{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T19:09:07Z","timestamp":1779908947640,"version":"3.53.1"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2023,5,24]],"date-time":"2023-05-24T00:00:00Z","timestamp":1684886400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Birth asphyxia is a consistent key contributor to neonatal morbidity and mortality, notably in sub-Saharan Africa. The APGAR score, though a globally used diagnostic tool for birth asphyxia, remains largely understudied especially in resource-poor settings.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objective<\/jats:title>\n<jats:p>This study determined how effectively the APGAR score is used to diagnose birth asphyxia in comparison to the gold standard (umbilical cord blood pH &lt;7 with neurologic involvement) at Moi Teaching and Referral Hospital (MTRH), and identified healthcare provider factors that affect ineffective use of the score.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Using a quantitative cross-sectional hospital-based design, term babies born in MTRH who weighed \u22652500g were randomly and systematically sampled; and healthcare providers who assign APGAR scores were enrolled via a census. Umbilical cord blood was drawn at birth and at 5minutes for pH analysis. APGAR scores assigned by healthcare providers were recorded. Effective use of the APGAR score was determined by sensitivity, specificity, positive and negative predictive values. At a significance level of 0.05, multiple logistic regression analysis identified the independent provider-associated factors affecting ineffective use of the APGAR score.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>We enrolled 102 babies, and 50 (49%) were females. Among the 64 healthcare providers recruited, 40 (63%) were female and the median age was 34.5years [IQR: 31.0, 37.0]. Assigned APGAR scores had a sensitivity of 71% and specificity of 89%, with positive and negative predictive values of 62% and 92% respectively. Healthcare provider factors associated with ineffective APGAR score use included: instrumental delivery (OR: 8.83 [95% CI: 0.79, 199]), lack of access to APGAR scoring charts (OR: 56.0 [95% CI: 12.9, 322.3]), and neonatal resuscitation (OR: 23.83 [95% CI: 6.72, 101.99]).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Assigned APGAR scores had low sensitivity and positive predictive values. Healthcare provider factors independently associated with ineffective APGAR scoring include; instrumental delivery, lack of access to APGAR scoring charts, and neonatal resuscitation.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0285828","type":"journal-article","created":{"date-parts":[[2023,5,24]],"date-time":"2023-05-24T17:31:56Z","timestamp":1684949516000},"page":"e0285828","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":12,"title":["A comparative analysis of APGAR score and the gold standard in the diagnosis of birth asphyxia at a tertiary health facility in Kenya"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6407-7379","authenticated-orcid":true,"given":"Albertine Enjema","family":"Njie","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Winstone Mokaya","family":"Nyandiko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phinehas Ademi","family":"Ahoya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jude Suh","family":"Moutchia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,5,24]]},"reference":[{"issue":"10053","key":"pone.0285828.ref001","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1016\/S0140-6736(16)31575-6","article-title":"Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980\u20132015: a systematic analysis for the Global Burden of Disease Study 2015.","volume":"388","author":"H Wang","year":"2016","journal-title":"The Lancet"},{"key":"pone.0285828.ref002","article-title":"Child Mortality","author":"UNICEF for every child","year":"2021","journal-title":"UNICEF DATA"},{"key":"pone.0285828.ref003","first-page":"6","author":"B Yelamali","year":"2014","journal-title":"Outcome of newborn with birth asphyxia in tertiary care hospital\u2014a retrospective study"},{"issue":"1","key":"pone.0285828.ref004","doi-asserted-by":"crossref","first-page":"1328796","DOI":"10.1080\/16549716.2017.1328796","article-title":"Effectiveness of antenatal care services in reducing neonatal mortality in Kenya: analysis of national survey data.","volume":"10","author":"M Arunda","year":"2017","journal-title":"Global Health Action."},{"key":"pone.0285828.ref005","article-title":"Kenya Demographic and Health Survey 2014","author":"KDHS","year":"2014","journal-title":"Central Bureau of Statistics (CBS) [Kenya] Kenya Demographic and Health Survey."},{"issue":"5","key":"pone.0285828.ref006","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1007\/s40258-014-0103-z","article-title":"Examining the Influence of Antenatal Care Visits and Skilled Delivery on Neonatal Deaths in Ghana","volume":"12","author":"MP Lambon-Quayefio","year":"2014","journal-title":"Applied Health Economics and Health Policy"},{"issue":"8","key":"pone.0285828.ref007","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0159388","article-title":"When, Where, and Why Are Babies Dying? Neonatal Death Surveillance and Review in Bangladesh","volume":"11","author":"A Halim","year":"2016","journal-title":"PLoS ONE."