Sensitivity, specificity, PPV and NPV of different screening algorithms for VSD (n=395)
| Prevalence, % (95% CI) | Sensitivity, % (95% CI) | Specificity, % (95% CI) | PPV, % (95% CI) | NPV, % (95% CI) | κ Statistic (p value) | |
|---|---|---|---|---|---|---|
| VSD computed using community health workers' assessment | ||||||
| Mirzapur original 8-sign | 2.5 (1.2 to 4.6) | 37.5 (15.2 to 64.6) | 98.9 (97.3 to 99.7) | 60.0 (26.2 to 87.8) | 97.4 (95.3 to 98.7) | 0.44 (0.00) |
| Mirzapur revised 11-sign | 3.5 (2.0 to 5.9) | 50.0 (24.7 to 75.3) | 98.4 (96.6 to 99.4) | 57.1 (28.9 to 82.3) | 97.9 (95.9 to 99.1) | 0.52 (0.00) |
| SEARCH, 2 out of 7 signs | 0.0 (0.0 to 0.9)* | – | – | – | – | – |
| SEARCH, 1 out of 7 signs | 2.0 (0.9 to 4.0) | 6.3 (0.2 to 30.2) | 98.2 (96.2 to 99.3) | 12.5 (0.3 to 52.7) | 96.1 (93.7 to 97.8) | 0.06 (0.11) |
| YIS7 | 6.8 (4.6 to 9.8) | 62.5 (35.4 to 84.8) | 95.5 (92.9 to 97.4) | 37.0 (19.4 to 57.6) | 98.4 (96.5 to 99.4) | 0.44 (0.00) |
| VSD computed using physicians' assessment | ||||||
| Mirzapur original 8-sign | 2.3 (1.0 to 4.3) | 43.8 (19.8 to 70.1) | 99.5 (98.1 to 99.9) | 77.8 (40.0 to 97.2) | 97.7 (95.6 to 98.9) | 0.55 (0.00) |
| Mirzapur revised 11-sign | 2.8 (1.4 to 4.9) | 50.0 (24.7 to 75.3) | 99.2 (97.7 to 99.8) | 72.7 (39.0 to 94.0) | 97.9 (95.9 to 99.1) | 0.58 (0.00) |
| SEARCH, 2 out of 7 signs | 1.3 (0.4 to 2.9) | 31.3 (11.0 to 58.7) | 100.0 (99.0 to 100.0) | 100.0 (47.8 to 100.0) | 97.2 (95.0 to 98.6) | 0.47 (0.00) |
| SEARCH, 1 out of 7 signs | 5.3 (3.3 to 8.0) | 50.0 (24.7 to 75.3) | 96.6 (94.2 to 98.2) | 38.1 (18.1 to 61.6) | 97.9 (95.8 to 99.1) | 0.41 (0.00) |
| YIS7 | 14.4 (11.1 to 18.3) | 56.3 (29.9 to 80.2) | 87.3 (83.6 to 90.5) | 15.8 (7.5 to 27.9) | 97.9 (95.8 to 99.2) | 0.20 (0.00) |
Screening was conducted to identify need for urgent referral-level evaluation for severe neonatal diseases. Lists of signs and symptoms for algorithms are presented in online supplementary table 1. Validity measures were not estimated.
↵* 97.5% one-sided CI.
NPV, negative predictive value; PPV, positive predictive value; VSD, very severe disease; SEARCH, Society for Education, Action and Research in Community Health; YIS7, Young Infant Study 7-sign.
Kappa statistic between the computed VSD based on child's assessment and referral need.