Skip to main content
NCBI home page
Bulletin of the World Health Organization logoLink to Bulletin of the World Health Organization
. 1995;73(4):477–482.

Using clinical signs to diagnose anaemia in African children.

S P Luby 1, P N Kazembe 1, S C Redd 1, C Ziba 1, O C Nwanyanwu 1, A W Hightower 1, C Franco 1, L Chitsulo 1, J J Wirima 1, M A Olivar 1
PMCID: PMC2486784  PMID: 7554019

Abstract

Anaemia is a serious and common problem among young children in sub-Saharan Africa. As a first step towards developing guidelines for its recognition and treatment, we conducted a study to evaluate the ability of health workers to use clinical findings to identify children with anaemia. Health care workers examined a total of 1104 children under 5 years of age at two hospital-based outpatient clinics in rural Malawi. Blood samples were taken to determine haemoglobin concentrations. Pallor of the conjunctiva, tongue, palm or nail beds was 66% sensitive and 68% specific in distinguishing children with moderate a anaemia (haemoglobin concentration, 5-8 g/dl) and 93% sensitive and 57% specific in distinguishing those with severe anaemia (haemoglobin concentration, < 5 g/dl). Even without laboratory support, which is often unavailable in rural Africa, clinical findings can identify the majority of children with anaemia.

Full text

PDF
477

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aukett M. A., Parks Y. A., Scott P. H., Wharton B. A. Treatment with iron increases weight gain and psychomotor development. Arch Dis Child. 1986 Sep;61(9):849–857. doi: 10.1136/adc.61.9.849. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bhatia D., Seshadri S. Anemia, undernutrition and physical work capacity of young boys. Indian Pediatr. 1987 Feb;24(2):133–139. [PubMed] [Google Scholar]
  3. Cohen A. R., Seidl-Friedman J. HemoCue system for hemoglobin measurement. Evaluation in anemic and nonanemic children. Am J Clin Pathol. 1988 Sep;90(3):302–305. doi: 10.1093/ajcp/90.3.302. [DOI] [PubMed] [Google Scholar]
  4. DeMaeyer E., Adiels-Tegman M. The prevalence of anaemia in the world. World Health Stat Q. 1985;38(3):302–316. [PubMed] [Google Scholar]
  5. Gumodoka B., Vos J., Kigadye F. C., van Asten H., Dolmans W. M., Borgdorff M. W. Blood transfusion practices in Mwanza Region, Tanzania. Bugando Medical Centre. AIDS. 1993 Mar;7(3):387–392. doi: 10.1097/00002030-199303000-00013. [DOI] [PubMed] [Google Scholar]
  6. Jacobs H. D., Farndell P. R., Grobbelaar P. S., Smith D. J., Bromfield M. E. Observer bias and error in the integumentary clinical diagnosis of chronic anaemia. S Afr Med J. 1979 Jun 16;55(25):1031–1034. [PubMed] [Google Scholar]
  7. Lackritz E. M., Campbell C. C., Ruebush T. K., 2nd, Hightower A. W., Wakube W., Steketee R. W., Were J. B. Effect of blood transfusion on survival among children in a Kenyan hospital. Lancet. 1992 Aug 29;340(8818):524–528. doi: 10.1016/0140-6736(92)91719-o. [DOI] [PubMed] [Google Scholar]
  8. Lozoff B., Brittenham G. M., Wolf A. W., McClish D. K., Kuhnert P. M., Jimenez E., Jimenez R., Mora L. A., Gomez I., Krauskoph D. Iron deficiency anemia and iron therapy effects on infant developmental test performance. Pediatrics. 1987 Jun;79(6):981–995. [PubMed] [Google Scholar]
  9. Nardone D. A., Roth K. M., Mazur D. J., McAfee J. H. Usefulness of physical examination in detecting the presence or absence of anemia. Arch Intern Med. 1990 Jan;150(1):201–204. [PubMed] [Google Scholar]
  10. Obladen M., Sachsenweger M., Stahnke M. Blood sampling in very low birth weight infants receiving different levels of intensive care. Eur J Pediatr. 1988 May;147(4):399–404. doi: 10.1007/BF00496419. [DOI] [PubMed] [Google Scholar]
  11. Palti H., Pevsner B., Adler B. Does anemia in infancy affect achievement on developmental and intelligence tests? Hum Biol. 1983 Feb;55(1):183–194. [PubMed] [Google Scholar]
  12. Sanchez-Carrillo C. I. Bias due to conjunctiva hue and the clinical assessment of anemia. J Clin Epidemiol. 1989;42(8):751–754. doi: 10.1016/0895-4356(89)90071-1. [DOI] [PubMed] [Google Scholar]
  13. Strobach R. S., Anderson S. K., Doll D. C., Ringenberg Q. S. The value of the physical examination in the diagnosis of anemia. Correlation of the physical findings and the hemoglobin concentration. Arch Intern Med. 1988 Apr;148(4):831–832. [PubMed] [Google Scholar]
  14. Viljanto J. Effect of haematocrit on wound healing in children. Z Kinderchir. 1990 Jun;45(3):146–147. doi: 10.1055/s-2008-1042569. [DOI] [PubMed] [Google Scholar]
  15. Wurapa F. K., Bulsara M. K., Boatin B. A. Evaluation of conjunctival pallor in the diagnosis of anaemia. J Trop Med Hyg. 1986 Feb;89(1):33–36. [PubMed] [Google Scholar]
  16. Zwart A., Buursma A., Kwant G., Oeseburg B., Zijlstra W. G. Determination of total hemoglobin in whole blood: further tests of the "Hemocue" method. Clin Chem. 1987 Dec;33(12):2307–2308. [PubMed] [Google Scholar]
  17. von Schenck H., Falkensson M., Lundberg B. Evaluation of "HemoCue," a new device for determining hemoglobin. Clin Chem. 1986 Mar;32(3):526–529. [PubMed] [Google Scholar]

Articles from Bulletin of the World Health Organization are provided here courtesy of World Health Organization

RESOURCES