ThermoSpots to detect hypothermia in children with severe acute malnutrition.

Tom Moule, Neil Kennedy, N Ndoya , Alan M Emond

Research output: Contribution to journalArticle (Academic Journal)peer-review

9 Citations (Scopus)


Introduction: Hypothermia is a risk factor for increased mortality in children with severe acute malnutrition (SAM). Yet
frequent temperature measurement remains unfeasible in under-resourced units in developing countries. ThermoSpot is
a continuous temperature monitoring sticker designed originally for neonates. When applied to skin, its liquid crystals are
designed to turn black with hypothermia and remain green with normothermia.
Aims: To (i) estimate the diagnostic accuracy of ThermoSpots for detecting WHO-defined hypothermia (core temperature
,35.5uC or peripheral temperature ,35.0uC) in children with SAM and (ii) determine their acceptability amongst mothers.
Methods: Children with SAM in a malnutrition unit in Malawi were enrolled during March-July 2010. The sensitivity and
specificity of ThermoSpots were calculated by comparing the device colour against ‘gold standard’ rectal temperatures
taken on admission and follow up peripheral temperatures taken until discharge. Guardians completed a questionnaire to
assess acceptability.
Results: Hypothermia was uncommon amongst the 162 children enrolled. ThermoSpot successfully detected the one rectal
temperature and two peripheral temperatures recorded that met the WHO definition of hypothermia. Overall, 3/846 (0.35%)
temperature measurements were in the WHO-defined hypothermia range. Interpreting the brown transition colour
(between black and green) as hypothermia improved sensitivities. For milder hypothermia definitions, sensitivities declined
(,35.4uC, 50.0%; ,35.9uC, 39.2%). Specificity was consistently above 94%. From questionnaires, 40/43 (93%) mothers
reported they were 90–100% happy with the device overall. Free-text answers revealed themes of ‘‘Skin Rashes’’, ‘‘Usersatisfaction’’
and ‘‘Empowerment".
Conclusion: Although hypothermia was uncommon in this study, ThermoSpots successfully detected these episodes in
malnourished children and were acceptable to mothers. Research in settings where hypothermia is common is needed to
determine performance with certainty. Instructing users to act when the device’s transition colour appears could improve
accuracy. If reliable, ThermoSpots may offer simple, acceptable and continuous temperature measurement for high-burden
areas and reduce the workload of over-stretched staff.
Original languageEnglish
Pages (from-to)e45823
JournalPLoS ONE
Early online date26 Sept 2012
Publication statusPublished - 26 Sept 2012


  • malnutrition


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