Comparison of Performance of Digital Hemoglobinometer over Automated Hematology Analyzer for Hemoglobin Estimation and Its user-friendliness among the Pregnant Women in Selected District Hospitals of Madhya Pradesh

Prevalence of anaemia among adolescent girls (10-19 years) in India: A systematic review and meta-analysis

Background Anaemia is a serious public health problem. It is the second-commonest contributing factor to years lost by adolescents to disability and death. Targeting adolescent girls will allow a window of opportunity to correct their nutritional health and improve their obstetric outcomes. Studies in India have reported varying prevalence rates of anaemia among adolescent girls. Hence, we did a systematic review and meta-analysis of community-based studies to obtain a comprehensive pooled estimate of the prevalence of anaemia among adolescent girls in India. Methods We did a systematic electronic search in PubMed, Embase, Cochrane Library and Google scholar to retrieve community-based studies that reported the prevalence of anaemia among adolescent girls (10-19 years) in India, without any date or language restriction. To estimate the pooled prevalence and heterogeneity, the random-effects model and I2 statistical methods were used. We did subgroup analyses based on geographical region, study setting, method used to measure haemoglobin concentration, and year of publication. Results We included 35 studies in this meta-analysis comprising 152 640 participants. The pooled prevalence of anaemia among adolescent girls was 65.7% (95% CI 59.3%- 71.9%). There was significant heterogeneity between the studies (I2 99.6%; p<0.001). Conclusion There is a high prevalence of anaemia among adolescent girls in India. While all regions of the country have a high prevalence, tribal areas need special attention. Targeted actions need to focus on the identification of determinants of anaemia apart from iron supplementation.

Feasibility of Real-Time Monitoring for Anemia Using Mobile Application Linked With Point-of-Care Testing Device

Background Anemia testing using digital hemoglobinometers (DH) enabled with real-time data visibility improves delivery outcomes, reduces the manual process of keeping records, and strengthens follow-up. In this study, testing of anemia was done by HealthTrender, an innovative mobile-based cloud-connected application, with HemoCue 301 device (HemoCue AB, Ängelholm, Sweden). Aim The objective of the study was to assess the feasibility, acceptability and coverage of anemia testing by the HealthTrender mobile application by the end users - Auxiliary Nursing Midwives (ANMs). Material and methods An exploratory mixed-method study was conducted for three months, i.e., from 1st January 2020 to 31st March 2020. The study was done at the antenatal clinics (ANCs) of two Primary Health Centres (PHCs) and their subcentres in the Ballabgarh block of Haryana, India. Qualitative data on the feasibility of the HealthTrender application was collected from 13 ANMs involved in the testing of anemia using in-depth interviews. Quantitative data of 1057 pregnant women attending the ANC clinics was also analysed. For data capturing, a Bluetooth dongle connected with HemoCue 301 transferred the hemoglobin (Hb) values to the HealthTrender mobile application and was uploaded to the cloud, displaying it on a webpage in real time. Result Among 1057 pregnant women enrolled, the mean (SD) hemoglobin was 10.9 gm/dl (1.5) and the prevalence of anemia was 47%. ANMs reported that the mobile application was easy to use, and half of them were very satisfied with its speed, easy uploading and quickness in reflecting Hb values on the mobile screen. Challenges related to internet connectivity, loss of Bluetooth dongle connection and less manpower with extra work required were expressed by the ANMs. Completion of records was significantly higher for the mobile application (100%) as compared to manual register-based records (81%). Conclusion Web-based application HealthTrender used by ANMs for screening pregnant women for anemia was feasible and had high acceptance. Using digital technology increases the reporting and coverage of hemoglobin testing. Information technology use may be highly beneficial for the serial recording of hemoglobin and subsequent management and follow-ups.

Digital Hemoglobinometers as Point-of-Care Testing Devices for Hemoglobin Estimation: A Validation Study from India

Introduction:

India has launched Anemia Mukt Bharat (AMB) strategy in 2018, to deal with the high burden of anemia in the country. Point-of-care testing (POCT) of anemia using digital hemoglobinometers and treatment is one of the primary interventions under AMB. This study aimed to determine the diagnostic validity of digital hemoglobinometers (TrueHb and HemoCue 301) for screening of anemia compared to hematology analyzer.

Methodology:

A hospital-based, cross-sectional study was conducted among pregnant women attending antenatal clinics of a selected primary health center and subdivisional hospital of Haryana, India, during January 2019. Hemoglobin (Hb) levels of the pregnant women were estimated in digital hemoglobinometers using capillary blood samples and hematology analyzer using venous blood samples. Bias, limits of agreement (LOA), and validity of digital hemoglobinometers were assessed against a hematology analyzer.

Results:

A total of 110 pregnant women were included. Bias (LOA) in Hb values estimated using digital hemoglobinometers was −0.09 g/dL (−1.97 to 1.80 ) for HemoCue301 and −0.04 g/dL (−1.69 to 1.60) for TrueHb compared to the hematology analyzer. HemoCue^® 301 (sensitivity: 86% and specificity: 83%) had relatively higher sensitivity and specificity compared to TrueHb (sensitivity: 78.9% and specificity: 81%).

Conclusions:

Digital hemoglobinometers have high sensitivity and specificity. Thus, these can be a potential POCTs for screening of anemia in peripheral health facilities. Further studies are required to establish the validity of the digital hemoglobinometers at community settings.

Diagnostic accuracy of point-of-care devices for detection of anemia in community settings in India

Background

Accurate diagnosis of anemia by community workers using a point-of-care device is a challenge. The objective of the study was to establish the diagnostic accuracy of point-of-care devices for detecting anemia in community settings.

Methods

It was diagnostic accuracy study with cross-sectional design on adult patients attending the outpatient department of rural/ urban health centres of Medical colleges from India. The index tests were HemoCue, TrueHb, Massimo’s device and spectroscopic device, compared against autoanalyzer (gold standard). Accuracy was expressed by sensitivity, specificity, likelihood ratios, predictive values, area under the curve (AUC) and levels of agreement. For the diagnostic accuracy component, 1407 participants were recruited with a minimum of 600 for each device. An additional 200 participants were considered to elucidate the performance of devices in different weather conditions.

Results

HemoCue and TrueHb performed better than Massimo and spectroscopic devices. Detection of anemia by technicians was similar between TrueHb and HemoCue (AUC 0.92 v/s 0.90, p > 0.05). Community workers performed better with Hemocue for detecting anemia compared to TrueHb (AUC 0.92 v/s 0.90, p < 0.05). For detection of severe anemia, accuracy of TrueHb was significantly better with technicians (AUC 0.91 v/s 0.70; p < 0.05) and community workers (AUC 0.91 v/s 0.73; p < 0.05).

HemoCue showed a bias or mean difference (95%CI) of 0.47 g/dl (0.42, 0.52) for all values, and 0.92 g/dl (0.82, 1.03) for severe anemia. For TrueHb, it was − 0.28 g/dl (− 0.37, − 0.20) for all readings, and 0.06 g/dl (− 0.52, 0.63) for severe anemia. TrueHb appeared to be more consistent across different weather conditions, although it overestimated Hb in extreme cold weather conditions.

Conclusion

For detection of anemia, True Hb and HemoCue were comparable. For severe anemia, True Hb seemed to be a better and feasible point-of-care device for detecting anemia in the community settings.