Evaluation of the Performance of Haemoglobin Colour Scale and Comparison with HemoCue Haemoglobin Assay in Diagnosing Childhood Anaemia: A Field Validation Study

BACKGROUND: Anaemia in children has high mortality. We present the results of assessment of the accuracy of Haemoglobin Colour Scale in identifying anaemia compared with HemoCue assay. METHODS: The presence of anaemia in 524 children from four communities was screened using the Haemoglobin Colour Scale (HCS) and HemoCue assay. Independent healthcare providers that estimated the haemoglobin level using Hb-301 haemoglobinometer were different from those that read the colour scale. The sensitivity, specificity, positive predictive value, and negative predictive value were estimated. RESULTS: Of the 524 children surveyed, 44.5% (233/524), 50% (262/524), and 32.2% (168/524) were found to be anaemic using the HemoCue, HCS (p= 0.25), and clinical pallor (p=0.03) respectively. Using the HemoCue as standard, the sensitivity of the HCS and clinical pallor was 89.1% and 72.1%, respectively, and specificity 90.2% and 84.6%, respectively. 74.7 % of the colour scale result was within the 1.0g/dl of the HemoCue reading and 23 % was within 2.0g/dl. CONCLUSION: The HCS can improve the ability to detect anaemia especially where the use of the HemoCue is not feasible as in the resource poor countries. However, every case of anaemia requires further investigation to determine the underlying causes.