},{"key":"pone.0285828.ref008","volume-title":"Every newborn: an action plan to end preventable deaths","author":"World Health Organization","year":"2014"},{"issue":"4","key":"pone.0285828.ref009","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1016\/j.ajog.2016.05.035","article-title":"Acidemia in neonates with a 5-minute Apgar score of 7 or greater\u2013What are the outcomes","volume":"215","author":"BA Sabol","year":"2016","journal-title":"American Journal of Obstetrics and Gynecology"},{"key":"pone.0285828.ref010","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s12887-015-0334-7","article-title":"Neonatal assessment in the delivery room\u2014Trial to Evaluate a Specified Type of Apgar (TEST-Apgar).","volume":"15","author":"M R\u00fcdiger","year":"2015","journal-title":"BMC pediatrics"},{"issue":"3","key":"pone.0285828.ref011","doi-asserted-by":"crossref","first-page":"e0122116","DOI":"10.1371\/journal.pone.0122116","article-title":"Comparison of the Four Proposed Apgar Scoring Systems in the Assessment of Birth Asphyxia and Adverse Early Neurologic Outcomes","volume":"10","author":"H Dalili","year":"2015","journal-title":"PLOS ONE."},{"issue":"2","key":"pone.0285828.ref012","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1515\/jpme.1994.22.2.129","article-title":"Diagnosis of severe birth asphyxia and early prediction of neonatal neurological outcome in term asphyxiated newborns","volume":"22","author":"JL Wayenberg","year":"1994","journal-title":"Journal of Perinatal Medicine"},{"issue":"5","key":"pone.0285828.ref013","first-page":"e1482","article-title":"American Academy of Pediatrics AA of. Neonatal Encephalopathy and Neurologic Outcome, Second Edition Report of the American College of Obstetricians and Gynecologists\u2019 Task Force on Neonatal Encephalopathy.","volume":"133","year":"2014","journal-title":"Pediatrics"},{"issue":"2","key":"pone.0285828.ref014","first-page":"5","volume":"7","author":"K Fares","year":"2019","journal-title":"Correlation between Umbilical Cord pH, Apgar Score and Pregnancy Outcome in High-Risk Pregnancy."},{"key":"pone.0285828.ref015","author":"American Academy of Pediatrics C on F and N","year":"2015","journal-title":"The Apgar Score | Pediatrics | American Academy of Pediatrics"},{"key":"pone.0285828.ref016","article-title":"Prediction of Neonatal Seizures in HIE by APGAR Score and Umbilical Cord Blood pH","author":"Rajah Muthiah Medical College Department of Pediatrics","year":"2018","journal-title":"jmscr"},{"key":"pone.0285828.ref017","author":"V Pathak","year":"2019","journal-title":"Relation between immediate postpartum APGAR score with umblical cord blood pH and fetal distress."},{"issue":"3","key":"pone.0285828.ref018","doi-asserted-by":"crossref","first-page":"e0264816","DOI":"10.1371\/journal.pone.0264816","article-title":"The magnitude of neonatal asphyxia and its associated factors among newborns in public hospitals of North Gondar Zone, Northwest Ethiopia: A cross-sectional study.","volume":"17","author":"FT Admasu","year":"2022","journal-title":"PLoS One."},{"issue":"2","key":"pone.0285828.ref019","doi-asserted-by":"crossref","first-page":"e0192232","DOI":"10.1371\/journal.pone.0192232","article-title":"Predicting mortality in extremely low birth weight infants: Comparison between gestational age, birth weight, Apgar score, CRIB II score, initial and lowest serum albumin levels.","volume":"13","author":"JH Park","year":"2018","journal-title":"PLOS ONE."},{"issue":"9","key":"pone.0285828.ref020","first-page":"668","article-title":"[Multicenter clinical study on umbilical cord arterial blood gas parameters for diagnosis of neonatal asphyxia].","volume":"48","author":"Parameters CSG of NUCBG","year":"2010","journal-title":"Zhonghua Er Ke Za Zhi = Chinese Journal of Pediatrics."},{"key":"pone.0285828.ref021","article-title":"Evaluation of a Comprehensive Delivery Room Neonatal Resuscitation and Adaptation Score (NRAS) Compared to the Apgar Score: A Pilot Study.","author":"SR Jurdi","year":"2015","journal-title":"Global Pediatric Health."},{"key":"pone.0285828.ref022","first-page":"238","article-title":"Factors affecting the differentiation of the Apgar score and the biochemical correlation of fetal well-being\u2014a prospective observational clinical study","volume":"22","author":"M Kostro","year":"2018","journal-title":"Developmental period medicine"},{"key":"pone.0285828.ref023","volume-title":"APGAR Score. In: StatPearls","author":"V Simon L","year":"2020"},{"issue":"1","key":"pone.0285828.ref024","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1186\/s12884-016-1141-3","article-title":"Helping Babies Breathe (HBB) training: What happens to knowledge and skills over time?","volume":"16","author":"A Bang","year":"2016","journal-title":"BMC pregnancy and childbirth."},{"issue":"10","key":"pone.0285828.ref025","doi-asserted-by":"crossref","first-page":"1666","DOI":"10.1111\/apa.13940","article-title":"Using quality improvement to decrease birth asphyxia rates after \u201cHelping Babies Breathe\u201d training in Kenya","volume":"106","author":"ARL Rule","year":"2017","journal-title":"Acta Paediatrica (Oslo, Norway: 1992)."},{"key":"pone.0285828.ref026","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.jbi.2014.02.013","article-title":"Sample size estimation in diagnostic test studies of biomedical informatics","volume":"48","author":"K. Hajian-Tilaki","year":"2014","journal-title":"Journal of Biomedical Informatics"},{"key":"pone.0285828.ref027","volume":"7","author":"A Chiabi","year":"2019","journal-title":"Relevance and Applicability of the Apgar Score in Current Clinical Practice"},{"issue":"4","key":"pone.0285828.ref028","doi-asserted-by":"crossref","first-page":"101146","DOI":"10.1016\/j.siny.2020.101146","article-title":"The fetal inflammatory response syndrome: the origins of a concept, pathophysiology, diagnosis, and obstetrical implications.","volume":"25","author":"E Jung","year":"2020","journal-title":"Seminars in Fetal and Neonatal Medicine."},{"key":"pone.0285828.ref029","article-title":"The newborn (Apgar) scoring system. Reflections and advice","author":"V. Apgar","year":"1966","journal-title":"Pediatric clinics of North America"},{"key":"pone.0285828.ref030","article-title":"European Society for Paediatric Research (ESPR) Neonatal Resuscitation Section Writing Group, et al. 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