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Evaluation of the diagnostic accuracy of the Haemoglobin Colour Scale to detect anaemia in young children attending primary healthcare clinics in Zanzibar.
Trop Med Int Health. 2012 Apr; 17(4):423-9.TM

Abstract

OBJECTIVES

This study evaluates the diagnostic accuracy of Haemoglobin Colour Scale (HCS), compared with clinical diagnosis, to detect anaemia and severe anaemia in preschool-age children attending primary healthcare clinics in rural Zanzibar.

METHODS

In all participants, haemoglobin (Hb) concentration was independently estimated by clinical examination for palmar pallor, HCS and HemoCue™. HemoCue was considered the reference method. Data collection was integrated into the usual health services and performed by local healthcare workers (HCWs). Sensitivity, specificity, positive and negative predictive values were calculated for HCS and clinical examination for palmar pallor. The limits of agreement between HCS and HemoCue, and inter-observer variability for HCS, were also defined.

RESULTS

A total of 799 children age 2-59 months were recruited to the study. The prevalence of anaemia (Hb<11 g/dl) and severe anaemia (<5 g/dl) were 71% and 0.8% respectively. The sensitivity of HCS to detect anaemia was 33% [95% confidence interval (CI) 29-36] and specificity was 87% (83-91). The sensitivity of HCS to detect severe anaemia was 14% (95% CI 0-58) and specificity was 100% (99-100). The sensitivity of palmar pallor to detect anaemia was low, but superior to HCS (58% vs. 33%, P<0.001); specificity was inferior to HCS (55% vs. 87%, P<0.001). There was no evidence of a difference in either sensitivity (P>0.1) or specificity (P>0.1) between HCS and palmar pallor to detect severe anaemia.

CONCLUSIONS

Haemoglobin Colour Scale does not improve the capacity of HCWs to diagnose anaemia in this population. Accuracy is limited by considerable variability in the performances of test operators. However, optimizing the training protocol for those using the test may improve performance.

Authors+Show Affiliations

London School of Hygiene and Tropical Medicine, London, UK. katealdridgekate@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22296167

Citation

Aldridge, Catherine, et al. "Evaluation of the Diagnostic Accuracy of the Haemoglobin Colour Scale to Detect Anaemia in Young Children Attending Primary Healthcare Clinics in Zanzibar." Tropical Medicine & International Health : TM & IH, vol. 17, no. 4, 2012, pp. 423-9.
Aldridge C, Foster HM, Albonico M, et al. Evaluation of the diagnostic accuracy of the Haemoglobin Colour Scale to detect anaemia in young children attending primary healthcare clinics in Zanzibar. Trop Med Int Health. 2012;17(4):423-9.
Aldridge, C., Foster, H. M., Albonico, M., Ame, S. M., & Montresor, A. (2012). Evaluation of the diagnostic accuracy of the Haemoglobin Colour Scale to detect anaemia in young children attending primary healthcare clinics in Zanzibar. Tropical Medicine & International Health : TM & IH, 17(4), 423-9. https://doi.org/10.1111/j.1365-3156.2011.02944.x
Aldridge C, et al. Evaluation of the Diagnostic Accuracy of the Haemoglobin Colour Scale to Detect Anaemia in Young Children Attending Primary Healthcare Clinics in Zanzibar. Trop Med Int Health. 2012;17(4):423-9. PubMed PMID: 22296167.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluation of the diagnostic accuracy of the Haemoglobin Colour Scale to detect anaemia in young children attending primary healthcare clinics in Zanzibar. AU - Aldridge,Catherine, AU - Foster,Hamish M E, AU - Albonico,Marco, AU - Ame,Shaali M, AU - Montresor,Antonio, Y1 - 2012/02/01/ PY - 2012/2/3/entrez PY - 2012/2/3/pubmed PY - 2012/12/10/medline SP - 423 EP - 9 JF - Tropical medicine & international health : TM & IH JO - Trop. Med. Int. Health VL - 17 IS - 4 N2 - OBJECTIVES: This study evaluates the diagnostic accuracy of Haemoglobin Colour Scale (HCS), compared with clinical diagnosis, to detect anaemia and severe anaemia in preschool-age children attending primary healthcare clinics in rural Zanzibar. METHODS: In all participants, haemoglobin (Hb) concentration was independently estimated by clinical examination for palmar pallor, HCS and HemoCue™. HemoCue was considered the reference method. Data collection was integrated into the usual health services and performed by local healthcare workers (HCWs). Sensitivity, specificity, positive and negative predictive values were calculated for HCS and clinical examination for palmar pallor. The limits of agreement between HCS and HemoCue, and inter-observer variability for HCS, were also defined. RESULTS: A total of 799 children age 2-59 months were recruited to the study. The prevalence of anaemia (Hb<11 g/dl) and severe anaemia (<5 g/dl) were 71% and 0.8% respectively. The sensitivity of HCS to detect anaemia was 33% [95% confidence interval (CI) 29-36] and specificity was 87% (83-91). The sensitivity of HCS to detect severe anaemia was 14% (95% CI 0-58) and specificity was 100% (99-100). The sensitivity of palmar pallor to detect anaemia was low, but superior to HCS (58% vs. 33%, P<0.001); specificity was inferior to HCS (55% vs. 87%, P<0.001). There was no evidence of a difference in either sensitivity (P>0.1) or specificity (P>0.1) between HCS and palmar pallor to detect severe anaemia. CONCLUSIONS: Haemoglobin Colour Scale does not improve the capacity of HCWs to diagnose anaemia in this population. Accuracy is limited by considerable variability in the performances of test operators. However, optimizing the training protocol for those using the test may improve performance. SN - 1365-3156 UR - https://www.unboundmedicine.com/medline/citation/22296167/Evaluation_of_the_diagnostic_accuracy_of_the_Haemoglobin_Colour_Scale_to_detect_anaemia_in_young_children_attending_primary_healthcare_clinics_in_Zanzibar_ L2 - https://doi.org/10.1111/j.1365-3156.2011.02944.x DB - PRIME DP - Unbound Medicine ER -