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Brehm R, South A, George EC. Use of point-of-care haemoglobin tests to diagnose childhood anaemia in low- and middle-income countries: A systematic review. Trop Med Int Health 2024; 29:73-87. [PMID: 38044262 PMCID: PMC7615606 DOI: 10.1111/tmi.13957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
OBJECTIVES Anaemia is a major cause of mortality and transfusion in children in low- and middle-income countries (LMICs); however, current diagnostics are slow, costly and frequently unavailable. Point-of-care haemoglobin tests (POC(Hb)Ts) could improve patient outcomes and use of resources by providing rapid and affordable results. We systematically reviewed the literature to investigate what, where and how POC(Hb)Ts are being used by health facilities in LMICs to diagnose childhood anaemia, and to explore challenges to their use. METHODS We searched a total of nine databases and trial registries up to 10 June 2022 using the concepts: anaemia, POC(Hb)T, LMIC and clinical setting. Adults ≥21 years and literature published >15 years ago were excluded. A single reviewer conducted screening, data extraction and quality assessment (of diagnostic studies) using QUADAS-2. Outcomes including POC(Hb)T used, location, setting, challenges and diagnostic accuracy were synthesised. RESULTS Of 626 records screened, 41 studies were included. Evidence is available on the use of 15 POC(Hb)Ts in hospitals (n = 28, 68%), health centres (n = 9, 22%) and clinics/units (n = 10, 24%) across 16 LMICs. HemoCue (HemoCue AB, Ängelholm, Sweden) was the most used test (n = 31, 76%). Key challenges reported were overestimation of haemoglobin concentration, clinically unacceptable limits of agreement, errors/difficulty in sampling, environmental factors, cost, inter-observer variability and supply of consumables. Five POC(Hb)Ts (33%) could not detect haemoglobin levels below 4.5 g/dL. Diagnostic accuracy varied, with sensitivity and specificity to detect anaemia ranging from 24.2% to 92.2% and 70% to 96.7%, respectively. CONCLUSIONS POC(Hb)Ts have been successfully utilised in health facilities in LMICs to diagnose childhood anaemia. However, limited evidence is available, and challenges exist that must be addressed before wider implementation. Further research is required to confirm accuracy, clinical benefits and cost-effectiveness.
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Affiliation(s)
- Rebecca Brehm
- Institute of Clinical Trials and Methodology, UCL, London, UK
| | - Annabelle South
- Medical Research Council Clinical Trials Unit (MRC CTU), University College London, London, UK
| | - Elizabeth C George
- Medical Research Council Clinical Trials Unit (MRC CTU), University College London, London, UK
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Um S, Cope MR, Muir JA. Child anemia in Cambodia: A descriptive analysis of temporal and geospatial trends and logistic regression-based examination of factors associated with anemia in children. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002082. [PMID: 37713392 PMCID: PMC10503718 DOI: 10.1371/journal.pgph.0002082] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/16/2023] [Indexed: 09/17/2023]
Abstract
Anemia in children remains a public health concern in many resource-limited countries. To better understand child anemia in Cambodia, we examined temporal and geospatial trends of childhood anemia and used logistic regression to analyze its association with individual and household characteristics using data from the Cambodia Demographic and Health Surveys for 2005, 2010, and 2014. The prevalence of childhood anemia decreased from 62.2% in 2005 to 56.6% in 2014. The prevalence of childhood anemia was highest in Pursat (84.3%) for 2005, Kampong Thom (67%) for 2010, and Preah Vihear and Steung Treng (68.6%) for 2014. After adjusting for other variables, factors positively associated with childhood anemia included having a mother who was anemic (adjusted odds ratio (AOR) = 1.77, 95% CI: 1.58-1.97); being male vs. female (AOR = 1.20, 95% CI: 1.07-1.33), underweight (AOR = 1.24, 95% CI: 1.14-1.57), or stunted (AOR = 1.24, 95% CI: 1.09-1.41); or having had a recent episode of fever (AOR = 1.16, 95% CI: 1.03-1.31). Children were less likely to have anemia if they were older than 12 months. They were also less likely to have anemia if they were from a wealthier household (AOR = 0.64; 95% CI: 0.50-0.84) or had taken medications for intestinal parasites (AOR = 0.86; 95% CI: 0.89-0.93). These associations were generally consistent across time and space. Public health interventions and policies to alleviate anemia should be prioritized to address these factors across geospatial divides. Anemia remains highly prevalent among children aged 6-59 months in Cambodia.
