.

8. Pejaver R K, Nisarga R, Gowda B. Temperature Monitoring in Newborns Using ThermoSpot. Indian Journal of Pediatrics: 2004: 71: 795- 796.