Summaryobjective To estimate the incidence of neonatal jaundice and hyperbilirubinemia in a poor urban community in Karachi, where 70% of births occur at home.methods Home-based pregnancy and newborn surveillance were conducted from September 2004 to July 2006 in a multi-ethnic population by trained community health workers. Newborns were visited several times at scheduled intervals until 59 days of life; any baby with jaundice was referred to the local clinic. Clinical assessments of jaundice were assigned by a physician and recorded using an adapted Kramer scale. Blood for plasma bilirubin was obtained if parents consented.results Of a birth cohort of 1690 young infants during the study period, 466 infants (27.6%) were referred to our centre with jaundice. Of these, 64% were 0-6 days old. Bilirubin was measured in 125 of 466 (27%) jaundiced newborns. Overall detected rate of hyperbilirubinemia (bilirubin >5 mg ⁄ dl) among 1690 newborns was 39.7 ⁄ 1000 live births (95% CI 29.3-47.6). Rate of plasma bilirubin levels in the range of 15-20 mg ⁄ dl was 13 ⁄ 1000 live births (95% CI 7.6-18.4); levels >20 mg ⁄ dl were observed in 3.5 ⁄ 1000 live births (95% CI 0.4-5.5). The proportion of newborns with bilirubin ‡15 mg ⁄ dl was significantly higher among those assigned a Kramer score of 4-5 compared to those receiving a score of 1-3 (P-value 0.00004).conclusion A significant burden of untreated severe neonatal jaundice, causing potential neurological sequelae, exists in developing countries such as Pakistan. WHO guidelines are needed for screening and appropriate management of neonatal jaundice in developing countries.

Objective: The purpose of this study was to validate primary health-care workers' and physicians' visual assessment of neonatal hyperbilirubinemia in Karachi, Pakistan.Study Design: We compared primary health-care workers' and physicians' clinical identification of jaundice in infants <60 days old.Result: Primary health-care workers identified 1-to 20-day-old neonates with hyperbilirubinemia X15 mg per 100 ml (260 mmol l À1 ) with 83.3% sensitivity and 50.5% specificity; neonates aged 1 to 6 days were identified with 76.2% sensitivity and 60.7% specificity. Physicians identified neonates aged 1 to 20 days with hyperbilirubimemia X15 mg per 100 ml (260 mmol l À1 ) with 51.4% sensitivity and 90.7% specificity, and neonates aged 1 to 6 days with 50% sensitivity and 88.5 % specificity. The primary health-care workers' and physicians' assessments showed fair interobserver agreement (k statistic 0.29).Conclusion: Primary health-care workers identified hyperbilirubinemic neonates with adequate sensitivity. With proper training and supervision, their assessment could improve the referral of hyperbilirubinemic neonates in low-resource settings in the developing world.

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