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Affiliation(s)
- Samnang Um
- The National Institute of Public Health, Tuol Kork District, Phnom Penh, Cambodia
| | - Michael R. Cope
- Department of Sociology, Brigham Young University, Provo, Utah, United States of America
| | - Jonathan A. Muir
- The Global Health Institute, Emory University, Atlanta, Georgia, United States of America
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Abu-Sulb A, Al-Najjar R, Maghnam R, Ashhab A. Acid-suppressive therapy among infants and risk of anemia at 12 months of age. SAGE Open Med 2022; 10:20503121221123117. [PMID: 36105547 PMCID: PMC9465608 DOI: 10.1177/20503121221123117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: Numerous studies have shown that links exist between exposure to acid
suppression among adults and nutritional deficiencies, especially vitamin
B12 and iron. While the use of acid suppression among children and infants
is common, nutritional deficiency remains a concern but does not have
numerous studies to support it. We conducted a cohort study to examine this
concern; the hypothesis we proposed is that acid-suppressive therapy (AST)
during infancy is linked to anemia in the first year of life. Methods: This retrospective cohort study included infants born between 2017 and 2018
who visited Legacy Community Health. The inclusion criteria were exposure to
acid suppression for a minimum of 1 month and a hemoglobin reading at
12–15 months. Infants who had hemoglobinopathies, failure to thrive, or
malabsorption syndromes were excluded. Mean hemoglobin was calculated, and
student’s t-test was applied to find statistical
differences between the two groups. Change in weight before and after
treatment was recorded. Occurrence of respiratory and gastroenterological
adverse events was recorded in the exposed group. Results: Overall, 135 exposed infants were identified 135 controls were selected. The
majority of the sample included Hispanic girls. Ranitidine was the most
commonly prescribed medicine. The duration of treatment was 3 months. Weight
improved significantly at termination of the treatment. There was no
significant difference between the hemoglobin level of cases and controls,
and both were not considered anemic. Conclusion: AST was not linked to anemia, despite the slightly lower hemoglobin in some
cases. There were few weaknesses in our study; therefore, further studies
can examine this link by focusing further on medication type and close
follow-up. We found that although proton pump inhibitors are considered the
first line of treatment, histamine-2 receptor antagonists were more
frequently prescribed. Strategies to familiarize general pediatricians with
the NSAPGHAN guidelines might be needed.
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Affiliation(s)
- Ahmad Abu-Sulb
- Division of Pediatrics, Legacy Community Health, Houston, TX, USA
| | - Rawan Al-Najjar
- Division of Neonatology, Baylor College of Medicine, Houston, TX, USA
| | - Rama Maghnam
- Department of Pediatrics, Monmouth Medical Center, Long Branch, NJ, USA
| | - Ashraf Ashhab
- Division of Digestive & Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Al-Jermmy ASM, Idris SM, Coulibaly-Zerbo F, Nasreddine L, Al-Jawaldeh A. Prevalence and Correlates of Anemia among Adolescents Living in Hodeida, Yemen. CHILDREN 2022; 9:children9070977. [PMID: 35883960 PMCID: PMC9322810 DOI: 10.3390/children9070977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 11/28/2022]
Abstract
This study assesses the prevalence and correlates of anemia among adolescents living in the war-affected region of Hodeida in Yemen. A secondary objective was to examine the effect of a nutrition education intervention on hemoglobin levels among anemic adolescents. A cross-sectional study was conducted on a random sample of adolescents aged 15–19 years in Hodeida (n = 400). A questionnaire was administered to inquire about demographic, socioeconomic, lifestyle and clinical characteristics. Capillary blood was obtained, anthropometric characteristics were measured and stool samples were collected. As for the secondary objective, anemic adolescents were randomly assigned to an intervention group (nutrition education and iron supplementation) and a control group (iron supplements only). The prevalence of anemia was 37.8%. Female gender, khat chewing, excessive menstruation, and experiencing headaches, fatigue, or dizziness were independent predictors of anemia. In contrast, adolescents who attended private schools, and reported snack consumption or handwashing had a significantly lower risk of anemia. A sample of 116 adolescents participated in the intervention (3 months). Hemoglobin levels were significantly higher in the intervention group compared to the control. Our findings contribute to the identification of high-risk groups that should be targeted by context-specific interventions. The implemented multicomponent intervention may serve as a prototype for larger-scale preventive programs.
