Early detection of anemia among school children using the World Health Organization Hemoglobin Color Scale 2006

Abstract

Background The high prevalence of anemic children in Indonesia is caused by the high incidence of diseases caused by parasitic infection such as malaria as well as iron deficiency. Early detection is needed for early intervention in order to allow optimal growth and development. A simple, economic, and practical tool for early detection of anaemic children is needed. The WHO recommended a Hemoglobin Color Scale as a suitable tool for the detection of anemia. Objective To assess the sensitivity, specificity, and predictive values of the WHO Hemoglobin Color Scale for early detection of anemic children. Methods A cross sectional diagnostic test was conducted in elementary school age children. Samples consisting of two drops of venous blood on paper were assessed by two observers (pediatrician & paramedic) using the Hemoglobin Color Scale to visually determine the level of hemoglobin. In addition, the hemoglobin level was also measured using a Hematology Analyzer to allow the visual test results to be compared to the results obtained using the gold standard of analysis. Agreement between these two methods of analysis was examined using the Cohen's kappa. Results Hemoglobin levels < 11.5 g/dL were detected in 15 of 124 (12%) elementary school children. The sensitivity, specificity, positive and negative predictive values when using the Hemoglobin Color Scale were 93%, 100%, 100% and 99% respectively for the first observer and 100%,99%,93%, and 100% respectively for the second observer. The Cohen's Kappa value was 0. 76. Conclusion The WHO Hemoglobin Color Scale 2006 could be used as an early detection method for anemia in children.

Keywords

• early detection
• anemia
• children
• Hemoglobin Color Scale