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 summary In 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%).

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.

BackgroundAnemia 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).

A BSTRACT Fortification of staple food items with iron is a potential strategy to address anemia for a larger population. We reviewed studies to assess the impact of iron-fortified rice (IFR) on hemoglobin levels of individuals more than six months of age. We included studies assessing the effectiveness of IFR (with or without other micronutrients) conducted in any part of the world available in PubMed, Embase, Web of Science, Cochrane Library, Google Scholar, clinicaltrials.gov, International database of prospectively registered systematic reviews in health and social care (PROSPERO), unicef.org, and who.int databases and published from January 1, 1990 to April 1, 2019 (PROSPERO registration number: RD42020139895). We extracted the changes in hemoglobin, serum ferritin, and serum transferrin levels among the participants. Finally, data from 15 trials and their 21 subsets were analyzed. Mean difference in hemoglobin was 0.53 g/dl (95% CI: 0.26, 0.80, P < 0.001, I2 = 84%) in the IFR group compared to the control group. In the subgroup analysis after removing studies with small sample size and high risk for bias, a mean difference of 0.44 g/dl (95% CI: 0.20, 0.69, P < 0.001, I2 = 82%) was observed. No significant effect on serum ferritin or transferrin levels was observed. From this review it can be concluded that fortification of rice with iron can be adopted as an intervention to improve hemoglobin levels, especially in countries where rice is the major part food of staple diet. Research is needed on an optimal iron compound for fortification and the acceptance of IFR.

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