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Affiliation(s)
| | - Shadia Mohamed Idris
- College of Public and Environmental Health, University of Bahri, Khartoum 12217, Sudan;
| | | | - Lara Nasreddine
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 11-0236, Lebanon
- Correspondence: ; Tel.: +961-1-350000 (ext. 4547)
| | - Ayoub Al-Jawaldeh
- Regional Office for the Eastern Mediterranean (EMRO), World Health Organization (WHO), Cairo 7608, Egypt;
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Field Experiences with Handheld Diagnostic Devices to Triage Children under Five Presenting with Severe Febrile Illness in a District Hospital in DR Congo. Diagnostics (Basel) 2022; 12:diagnostics12030746. [PMID: 35328299 PMCID: PMC8947034 DOI: 10.3390/diagnostics12030746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 12/10/2022] Open
Abstract
As part of a field study (NCT04473768) in children presenting with severe febrile illness to Kisantu hospital (DR Congo), we retrospectively compiled user experiences (not performance) with handheld diagnostic devices assisting triage: tympanic thermometer, pulse oximeter (measuring heart rate, respiratory rate and oxygen saturation), hemoglobinometer and glucometer. Guidance documents for product selection were generic and scattered. Stock rupture, market withdrawal and unaffordable prices interfered with procurement. Challenges at implementation included environmental temperature, capillary blood sampling (antisepsis, order of multiple tests, filling microcuvettes and glucose strips), calibration (environmental temperature, cold chain) and liability-oriented communication with a manufacturer. Instructions for use were readable and contained symbol keys; two devices had printed French-language instructions. Shortcomings were poor integration of figures with text and distinct procedures for the oximeter and its sensor. Usability interview revealed appreciations for quick results, visibility of the display and memory function (three devices) but also problems of capillary blood sample transfer, cleaning, too long of a time-to-results (respiratory rate) and size, fitting and disposal of thermometer probes. Pictorial error messages were preferred over alphanumeric error codes but interpretation of symbols was poor. Alarm sounds of the oximeter caused unrest in children and caretakers perceived the device as associated with poor prognosis.
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An R, Huang Y, Man Y, Valentine RW, Kucukal E, Goreke U, Sekyonda Z, Piccone C, Owusu-Ansah A, Ahuja S, Little JA, Gurkan UA. Emerging point-of-care technologies for anemia detection. LAB ON A CHIP 2021; 21:1843-1865. [PMID: 33881041 PMCID: PMC8875318 DOI: 10.1039/d0lc01235a] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Anemia, characterized by low blood hemoglobin level, affects about 25% of the world's population with the heaviest burden borne by women and children. Anemia leads to impaired cognitive development in children, as well as high morbidity and early mortality among sufferers. Anemia can be caused by nutritional deficiencies, oncologic treatments and diseases, and infections such as malaria, as well as inherited hemoglobin or red cell disorders. Effective treatments are available for anemia upon early detection and the treatment method is highly dependent on the cause of anemia. There is a need for point-of-care (POC) screening, early diagnosis, and monitoring of anemia, which is currently not widely accessible due to technical challenges and cost, especially in low- and middle-income countries where anemia is most prevalent. This review first introduces the evolution of anemia detection methods followed by their implementation in current commercially available POC anemia diagnostic devices. Then, emerging POC anemia detection technologies leveraging new methods are reviewed. Finally, we highlight the future trends of integrating anemia detection with the diagnosis of relevant underlying disorders to accurately identify specific root causes and to facilitate personalized treatment and care.
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Affiliation(s)
- Ran An
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Glennan Building, Cleveland, OH 44106, USA.
| | - Yuning Huang
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Glennan Building, Cleveland, OH 44106, USA.
| | - Yuncheng Man
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Glennan Building, Cleveland, OH 44106, USA.
| | - Russell W Valentine
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Glennan Building, Cleveland, OH 44106, USA.
| | - Erdem Kucukal
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Glennan Building, Cleveland, OH 44106, USA.
| | - Utku Goreke
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Glennan Building, Cleveland, OH 44106, USA.
