Anaemia frequently occurs in association with an underlying condition and is linked to poor clinical outcomes. In school-aged children in sub-Saharan Africa, the prevalence of anaemia is reported to be high (affecting 25.4%). [1] There is, however, a notable paucity of data relating to haemoglobin (Hb) levels, onset and duration of anaemia, and the underlying illness causing the anaemia in schoolaged children. This is a significant deficiency, as any anaemia, even if it is mild, can compromise growth and development, irrespective of the underlying condition causing it. The Hb level is endorsed by the World Health Organization (WHO) as the universal indicator of anaemia at individual and population levels. [2] However, most reliable ways of measuring it require some automated equipment that is not readily available in primary healthcare centres or resource-poor settings. An accurate diagnostic test is essential for identifying suboptimal Hb levels and monitoring the response to interventions. The HemoCue method has some key advantages over the routinely used laboratory method. The HemoCue device measures Hb in a small sample of undiluted capillary or venous blood, is portable and user friendly, does not require access to refrigeration or electricity, gives immediate digitally displayed results, and is relatively inexpensive. This study assessed the HemoCue as an alternative point-of-care (POC) test for diagnosing anaemia and as a potential vehicle to improve coverage for anaemia screening programmes. We also determined a practical initial diagnostic approach that could assist in selecting an appropriate management strategy. Methods Design and participants We carried out a cross-sectional survey in a rural community living in an isolated mountainous part of western KwaZulu-Natal Province (KZN), South Africa. This study was an ancillary investigation in a larger longitudinal study measuring various health indicators and psychosocial needs of preschool and school-aged children. Data collection was integrated into the usual services at the research site as far as possible. One hundred and eighty-four consecutive children attending follow-up over a 4-month period were invited to take part in the current study.

EMLA cream was safe and effective for alleviating the pain associated with venepuncture in a fieldwork setting. We therefore believe that it merits a place in the routine premedication of children before phlebotomy and cannulation procedures in clinical settings, research studies and field surveys. Further research is recommended to assess whether EMLA cream can be used for immunisations.

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BackgroundAnaemia is one of the world’s most prevalent child health problems. Its control in Africa and other developing nations has been hindered by uncertainty regarding its cause. Anaemia control has been particularly problematic in regions where the non-iron deficiency causes of anaemia, are projected to be substantial. The implementation of effective interventions to reduce the anaemia prevalence, requires improved documentation on iron status and other causes of anaemia for target populations.MethodsThis cross-sectional study enrolled n = 184 children, aged 6–8 years from Kwazulu-Natal, South Africa. Tests of haemoglobin, serum ferritin, soluble transferrin receptor and C-reactive protein were performed. These conventional measures of iron status were used to calculate body iron and to categorize the children into different groups of anaemia profiles.ResultsAnaemia prevalence was high, 43/184 (23.4%). Iron deficiency anaemia contributed 7/43 (16.3%) to the anaemia prevalence compared to non-iron deficiency anaemia 34/43 (79.1%) and mixed anaemia 2/43 (4.7%). In total 47/184 (25.5%) of the sampled children had either iron deficiency or anaemia. Information about the presence of inflammation was used to adjust serum ferritin concentrations, resulting in improved diagnosis of iron deficiency.ConclusionAppropriate investigations for iron status and inflammation/infection screening, need to be integral in the evaluation of anaemia and its causes before anaemia control interventions are implemented. Interventions that target the multifactorial nature of anaemia in school-aged children need to be strengthened. Additionally, regular screening of anaemia in school-aged children from disadvantaged communities is recommended.

Anaemia impairs normal development in children and is implicated as both a cause and an effect of adverse social and economic family circumstances. [1] Global estimates of childhood anaemia indicate that 293.1 million children aged <5 years are anaemic worldwide, with 28.5% of these living in sub-Saharan Africa. [2] This high anaemia burden among children of sub-Saharan Africa is generally attributed to poverty, communicable diseases, food insecurity, HIV and other associated concerns such as access to healthcare and sanitation. [3] In South Africa (SA), where poor nutrition, poverty and poor parental education are prevalent, the implications are severe for children's future and for national development. Existing global solution strategies to control anaemia in early childhood such as micronutrient supplementation and breastfeeding support have been successful, though associated with questionable sustainability in terms of protecting children from developing anaemia after infancy. [3] A significant proportion of anaemia in school-aged children is attributed to iron deficiency. [2] Subclinical iron deficiency is even more common and has comparable developmental consequences. In the present study, anaemia was used as an indicator of deprived nutrition and poor health status. This study was conducted in a rural community from KwaZulu-Natal (KZN) province where the children are disadvantaged by poor socioeconomic circumstances. Although the association between anaemia and poverty has been described by various researchers, [1,3] the natural history of anaemia associated with poor social environments in young children is not yet well described. Methods Study population This was a longitudinal survey in KZN. This research was an ancillary study to a larger cohort study investigating the health and psychosocial needs of children. The parent study enrolled 1 787 children aged 4-6 years identified in a door-to-door survey in the Valley of a Thousand Hills. The current study was conducted when these children were undergoing follow-up assessments at ages of between 6 and 8 years. A total of 184 consecutive children over a 4-month period were invited to join this study. Diagnostic testing Haemoglobin (Hb) determination by HaemoCue (Angelholm, Sweden) was conducted by a clinician. Anaemia was defined using Hb levels. The World Health Organization (WHO)-recommended cutoffs were used to classify anaemia severity. Children aged up to 59 months had an Hb cutoff of 11.0 g/dL, and 11.5 g/dL was applied for children 5-11 years old. Children aged up to 59 months had anaemia categorised as mild for Hb levels 10.0-10.9 g/dL, moderate 7.0-9.9 g/dL and severe <7.0 g/dL, while for children 5-11 years of age anaemia was classified as mild with Hb levels 11.0-11.4 g/dL, moderate 8.0-10.9 g/dL and severe <8.0 g/dL [4] Stool and urine samples were collected and sent for microscopy at a local academic hospital. All caregivers and children were offered voluntary HIV counselling and testing.