Evaluation and costs of different haemoglobin methods for use in district hospitals in Malawi

Abstract

Aims: To evaluate the characteristics of manual haemoglobin methods in use in Malawi and provide evidence for the Ministry of Health in Malawi to enable them to choose a suitable method for district hospitals. Methods: Criteria on accuracy, clinical usefulness, user friendliness, speed, training time, and economic costs were determined by local health professionals and used to compare six different manual haemoglobin methods. These were introduced sequentially into use in a district hospital in Malawi alongside the reference method. Results: HemoCue was the optimal method based on most of the outcome measures but was also the most expensive (US$0.75/test). DHT meter and Jenway colorimeter were the second choice because they were cheaper (US$0.20-0.35/test), but they were not as accurate or user friendly as HemoCue. Conclusions: The process for choosing appropriate laboratory methods is complex and very little guidance is available for health managers in poorer countries. This paper describes the development and testing of a practical model for gathering evidence about test efficiency that could be adapted for use in other resource poor settings.

Exploring Socioeconomic Vulnerability of Anaemia Among Women in Eastern Indian States

“…It has been found to give accurate results, comparable to estimates from more refined laboratory instruments (Gehring et al, 2002;Medina et al, 2005;Gupta et al, 2007). The HemoCue analyser has been used extensively for estimating the haemoglobin concentration in capillary blood in field situations.…”

Diagnostic accuracy of haemoglobin colour strip (HCS-HLL), a digital haemoglobinometer (TrueHb) and a non-invasive device (TouchHb) for screening patients with anaemia

“…A review of Hemocue suggested a sensitivity ranging from 75.0% to 91.0% and a specificity of 88.0% to 100%; however, they also found a positive reporting bias 19. Although found optimal, the readings are likely to get affected by humidity18 19 and this is one of the most expensive methods with an estimated cost of around US$0.75/test (the cost of Hemocue B instrument is about 35 000 Indian Rupees and each disposable microcuvette costs approximately 30 Indian Rupees) 20 21. Procurement of the device sometimes poses a challenge, particularly in low-income and middle-income countries 20 22…”

“…Previous studies have shown that the process of choosing an appropriate laboratory method is complex and very little guidance is available for health managers 20. Diagnostic accuracy is reported to be higher in laboratory-based studies compared with more pragmatic ‘real-life’ studies 15 25.…”

Anaemia: A Useful Indicator of Neglected Disease Burden and Control

“…The colours of the haemoglobin samples are represented in 2 g/dl increments from 4 g/dl to 14 g/dl. The HCS can be used by non-laboratory health workers after only a few hours training and is durable in dusty, hot, dry, and humid conditions; recurrent costs are less than $0.05 a test [30]. A systematic review suggests that the HCS is better than clinical diagnosis for detecting mild and moderate degrees of anaemia in children and pregnant women [31,32] and avoids the need to collect and transport venous samples [33].…”