| | - Zoe Sekyonda
- Biomedical Engineering Department, Case Western Reserve University, Cleveland, OH, USA
| | - Connie Piccone
- Department of Pediatric Hematology, Carle Foundation Hospital, Urbana, IL, USA
| | - Amma Owusu-Ansah
- Department of Pediatrics, Division of Hematology and Oncology, University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA
| | - Sanjay Ahuja
- Department of Pediatrics, Division of Hematology and Oncology, University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA
| | - Jane A Little
- Division of Hematology & UNC Blood Research Center, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Umut A Gurkan
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Glennan Building, Cleveland, OH 44106, USA. and Biomedical Engineering Department, Case Western Reserve University, Cleveland, OH, USA and Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
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Ramaswamy G, Vohra K, Yadav K, Kaur R, Rai T, Jaiswal A, Kant S. Point-of-Care Testing Using Invasive and Non-Invasive Hemoglobinometers: Reliable and Valid Method for Estimation of Hemoglobin among Children 6-59 Months. J Trop Pediatr 2021; 67:6047276. [PMID: 33367788 DOI: 10.1093/tropej/fmaa111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Globally around 47.4% of children and in India, 58% of children aged 6-59 months are anemic. Diagnosis of anemia in children using accurate technologies and providing adequate treatment is essential to reduce the burden of anemia. Point-of-care testing (POCT) devices is a potential option for estimation of hemoglobin in peripheral and field settings were the hematology analyzer and laboratory services are not available. OBJECTIVES To access the validity of the POCTs (invasive and non-invasive devices) for estimation of hemoglobin among children aged 6-59 months compared with hematology analyzer. METHODS The study participants were enrolled from the pediatric outpatient department in Haryana, India, from November 2019 to January 2020. Hemoglobin levels of the study participants were estimated in Sahli's hemoglobinometer and invasive digital hemoglobinometers (DHs) using capillary blood samples. Hemoglobin levels in non-invasive DH were assessed from the finger/toe of the children. Hemoglobin levels measured in POCTs were compared against the venous blood hemoglobin estimated in the hematology analyzer. RESULTS A total of 120 children were enrolled. The mean (SD) of hemoglobin (g/dl) estimated in auto-analyzer was 9.4 (1.8), Sahli's hemoglobinometer was 9.2 (1.9), invasive DH was 9.7 (1.9), and non-invasive DH was 11.9 (1.5). Sahli's hemoglobinometer (95.5%) and invasive DH (92.2%) had high sensitivity for the diagnosis of anemia compared with non-invasive DH (24.4%). In contrast, non-invasive DH had higher specificity (96.7%) compared with invasive DH (83.3%) and Sahli's hemoglobinometer (70%). Invasive DH took the least time (2-3 min) for estimation of hemoglobin per participant, followed by Sahli's (4-5 min) and non-invasive DH (5-7 min). CONCLUSION All three POCT devices used in this study are reasonable and feasible for estimating hemoglobin in under-5 children. Invasive DHs are potential POCT devices for diagnosis of anemia among under-5 children, while Sahli's can be considered as a possible option, where trained and skilled technicians are available. Further research and development are required in non-invasive DH to improve accuracy. Lay summaryIn India, anemia is a serious public health problem, where 58% of the children aged 6-59 months are anemic. Point-of-care testing (POCT) using digital hemoglobinometers (DHs) has been recommended as one of the key interventions by the Anemia Mukt Bharat program since 2018 in India. These POCT devices are easy to use, less invasive, can be carried to field, require minimal training and results are available immediately. Therefore this study assessed the validity of POCT devices-invasive DH, non-invasive DH and Sahli's hemoglobinometer among 6-59 months children in facility setting compared with the gold standard hematology analyzer. A total of 120 children under 6-59 months of age were enrolled from the pediatric outpatient department in Haryana, India, from November 2019 to January 2020. The (mean hemoglobin in g/dl) invasive (9.7) and non-invasive DH (11.9) overestimated hemoglobin value, while Sahli's (9.2) underestimated hemoglobin compared with hematology analyzer (9.4). Invasive DH (92.2%) and Sahli's hemoglobinometer (95.5%) reported high ability to correctly identify those with anemia compared with non-invasive DH (24.4%). In contrast, non-invasive DH (96.73%) had higher ability to correctly identify those without the anemia compared with invasive DH (83.3%) and Sahli's (70%).
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Affiliation(s)
- Gomathi Ramaswamy
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Kashish Vohra
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Kapil Yadav
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Ravneet Kaur
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Tripti Rai
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Abhishek Jaiswal
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Shashi Kant
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi 110029, India
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Mahapatra S, Parker ME, Dave N, Zobrist SC, Shajie Arul D, King A, Betigeri A, Sachdeva R. Micronutrient-fortified rice improves haemoglobin, anaemia prevalence and cognitive performance among schoolchildren in Gujarat, India: a case-control study. Int J Food Sci Nutr 2021; 72:690-703. [PMID: 33427528 DOI: 10.1080/09637486.2020.1855126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Anaemia is a public health problem in India. A case-control, quasi-experimental study was conducted to evaluate the effect of a multiple micronutrient fortified rice intervention among school children (6-12 years) through the midday meal programme in Gujarat, India, over 8 months. The fortified rice provided approximately 10% Recommended Dietary Allowance of iron; 25-33% of vitamin A, thiamine, niacin and vitamin B6; and 100% of folic acid and vitamin B12. Outcomes of interest included haemoglobin concentration, anaemia prevalence, and cognitive performance. Cognitive performance was evaluated using J-PAL-validated Pratham reading and mathematics testing tools. 973 children completed the study (cases n = 484; controls n = 489). The intervention significantly increased mean haemoglobin by 0.4 g/dL (p = 0.001), reduced anaemia prevalence by 10% (p < 0.00001), and improved average cognitive scores by 11.3 points (p < 0.001). Rice fortification can help address anaemia in settings where rice is a staple food.
