Evaluation of the diagnostic accuracy of the HemoCue device for detecting anaemia in healthy school- aged children in KwaZulu-Natal, South Africa

Abstract

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.

Prevalence and risk factors of anaemia among ever-married women in Jordan

“…Third, most of variables measured in the study were self-reported, which make the results of study subject to recall and social desirability biases. Fourth, measuring serum haemoglobin concentration at the population level as an indicator of anaemia is considered the most reliable method as compared to other clinical measures (39,40). However, anaemia is a multifaceted condition that requires obtaining medical and family histories as well as physical examination for accurate diagnosis.…”

Comparison of haemoglobin assessments by HemoCue and two automated haematology analysers in young Laotian children

“…Our finding that capillary Hb concentrations by HemoCue Hb301 are significantly higher than venous Hb concentrations obtained with two different automated haematology analysers is consistent with some previous studies in pregnant women in Sudan 19 and Brazil, 36 blood donors in the USA 26 and different population subgroups (preschool children, school children, pregnant women, non-pregnant women and men) in Ghana, 25 but not with studies in women with genetic Hb disorders in Cambodia, 21 adults and children in Mexico, 29 blood donors in Ireland 38 and children in South Africa. 30 Time and position during blood collection 39 40 have been suggested to explain discrepancies between different devices and to influence the variability in Hb levels obtained by HemoCue. An additional source of error may be inadequate mixing of venous blood in the blood collection tube, which may lead to a reading of relatively more plasma rather than red blood cells by the automated analyser and would result in a lower Hb concentration.…”

Methods and analyzers for hemoglobin measurement in clinical laboratories and field settings

“…Eleven studies analyzed venous blood with eight comparisons finding higher mean Hb concentrations (2.0−16.0 g/L) by the Hb-201+ compared with the reference 8,19,54,103,104,106,107,139 and four comparisons found lower mean Hb concentrations (0.2−15.0 g/L). 64,115,147 Fourteen comparisons from 13 studies compared capillary blood with venous blood 8,54,64,65,103,[108][109][110][111][112][113][114]133 with 9 comparisons finding higher mean Hb concentrations (2.0−9.0 g/L). 8,54,103,108,[110][111][112][113] Five found a lower mean Hb concentration (2.6−13.0 g/L for all findings).…”

“…8,54,103,108,[110][111][112][113] Five found a lower mean Hb concentration (2.6−13.0 g/L for all findings). 64,65,109,114,115 When applying the mean concentration variation threshold of ±7% for the studies comparing the Hb-201+ with the reference, 27 of the 28 comparisons 8,19,54,64,65,104,[106][107][108][109][110][111][112][113][114]133,139,147 met the allowable degree of variation with one comparison from one study exceeding the ±7% bias 115 (Fig. 3A).…”