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Affiliation(s)
- Sudip Mahapatra
- Maternal, Newborn, Child Health and Nutrition Division, PATH, New Delhi, India
| | - Megan E Parker
- Maternal, Newborn, Child Health and Nutrition Division, PATH, Seattle, WA, USA
| | - Niraj Dave
- Nielsen India Pvt. Ltd., Gurugram, India
| | - Stephanie C Zobrist
- Maternal, Newborn, Child Health and Nutrition Division, PATH, Seattle, WA, USA
| | - Danie Shajie Arul
- Maternal, Newborn, Child Health and Nutrition Division, PATH, New Delhi, India
| | - Allie King
- Maternal, Newborn, Child Health and Nutrition Division, PATH, Seattle, WA, USA
| | - Arvind Betigeri
- Maternal, Newborn, Child Health and Nutrition Division, PATH, New Delhi, India
| | - Ruchika Sachdeva
- Maternal, Newborn, Child Health and Nutrition Division, PATH, New Delhi, India
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Hermoza L, De La Cruz J, Fernandez E, Castaneda B. Development of a Semaphore of Anemia: Screening Method Based on Photographic Images of the Ungueal Bed Using a Digital Camera. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:1931-1935. [PMID: 33018380 DOI: 10.1109/embc44109.2020.9176017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Anemia is a disease present worldwide. High prevalence of anemia (43%) is found in the child population and its main long-term effect (slow cognitive development) can remain even if the disease has disappeared. One of the main reasons for the high prevalence of anemia in Peru is the poor screening coverage during the growth of the child due to the parents' fear of infringing pain on their children. We take advantage that anemia produces pallor in the hands, fingers and ungueal bed to develop a semaphore for this disease. This screening tool uses photographic images of the patient's ungueal bed to determine if they have a high, medium or low possibility of having anemia. Sixty people participated in the study and 6 photographic images for each participant's right hand were captured. The images were processed to extract regions of interest from each of the fingernails. Datasets were generated and a neural network was used to predict the risk of anemia. Initial results show that the proposed semaphore of anemia reaches a sensitivity of 0.79 and specificity of 0.91. These results indicate that the semaphore of anemia may be used as a screening method to reduce the number of blood tests and the time of evaluation from 15 minutes (rapid test with portable hemoglobinometer) to 1 minute.
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Carneiro LBV, Castro IRRD, Juvanhol LL, Gomes FDS, Cardoso LDO. Associação entre insegurança alimentar e níveis de hemoglobina e retinol em crianças assistidas pelo Sistema Único de Saúde no Município do Rio de Janeiro, Brasil. CAD SAUDE PUBLICA 2020; 36:e00243418. [DOI: 10.1590/0102-311x00243418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 05/20/2019] [Indexed: 11/22/2022] Open
Abstract
Neste trabalho foi analisada a associação entre insegurança alimentar e níveis de hemoglobina e retinol em crianças de 6 a 59 meses de idade. Trata-se de um estudo seccional, realizado em 2014, com amostra representativa da população de crianças nessa faixa etária, atendidas em unidades básicas de saúde do Município do Rio de Janeiro, Brasil. Para a análise dos níveis de insegurança alimentar foi utilizada a Escala Brasileira de Insegurança Alimentar e, para a determinação de hemoglobina e de retinol sérico, foi realizada a punção venosa. A associação entre as variáveis foi avaliada por intermédio de modelos de regressão quantílica. Do total de crianças estudadas, 40,3% apresentavam insegurança alimentar e as prevalências de anemia e de deficiência de vitamina A foram 13,7% e 13%, respectivamente. Os resultados do estudo revelaram associação inversa, estatisticamente significativa, entre insegurança alimentar leve e níveis de retinol. Para os demais níveis de insegurança alimentar (moderada e grave), os resultados também sugerem a presença de associação inversa para hemoglobina e, quanto aos níveis de retinol, as estimativas pontuais parecem menores em crianças com insegurança alimentar grave, entretanto, estas estimativas não foram estatisticamente significativas. Esses resultados sugerem que a insegurança alimentar pode estar associada com carências de micronutrientes em crianças menores de 5 anos.
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Didzun O, De Neve JW, Awasthi A, Dubey M, Theilmann M, Bärnighausen T, Vollmer S, Geldsetzer P. Anaemia among men in India: a nationally representative cross-sectional study. LANCET GLOBAL HEALTH 2019; 7:e1685-e1694. [DOI: 10.1016/s2214-109x(19)30440-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/20/2019] [Accepted: 09/25/2019] [Indexed: 02/07/2023]
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12
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Yadav K, Kant S, Ramaswamy G, Ahamed F, Jacob OM, Vyas H, Kaur R, Malhotra S, Haldar P. Validation of Point of Care Hemoglobin Estimation Among Pregnant Women Using Digital Hemoglobinometers (HemoCue 301 and HemoCue 201+) as Compared with Auto-Analyzer. Indian J Hematol Blood Transfus 2019; 36:342-348. [PMID: 32425387 DOI: 10.1007/s12288-019-01196-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 09/25/2019] [Indexed: 01/03/2023] Open
Abstract
Accurate and reliable point of care tests (POCTs) for hemoglobin estimation is essential for early diagnosis and management of anemia. This study was aimed to assess the reliability and validity of two versions of digital hemoglobinometer (HemoCue 201+ and HemoCue 301) compared to the gold standard Sysmex autoanalyzer for hemoglobin estimation. Pregnant women attending antenatal clinics of Primary Health Centre and a Sub Divisional Hospital in Haryana, India, were recruited. After obtaining consent, capillary blood samples were collected and tested for hemoglobin levels with digital hemoglobinometers (HemoCue 201+ and HemoCue 301). Among same pregnant women venous blood was collected and hemoglobin levels were estimated using autoanalyzer. Validity and reliability of POCTs compared to Sysmex autoanalyzer were reported. Of the 102 pregnant women included in the study, 44 (43%) were primigravida, with mean (SD) age of 23.3 (3.4) years. The mean (SD) of difference in hemoglobin levels using HemoCue 201+ was - 0.53 (1.01) and using HemoCue 301 was - 0.25 (0.85) g/dL as compared to auto-analyzer. Lin's concordance coefficient was 0.80 for HemoCue 201+ and 0.85 for HemoCue 301. Weighted Cohen's Kappa indicated moderate degree of agreement with the gold standard. Sensitivity (HemoCue 201+: 93%; HemoCue 301: 90%) and specificity (HemoCue 201: 76% HemoCue 301: 80%) for detecting anemia was similar for both the POCT devices. The digital hemoglobinometers used in the study had moderate degree of agreement and concordance with the autoanalyzer for hemoglobin estimation. HemoCue 301 had higher validity as compared to HemoCue 201+.
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Affiliation(s)
- Kapil Yadav
- 4Room No: 33, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shashi Kant
- 1Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Gomathi Ramaswamy
- 2National Centre of Excellence and Advanced Research on Anemia Control, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Farhad Ahamed
- 1Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Olivia Marie Jacob
- 1Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Himani Vyas
- 3All India Institute of Medical Sciences, New Delhi, India
| | - Ravneet Kaur
- 1Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sumit Malhotra
- 1Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Partha Haldar
- 1Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
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Invasive and non-invasive point-of-care testing and point-of-care monitoring of the hemoglobin concentration in human blood – how accurate are the data? BIOMED ENG-BIOMED TE 2019; 64:495-506. [DOI: 10.1515/bmt-2018-0066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 09/11/2018] [Indexed: 11/15/2022]
Abstract
Abstract
In this review, scientific investigations of point-of-care testing (POCT) and point-of-care monitoring (POCM) devices are summarized with regard to the measurement accuracy of the hemoglobin concentration. As a common basis, information according to the Bland and Altman principle [bias, limits of agreement (LOA)] as well as the measurement accuracy and precision are considered, so that the comparability can be mapped. These collected data are subdivided according to the manufacturers, devices and procedures (invasive and non-invasive). A total of 31 devices were identified. A comparability of the scientific investigations in particular was given for 23 devices (18 invasive and five non-invasive measuring devices). In terms of measurement accuracy, there is a clear leap between invasive and non-invasive procedures, while no discernible improvement can be derived in the considered time frame from 2010 to 2018. According to the intended use, strict specifications result from the clinical standards, which are insufficiently met by the systems. More stringent requirements can be derived both in the area of blood donation and in the treatment of patients.
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Whitehead RD, Mei Z, Mapango C, Jefferds MED. Methods and analyzers for hemoglobin measurement in clinical laboratories and field settings. Ann N Y Acad Sci 2019; 1450:147-171. [PMID: 31162693 DOI: 10.1111/nyas.14124] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/22/2019] [Accepted: 05/02/2019] [Indexed: 01/17/2023]
Abstract
This paper describes and compares methods and analyzers used to measure hemoglobin (Hb) in clinical laboratories and field settings. We conducted a literature review for methods used to measure Hb in clinical laboratories and field settings. We described methods to measure Hb and factors influencing results. Automated hematology analyzer (AHA) was reference for all Hb comparisons using evaluation criteria of ±7% set by College of American Pathologists (CAP) and Clinical Laboratory Improvement Amendments (CLIA). Capillary fingerprick blood usually produces higher Hb concentrations compared with venous blood. Individual drops produced lower concentrations than pooled capillary blood. Compared with the AHA: (1) overall cyanmethemoglobin (1.0-8.0 g/L), WHO Colour Scale (0.5-10.0 g/L), paper-based devices (5.0-7.0 g/L), HemoCue® Hb-201 (1.0-16.0 g/L) and Hb-301 (0.5-6.0 g/L), and Masimo Pronto® (0.3-14.0 g/L) overestimated concentrations; (2) Masimo Radical®-7 both under- and overestimated concentrations (0.3-104.0 g/L); and (3) other methods underestimated concentrations (2.0-16.0 g/L). Most mean concentration comparisons varied less than ±7% of the reference. Hb measurements are influenced by several analytical factors. With few exceptions, mean concentration bias was within ±7%, suggesting acceptable performance. Appropriate, high-quality methods in all settings are necessary to ensure the accuracy of Hb measurements.This paper describes and compares methods and analyzers used to measure hemoglobin (Hb) in clinical laboratories and field settings. With few exceptions, mean concentration bias was within ±7%, suggesting acceptable performance. Appropriate, high-quality methods in all settings are necessary to ensure the accuracy of Hb measurements.
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Affiliation(s)
- Ralph D Whitehead
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Zuguo Mei
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carine Mapango
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maria Elena D Jefferds
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Ntenda PAM, Nkoka O, Bass P, Senghore T. Maternal anemia is a potential risk factor for anemia in children aged 6-59 months in Southern Africa: a multilevel analysis. BMC Public Health 2018; 18:650. [PMID: 29788935 PMCID: PMC5964691 DOI: 10.1186/s12889-018-5568-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/15/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The effect of maternal anemia on childhood hemoglobin status has received little attention. Thus, we examined the potential association between maternal anemia and childhood anemia (aged 6-59 months) from selected Southern Africa countries. METHODS A cross-sectional study using nationally representative samples of children aged 6-59 months from the 2010 Malawi, 2011 Mozambique, 2013 Namibia, and 2010-11 Zimbabwe demographic and health surveys (DHS) was conducted. Generalized linear mixed models (GLMMs) were constructed to test the associations between maternal anemia and childhood anemia, controlling for individual and community sociodemographic covariates. RESULTS The GLMMs showed that anemic mothers had increased odds of having an anemic child in all four countries; adjusted odds ratio (aOR = 1.69 and 95% confidence interval [CI]:1.37-2.13) in Malawi, (aOR = 1.71; 95% CI: 1.37-2.13) in Mozambique, (aOR = 1.55; 95% CI: 1.08-2.22) in Namibia, and (aOR = 1.52; 95% CI: 1.25-1.84) in Zimbabwe. Furthermore, the odds of having an anemic child was higher in communities with a low percentage of anemic mothers (aOR = 1.52; 95% CI: 1.19-1.94) in Mozambique. CONCLUSIONS Despite the long-standing efforts to combat childhood anemia, the burden of this condition is still rampant and remains a significant problem in Southern Africa. Thus, public health strategies aimed at reducing childhood anemia should focus more on addressing infections, and micronutrient deficiencies both at individual and community levels in Southern Africa.
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Affiliation(s)
- Peter A. M. Ntenda
- School of Public Health, College of Public Health, Taipei Medical University, No.250, Wu-Hsing St, Taipei City, 110 Taiwan, R.O.C
| | - Owen Nkoka
- School of Public Health, College of Public Health, Taipei Medical University, No.250, Wu-Hsing St, Taipei City, 110 Taiwan, R.O.C
| | - Paul Bass
- School of Public Health, College of Public Health, Taipei Medical University, No.250, Wu-Hsing St, Taipei City, 110 Taiwan, R.O.C
- School of Medicine and Allied Health Sciences, University of The Gambia, P.O. Box 1646, Independence Drive, Banjul, The Gambia
| | - Thomas Senghore
- School of Public Health, College of Public Health, Taipei Medical University, No.250, Wu-Hsing St, Taipei City, 110 Taiwan, R.O.C
- School of Medicine and Allied Health Sciences, University of The Gambia, P.O. Box 1646, Independence Drive, Banjul, The Gambia
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Feng X, Li G, Yu H, Wang S, Yi X, Lin L. Wavelength selection for portable noninvasive blood component measurement system based on spectral difference coefficient and dynamic spectrum. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2018; 193:40-46. [PMID: 29223052 DOI: 10.1016/j.saa.2017.10.063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 10/21/2017] [Accepted: 10/25/2017] [Indexed: 06/07/2023]
Abstract
Noninvasive blood component analysis by spectroscopy has been a hotspot in biomedical engineering in recent years. Dynamic spectrum provides an excellent idea for noninvasive blood component measurement, but studies have been limited to the application of broadband light sources and high-resolution spectroscopy instruments. In order to remove redundant information, a more effective wavelength selection method has been presented in this paper. In contrast to many common wavelength selection methods, this method is based on sensing mechanism which has a clear mechanism and can effectively avoid the noise from acquisition system. The spectral difference coefficient was theoretically proved to have a guiding significance for wavelength selection. After theoretical analysis, the multi-band spectral difference coefficient-wavelength selection method combining with the dynamic spectrum was proposed. An experimental analysis based on clinical trial data from 200 volunteers has been conducted to illustrate the effectiveness of this method. The extreme learning machine was used to develop the calibration models between the dynamic spectrum data and hemoglobin concentration. The experiment result shows that the prediction precision of hemoglobin concentration using multi-band spectral difference coefficient-wavelength selection method is higher compared with other methods.
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Affiliation(s)
- Ximeng Feng
- State Key Laboratory of Precision Measurement Technology and Instruments, Tianjin University, Tianjin 300072, China; Tianjin Key Laboratory of Biomedical Detecting Techniques & Instruments, Tianjin University, Tianjin 300072, China
| | - Gang Li
- State Key Laboratory of Precision Measurement Technology and Instruments, Tianjin University, Tianjin 300072, China; Tianjin Key Laboratory of Biomedical Detecting Techniques & Instruments, Tianjin University, Tianjin 300072, China
| | - Haixia Yu
- State Key Laboratory of Precision Measurement Technology and Instruments, Tianjin University, Tianjin 300072, China; Tianjin Key Laboratory of Biomedical Detecting Techniques & Instruments, Tianjin University, Tianjin 300072, China
| | - Shaohui Wang
- Jinan Central Hospital Affiliated to Shandong University, Jinan 250013, China
| | - Xiaoqing Yi
- State Key Laboratory of Precision Measurement Technology and Instruments, Tianjin University, Tianjin 300072, China; Tianjin Key Laboratory of Biomedical Detecting Techniques & Instruments, Tianjin University, Tianjin 300072, China
| | - Ling Lin
- State Key Laboratory of Precision Measurement Technology and Instruments, Tianjin University, Tianjin 300072, China; Tianjin Key Laboratory of Biomedical Detecting Techniques & Instruments, Tianjin University, Tianjin 300072, China.
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The WHO recommendation of home fortification of foods with multiple-micronutrient powders in children under 2 years of age and its effectiveness on anaemia and weight: a pragmatic cluster-randomized controlled trial. Public Health Nutr 2018; 21:1350-1358. [PMID: 29352829 DOI: 10.1017/s1368980017003858] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess under real community settings the effectiveness of the WHO strategy of home fortification of foods (HFF) with multiple-micronutrient powders on Hb change, anaemia and weight in children. DESIGN A pragmatic cluster-randomized controlled trial. SETTING Forty villages in the Nioro Circle in Mali and 722 children aged 6-23 months were randomized to the intervention or control group. The intervention consisted of a daily dose of multiple-micronutrient powder for 3 months; in the control group, no supplement was given. In both groups, mothers received group education on child complementary feeding. Changes in weight, Hb concentration and anaemia were assessed as primary outcomes at baseline and 3 months. The HFF effect was determined using regression analyses and quantile regression with standard errors taking account of the cluster design. SUBJECTS Children aged 6-23 months. RESULTS Overall prevalence of anaemia in the sample was high: 90 %. HFF provided a modest but statistically significant Hb change v. no intervention (0·50 v. 0·09 g/dl, P=0·023). Prevalence of anaemia changed little: 91·3-85·8 % (P=0·04) in the intervention group v. 88·1-87·5 % % (P=0·86) in the control group. Proportion of severe anaemia was reduced by 84 % (from 9·8 to 1·6 %) in the intervention group, but increased in the control group (from 8·5 to 10·8 %). No effect was observed on weight. CONCLUSIONS The WHO HFF strategy to fight anaemia showed a modest change on Hb concentration and significantly reduced the rate of severe anaemia.
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